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India lags behind in Health related Millennium Development Goals

India lags behind in Health related Millennium Development Goals

A few days are left for the nation to achieve the targets set under the United Nations’ Millennium Development Goals (MDGs).  There are eight such goals which range from halving extreme poverty rates to halting the spread of HIV/AIDS and providing universal primary education. Most of them relate to health directly or indirectly. It seems unlikely that India can achieve the targets.  India is way off track in achieving the target set under the first goal for reducing poverty and hunger. Malnutrition among children is still high. From an estimated 52 per cent in 1990, the proportion of underweight children below three years was to be reduced to 26 per cent by 2015. That has not happened.  MDG 2, which relates to ACHIEVE UNIVERSAL PRIMARY EDUCATION is moderately on track.  MDG 3 entails to  PROMOTE GENDER EQUALITY AND EMPOWER WOMEN is  on track. MDG 7 relates to environment and MDG 8 covers aspects of development. These two are moderately on track. Let us look at some details on MDG4,5 and 6, which relate to health.
The factors influencing infant mortality enshrined under MDG 4 are likely to influence the health status of the whole population such as health of mothers and extent of pre/post natal care, general living conditions, rates of illness, their economic development and the quality of the environment. India shapes the global MDGs 4 and 5 targets, because of its share of the global burden of child (23%) and maternal mortality. Due to slow progress in reducing infant and maternal mortality rate (MMR-MDG -5), the United Nations (UN) launched the Global Strategy for Women’s and Children’s Health,  and India committed to spend US$ 3.5 billion annually, for strengthening maternal and child health services in 235 districts, which account for nearly 70% of infant and maternal deaths. India’s MDG 4 target was to reduce IMR by two-thirds between 1990 and 2015, i.e., from 80 infant deaths per 1000 live births in 1990 to ‘27’ by 2015. It may have  reached 42 but not less.  Under MDG 4, another target was to improve the proportion of one-year-old children immunized against measles from 42% in 1992-1993 to 100% by 2015. India is lagging in the task of achieving universal coverage of one year old children immunized against measles. Although, there is substantial improvement, yet at this rate of improvement, India is likely to achieve about 89% coverage.  India’s IMR would be 42 per 1000 live births (95% ) by 2015 and MDG 4 target level of ‘27’ would be achieved in 2023–2024, unless special efforts are made to reduce IMR in Assam, Bihar/Jharkhand, Haryana, Rajasthan and Uttar Pradesh and Uttarakhand .

India’s MDG 5 target is to reduce MMR by three .quarters between 1990 and 2015, i.e., from 437 maternal deaths per 100 000 live births to ‘109’. During 1997– 2009, MMR of India declined by 47%. Maternal deaths decreased from around 100 000 to 60 000, If the declining trend in MMR observed during 1997-2009 continues linearly, India will be very close to achieving the MDG 5 target level of ‘109’ by 2016, as the MMR is predicted to be 117 (95% CI: 109–125) in 2015. A recent Lancet series projected India’s IMR and MMR in 2015 as 43 and 153 respectively. MMR is a slow moving social indicator. India is unlikely to have achieved the target level of 109 per 1,00,000 live births by 2015. Among the major States, the MMR ranges from 61 in Kerala to 300 in Assam in 2011-13. In the States of Bihar/ Jharkhand , Madhya Pradesh / Chhattisgarh (221), Orissa (222), Rajasthan (244), Uttar Pradesh / Uttarakhand (285) and Assam (300), the MMR estimates were reportedly higher than the estimate at all India level (167). Four States i.e. UP, Bihar, MP and Rajasthan together contributes to 67 % of MMR in the country. The latest results of Sample Registration System (SRS) 2013 reveal that, the percentage of live births attended by skilled health personnel (Government hospitals, Private hospital, qualified professional) is 87.1% in 2013, which indicates a better status. Also, with the recent sharp progress in the percentage of births attended by skilled health personnel the gap between the likely achievement and the target in 2015 is likely to havenarrowed down.

MDG 6 aims to  COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES is also on track. India has taken an aggressive step toward HIV/AIDS control by implementing the third phase of its National AIDS Control Programme (NACP), which is designed to reverse the spread of HIV/AIDS by 2012. Its thrust areas include treatment of sexually transmitted infections, voluntary counseling and testing, and condom promotion.

Over the years, malaria has been showing a declining trend from high incidence levels. While in 1996, 3.04 million cases (including 1.18 million P. falciparum cases) were reported, according to 2006, 1.78 million cases of malaria (including 0.84 million P. falciparum cases) and 1708 deaths were reported from the country.(India accounts for nearly one fifth of the global burden of tuberculosis, which amounts to 1.9 million cases. TB mortality in the country has reduced from over 42/100,000 population in 1990 to 28/100,000 population in 2006.  The prevalence of TB in the country also decreased from 568/100,000 population in 1990 to 299/100,000 population in 2006. WHO stop TB strategy for TB control is a step toward achieving the TB-related MDGs in terms of reducing the prevalence of TB by 50% by 2015. The vision of the program is to achieve and maintain a cure rate of at least 85% in new sputum positive pulmonary TB patients.

Besides the above India has to improve primary healthcare by following a family physician model and reduce the curse of over-medicalization.

 

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