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It
is not that nothing has been achieved in these fifty years. The first
landmark in official health policy of Independent India was the
acceptances of the Bhore Committee recommendations of 1946, which laid the
foundations of comprehensive rural health services through the concept of
primary health care. Primary Health Centers (PHCs) came up in the country
side from 1952 onwards, population control came center-stage from the
mid-1960s, sanitation and drinking water programs were launched from the
fifth five year plan, the integrated Child Development Program (ICDS),
integrating nutrition and health inputs for preschool children and
pregnant and lactating mothers, was started in 1975, the multi-purpose
health workers scheme started in 1971, the community health guide scheme
in 1977 and a package of minimum needs programs was launched from the
early 1980s.
There has been a significant extension in health infrastructure, the
number of PHCs increasing form 725 to 21024 between 1956 to
1993 and subcenters from 28,489 in 1971 to 1,31471 in 1993.
Under the cumulative impact of these measures and a host of programs for
livelihood, nutrition and shelter, life expectancy at birth rose from
33 years at Independence to 61 years in 1992. Infant mortality (IMR)
declined from 146 per 1000 live births in 1961 to 74 in 1993, Under
five mortality rate (U5MR) declined from 236 per 1000 live births in 1960
to 109 in 1993 . The IMR and U5MR are accurate indices not only of child
survival , but of the availability of livelihood, nutrition, safe drinking
water, sanitation, health services and health and status of women in
society.
These achievements appear significant, yet it must be stressed that
survival rates in India are comparable even today only to the
poorest nations of sub-Saharan Africa. Of 25 million children born in
India every year, nearly 2 million die before reaching the age of one, and
most of these deaths are avoidable. Many are disabled or blinded by polio,
Vitamin A deficiency and malnutrition. Tuberculosis, a preventable and
curable disease, still claims 5 lakh lives each year, in conditions of
acute poverty and deprivation. Of the 16 million tuberculosis
cases worldwide, 12.7 million are in India. Waterborne and water related
diseases like diarrhea, typhoid, cholera and infectious hepatitis account
for 80 percent of India's health problems, and every fourth person
dying of such diseases is an Indian. Every third person in the world
suffering from leprosy is an Indian. The menacing resurgence of epidemics,
in which state authorities watch helplessly as hundreds, even thousands
die of medically preventable and curable diseases, reflects the extent of
degradation of our public health services.
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hopeless and
constantly losing battle for survival and health even fifty years after
India's independence. The war begins even before birth, as malnourishment
of the mother reduces life chances, while the fetus is still in the womb.
Only the most sturdy survive subsequent onslaughts of unsafe and
unhygienic birth practices, unclean water, poor nutrition, sub-human
habitats and degraded and unsanitary environments. With little or no
access to health care, the grim battle continues into adulthood, until
precarious survival once again spawns a fresh cycle of birth and struggle.
