Poor immunisation record

High child mortality rates and resurgence of communicable diseases that were more or less eradicated, should be a matter of grave concern

The poor progress on the immunisation front, as reflected in the continuing high rate of child mortality and the resurgence of communicable diseases that were once more or less eradicated, should be a matter of grave concern. The numbers gathered by some international charity organisations, the United Nations Children’s Fund and domestic surveyors indicate that even six decades after Independence, the condition of children in India is as deplorable as in sub-Saharan Africa. Over 2.1 million children under the age of five die every year due to various factors, including avoidable diseases. This is notwithstanding the fact that an immunisation programme, launched way back in 1978 to control vaccine-preventable diseases like diphtheria, pertussis, tetanus (DPT), poliomyelitis, typhoid and child tuberculosis, was universalised in 1985 to include even measles. Still, the child mortality rate has remains virtually unchanged for nearly a decade, at around 57 deaths per thousand live births.

 

One reason for this lack of progress has to be the limited reach of an immunisation programme that leaves out children in remote areas and even those in urban slum clusters. The situation is dismal in “Bimaru” states like Uttar Pradesh, Rajasthan, Madhya Pradesh, Bihar and Orissa, all of which suffer from the same set of problems: the poor public health infrastructure, the paucity of qualified staff, the unavailability of medicines when needed, and of course the widespread use of fake drugs that have no effect. Indeed, it has been argued that the recent intensification of the pulse polio drive in the wake of the international criticism that greeted the reappearance of polio in areas where it had been successfully tackled, worsened the situation as it drew attention away from routine immunisation work.

The availability of vaccines, as also their quality, is an issue. The government’s inexplicable move to shut down three public sector vaccine production units, including the country’s oldest such facility at Kasauli in Himachal Pradesh, further curtailed the vaccine availability at affordable prices; recent reports suggest that the Kasauli unit will be re-opened. Meanwhile, the introduction of the latest pentavalent vaccine (the five-in-one potion that protects against five diseases, including DPT, Hepatitis B and Haemophilus Influenza type B (HIB), through a single dose) from the current financial year is in limbo for want of Cabinet clearance, due perhaps to the poll process having begun and the electoral code of conduct having come into force. This vaccine strikes at the bacteria which cause dreaded maladies like meningitis, pneumonia and septic arthritis. Some 130 countries are said to have shifted to pentavalent vaccines in their national immunisation programmes.

The limited resources allocated for public health programmes have been another constraint. Though the United Progressive Alliance (UPA) government had vowed in its common minimum programme to increase public expenditure on health services, from around 1 per cent of the gross domestic product (GDP) to between 2 and 3 per cent, there has been no perceptible action other than the launch of the rural health mission. The track record of this mission, too, is not very satisfactory. Public health is of course a state subject, and the Centre’s role is that of a catalyst, but it has not succeeded in this capacity. Health expenditure by the states is estimated to have shrunk from 4.5 per cent of their budgetary allocations in the 1990s to 3.6 per cent in 2008-09. It is, therefore, worth considering whether there is a case for shifting public health to the Concurrent List in the Constitution, for this would give the Centre a greater role.