The findings emerging from the latest National Health and Family Survey (NHFS) have good news on the population front, and mixed-to-bad news on the health front. The first element is that India’s demographic transition has probably been faster than previously estimated—female fertility in some key states has already reached net reproduction levels (two births per woman); the survey also shows that 75 per cent of women do not want more pregnancies after they have had two children. These dramatic numbers will be confirmed at the time of the next census, still more than four years away. But it is clear that a variety of factors have contributed to this very significant change.
On the health front, though, the picture is far from positive even as some hope is provided by specific points. So while the country’s poverty numbers continue to decline, thanks to faster economic growth, little of this appears to be getting reflected in the health of the country’s children and mothers. The Survey’s third round in 2005-06 is a sequel to the previous round, in 1998-99. That earlier Survey showed, for instance, that 74 per cent of children below the age of 3 years were anaemic, a figure that remains around the same level in the latest round. There is improvement in other areas, but the distance to be travelled is vast. The 1998-99 round showed, for instance, that 45 per cent of children were stunted—this is now down to 33 per cent. The proportion that is ‘wasted’, or too thin for their age, remains more or less the same, at around a sixth; the proportion of those who are underweight has gone down from 47 per cent to 40. All of this then reflects in other health statistics.
The public health programme shows up poorly. Though the NHFS data are still to be fully collated for all states, in eight states (which include not just the obvious Uttar Pradesh, but even Gujarat), less than half the children below the age of two years have been immunised. Uttar Pradesh has seen the proportion of those under two getting vaccinated rise from 20 to 23 per cent between 1998-99 and 2005-06, Orissa has seen this rise from 44 to 52 per cent, and West Bengal from 44 to 64 per cent, but Gujarat has seen this fall from 53 to 45 per cent. In the case of Kerala, also, the ratio has fallen from 80 to 75 per cent. While 47 per cent of children below the age of three are either stunted, wasted or underweight in Uttar Pradesh, the figure is the same in the case of Gujarat as well. The list goes on.
When such data are juxtaposed, as they will be, with data on the state of the country’s health delivery system—just 40 per cent of all primary health centres had adequate medical supplies and less than half have adequate staff—the traditional response will be that more money needs to be spent. That is of course true since India shows up as one of the countries with the highest proportion of private medical expenditure, in relation to state-provided care. And right now, whatever little is spent by cash-strapped state governments gets spent on salaries—which is not of much use because of poor control over doctors and other health staff, many of whom simply do not turn up at various primary and secondary health centres across the country. Several questions also need to be raised about the design of specific programmes, like the Integrated Child Development Scheme.