Move to pre-emptive care model where the focus and thrust will be on child health and prevention

By: Ashwin Mb

There are 2 important impact indicators to measure the child’s health: child mortality rate for children under five and malnutrition levels.

Child Mortality Rate:

Over the past few year, India has seen a drop in the child mortality rate from 48 in 2015 to 39.4 in 2017 according to United Nations Inter-agency Group for Child Mortality Estimation (UN-IGME). About 8,02,000 infant deaths were reported in India in 2017, the lowest in five years, according to the same report. Neonatal death accounted for 6.05 lakhs out of the total 8.02 lakh infant deaths. It must be noted that advanced countries like United Kingdom (UK) have child mortality rate of mere 4.5, Estonia at 2.9, and most European countries around the same range. Therefore, India has a long way to go.

Malnutrition Levels:

According to National Family Health Survey-4 done in 2015-16, about 37% of our under-five children are underweight, 39% are stunted (low height-for-age), 21% are wasted (low weight-for-height) and 8% are severely acutely malnourished. Further, India is home to 50% of malnourished children in the world. India’s malnutrition statistics present an alarming picture, where more than 70% of children between the age group of six months to three years suffer from anaemia.

To reduce malnutrition in all forms, the Government of India (GoI) converged different schemes and services under the POSHAN Abhiyan, in March 2018 with a budget of Rs 9,000 crore over 3 years commencing from 2017-18. However, 950 crore rupees has been allocated in 2017-18, Rs. 3000 crores in 2018-19 No mention of the outlay for the scheme in the Budget document that mentions outlays for all major schemes. The scheme was not mentioned in the Budget Speech 2019-20 by the Finance Minister. The press release issued by the Government skips POSHAN Abhiyan budgetary allocation. 

Further, it must be pointed out only 16% of the funds allocated to the states was utilised, as mentioned in the minutes of National Council’s meeting dated 12.02.2019.

Further, no data has been put forth with respect to outcomes of the Abhiyaan.

The budget for two programs that tackle malnutrition has seen drop. The budget for Integrated Child Development Services (ICDS) declined from 18,195 crore in 2014-15 to 16,335 crore in 2018-19 while budget allocated for mid-day meal programme was reduced from Rs 13,215 crore for FY 2013-14 to Rs 11,000 crore in interim budget for FY 2018-19.

In 2015-16, 62% Indian children (6 of 10) aged 12-23 months received basic vaccinations, up from 44% a decade ago in 2005-06, according to the latest national health data. Government of India had launched Mission Indradhanush in Dec 2014, which aims to achieve full immunization coverage for children. This initiative has resulted in increase of full immunisation coverage by about 5-7%. Given the uncertainty around “5-7%”, it appears more like a guess (may be reasonable) rather than a calculated number.

In the absence of data put forth by the Government, decline in budget, and some progress, the category chosen for this is “Inadequate Progress”