Look from outside to see what's ailing

Nurse back delivery systems to health


Sonal Matharu | January 21, 2011

At a symposium on 'Evidence to action for reducing maternal and newborn mortality' at AIIMS recently, former health secretary Sujatha Rao marked her attendance, perhaps her first after retirement. After attentively listening to all speakers, including some heads of department at AIIMS and other dignitaries, it was her turn to take the dais.

The gynecologists and pediatricians, who were rather critical of the pace at which our health systems work, called for a quick response to meet the UN millennium development goals. The pie-charts, graphs and percentages followed on slides after slides. But Rao had a different flavour to add to the bland speeches she heard that morning.

“If I sign the minutes of the meetings held in 1992 on the same issues and mark today’s date on it, no one will be able to say that it is an old document,” said Rao. "Why? Because time has stood still and we haven’t moved an inch in the health sector since decades," she added.

And very rightly so.

India was the first country in the world to launch a family planning programme, in 1951, with a special focus on women and child health. Several programmes and policies, claiming to be better than the existing ones, have been launched since, but the burden of maternal and child mortality and morbidity still top the list.

Millions have been spent by the government and associated agencies to meet the targets of lower infant mortality rate, neonatal mortality rate, child mortality rate and maternal mortality rate. Yet we lose 254 mothers per lakh of population every year during child birth. Infant mortality is as high as 53 per 1,000 live births, child mortality rate stands at 69 per 1,000 live births and neonatal mortality rate is 35 per 1,000 live births (as per the 2008 data from The Lancet India series).

There should be a ban on technical guidelines and modules on how to address problems in healthcare as we have enough of these available, said Rao, who spent 22 years of her 35 years in public service with the health ministry.

“We do not talk to people at the district level. We do not do risk identification,” she said, now seeing the system from outside.

Wisdom comes with age, some say. In her case, however, it came a little too late as she no more holds the authority to sign and push forward files gathering dust in the health ministry which hold the master key to saving millions of poor lives across the country.

If only the public servants could see the system from outside once in a while and assess the impact of their policies by going to the people those are meant for and not by mere facts and statistics, they would surely know what they are doing wrong where. And then perhaps, we can hope for a better and faster recovery of our sickening health systems.



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