Health Care Systems India Malnutrition, Mortality, Malaria: Health Care in India

Perri Klass in her article "India" describes a situation when she is unable to diagnose a case of tuberculosis in a South Asian child. As a pediatrician, her repertoire of knowledge of first world diseases is unable to assist her amongst the medical travails of the children of India. Klass describes scenarios where she is unable to comprehend the magnitude of poverty, malnutrition and disease in India, and can only mobilize the word "different" to encapsulate it.

Klass states that even "expectations are different." In Boston, "they expect every child to live to grow up" but here early death is a possibility. Klass tries to fight this resignation for the most part. She states that these diseases are preventable, through vaccinations, hygiene and proper food. First world medical care is taken for granted, as well as its wealth, Klass implies. She also implies that these differences are not only cultural and ethnic but also economic, and that the economic differences must be addressed. Klass offers a powerful argument for the social determinants of health and the need to help the poor, vulnerable populations of the developing world.

However, many efforts have been directed to decreasing the divide between the developed and developing world. In fact, despite Klass' apparent pessimism, numerous initiatives taking place globally are striving to improve health care in developing countries such as India in combating communicable diseases, poor nutrition and bettering sanitation conditions. As David Butler-Jones writes, "…public health is inextricably linked to human development, through activities such as improvements in sanitation and access to clean water, advances in immunization and microbiology, advocacy for appropriate housing and nutrition, health promotion efforts and social reforms. As such, public health measures have played important roles in the successes of various societies and their economies. In the broader agenda to improve health and well-being and to reduce inequalities, public health has played, and can continue to play, many roles" (Butler-Jones 2007). While some statistics remain alarming, there is room for hope and optimism in the amelioration of health care outcomes and quality of life among the inhabitants of South Asia.

The Public Health Agency of Canada is playing a central role in coordinating public health efforts in developing countries. The PHAC recently sponsored representatives from low and middle-income countries to participate in dialogue on approaches for working across sectors to improve health equity. Furthermore, ODA, grants or loans by governments to developing countries with the promotion of economic and welfare as the main objective has increased from $70.5 billion in the period 1980-1984 to $108.7 billion in the period 2002-2006. Global and regional multi-country initiatives accounted for 25% of all health ODA, with HIV / AIDS accounting for 40.7% of support (Piva and Dodd, 2009).

Gupta and Guin have conducted a study looking at the current burden of communicable diseases in the South-East Asia Region of the World Health Organization and analyzing whether the current levels and trends in funding are adequate to meet the needs of control, prevention and treatment. They analyze the Millennium Development Goals (MDGs) for health and indicators of economic progress in each country, as well as the impact of the global financial crisis on progress towards MDGs for communicable diseases in the region.

According to WHO, low-income countries currently have a relatively higher share of deaths from: (i) HIV infection, TB and malaria, (ii) other infectious diseases, including influenza and cholera and (iii) maternal, perinatal and nutritional causes compared with high- and middle-income countries Furthermore, according to a recent study of 25 developing countries, a decrease in the growth rate of gross domestic product (GDP) by three percentage points in Asia and the Pacific is likely to translate into 10 million more undernourished people, 56-000 more deaths among children < 5 years old, and 2000 more mothers dying in childbirth. Preventing and responding to traditional, emerging and re-emerging communicable diseases is therefore a complex endeavor that will not succeed if it is limited to simply increasing...

In times of financial crisis it is important for donor countries to find innovative solutions to enhance the effectiveness of their reduced volume of aid.
Although the 11 countries of the region are on different trajectories of growth and development, their struggle to eliminate underdevelopment and poverty has driven them to a high-growth strategy. However, high-growth policies are increasing the population vulnerable to communicable diseases. Clearly, economic growth alone is not the solu- tion. The 2009 Global monitoring report of the International Monetary Fund and The World Bank calls the current crisis a development emergency because the potential increase in vulnerable populations may delay progress in the fight against communicable diseases.

Funding needs to be much more carefully matched to disease and health system priorities in each country. Although the MDG health goals are important benchmarks, program goals should be more relevant, inclusive and realistic. They should be multisectoral and take into account both the realities of the health sector and the development path chosen by the country. Global health and development initiatives need to expand their focus to include diseases and conditions that are less well-known or less discussed, while at the same time addressing socioeconomic and health sector constraints in each country. This approach would go a long way towards making aid more effective. Moreover, it would make donors and policy-makers more aware of traditional vaccine-preventable child- hood diseases, traditional and emerging vector-borne diseases and respiratory infections, which remain among the most important contributors to high disease burdens in the WHO South-East Asia Region (Gupta and Guin 2009).

Specific Case of India

The case of India offers spectacular examples of how policy and programs are combining to combat malnutrition and poverty and eradicate disease. The Child in Need Institute (CINI) has been working toward sustainable health and nutrition development for women and children for the last twenty-six years. During the initial stages, the Institute focused on treatment and prevention of malnutrition in children under five years of age. Over the years, the program strategies have shifted to a more holistic lifecycle approach. This approach targets individuals during crucial periods of their lives -- pregnant women, children (0 -- 2 years of age) and adolescents (10 -- 19 years of age) -- as well as other vulnerable segments of the population. To reach out to these target groups, the Institute uses a three-pronged strategy that includes case management, behavior change communication, and linkage formation. Programs are either community- or center-based depending upon the need of the populations. CINI's current strategy has shown positive trends in improving the health and nutrition status of women, children, and adolescents in the community. Results include reduction of low birth weight babies, increase in proper antenatal care, reduction of severely malnourished children, decrease in maternal and infant mortality and morbidity rates, and improvement in community involvement in all reproductive and child health programs. CINI is currently monitoring its performance and activities to carry out operations research for providing further evidence for the effectiveness of its interventions (Chaudhuri, 2002).

Government policy particularly in the southern state of Tamil Nadu has intervened to reverse infant mortality inequality in India. In particular, two forms of inequality may be distinguished that play important but diverse roles. One is the availability of technology to diagnose the sex of the child a few weeks after conception and the resulting sex-selective abortion, which may be termed 'natal inequality'. It could also take the form of 'mortality inequality' whereby, relative to boys and men, there is a general neglect of girls and women, and explicit neglect and infanticide of the female child. The two forms of inequality combined have resulted in fewer women relative to men (Narayana 2008).

In India, policy interventions to protect the girl child have been of three kinds: financial incentives, administrative and legal actions, and sensitization of self-help groups (SHGs) and the associated women's bonding. A number of Indian states -- Tamil Nadu, Haryana, Karnataka -- have implemented financial incentive schemes. The latter envisage depositing a certain sum of money in the name of the girl child, which will grow into a tidy sum when the girl reaches 18 or 20 years of age, for her to pursue her studies or get married. In 1992, the Tamil Nadu Government (under the All India Anna Dravid Munnetra Kazhakam party) started the Cradle Baby Scheme, under which parents who did not wish to keep their girl babies could leave them in cradles kept at government reception centres. It was started with one reception centre each in Salem, Madurai, Theni and Dindigul, areas most notorious for female infanticide (members of the second group of districts discussed in the previous section). Like the financial incentive scheme, this was also put on the backburner by the government that came to power during 1996 -- 2001. In April 2001, on coming back to power, the All India Anna Dravid Munnetra Kazhakam Government extended the cradle scheme to the whole of Tamil Nadu, and a total of 188 reception…