Large masses of the Indian poor continue to fight a hopeless and constantly losing battle for survival and health even sixty 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.

It is not that nothing has been achieved in these sixty 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.