Last month, world leaders agreed to 17 global goals to achieve by 2030. Indian diplomats were active participants in helping create these Sustainable Development Goals or SDGs. And Prime Minister Modi told the UN General Assembly that India's development agenda is mirrored in the SDGs. But a lot has to happen if this is to be more than aspirational rhetoric.
Goal 3 is to ensure healthy lives and promote well-being for all at all ages. One specific target of this health goal is to end preventable deaths of newborns and children under 5 years of age. All countries should aim to reduce neonatal mortality to at least 12 per 1,000 live births and under-5 mortality to at least 25 per 1,000 live births.
In India, the current rate of neo-natal mortality is 28 per 1,000 live births and under-5 mortality is 48 per 1,000 live births. More simply, more than 12 lakh children die in India every year. In a global perspective, that means that one in five children under-5 who dies in the world is Indian. The situation of child mortality in India is so bad that it repeatedly makes international news. No matter how much better the situation is than in years before, the present state child health and mortality should be a national embarrassment and urgent policy issue as most under-5 deaths are entirely preventable.
Letting so many children die and millions go undernourished is literally robbing India of its full progress. James Heckman, a Nobel prize winning economist, has been showing for decades how investing in early childhood is important for strengthening economic growth, even during recessions.
The astounding thing is that many of these child deaths are they are entirely preventable through vaccinations.
Without vaccinations, these diseases kill children and make poor families even more impoverished because they borrow money for health care and lose wages from not working while provide care. Hospitals are further burdened and quacks profit. It is a vicious downward cycle that begins with a child getting sick. Much of this could be avoided by providing all children with the necessary healthcare including complete set of vaccinations.
The recently launched Mission Indradhanush, the immunization catch-up campaign, is a good start. But as we have learned from so many government programmes a lot needs to be done to translate policy into reality on the ground.
There are some major hurdles.
Recent data shows that levels of immunisations are stagnating or decreasing across many Indian states. Even in states that often do well in standard socioeconomic indicators such as Tamil Nadu, Kerala, Andhra Pradesh, and Punjab, there is a decline in immunization coverage in comparison to previous years. We need to find out urgently why?
We need to make sure vaccinations are provided thoroughly and systematically. Close to 89 lakh newborns annually are either partially vaccinated or not vaccinated at all. This can be useless for the child, and dangerous for the community and the world.
There are wide inequalities in immunization coverage across different socio-economic groups. The worst child health and mortality is among the most poor and marginalized. Effective and comprehensive public immunization programs would mean that the poor and marginalized groups no longer have to suffer child deaths that other better-off groups are avoiding by paying of immunizations privately.
Perhaps the most surprising hurdle is this. I was invited to a national consultation of child advocacy organizations to speak on the right to health of children. What surprised me was the visible scepticism of vaccinations even among child advocates. A recent Harris poll found the public perception of the trustworthiness of pharmaceutical companies is at the bottom alongside other industries like airlines and tobacco.
Somehow, despite two decades of rapid economic growth and progress in health indicators, we have reached a point where child immunization rates are stagnating or decreasing across many states. And the inequalities in childhood deaths and diseases across socio-economic groups are increasing; they are increasing partly because of the difference in what is provided through government programmes versus what is available to purchase in the market. Another reason is that millions of Indians are now living in areas that are neither rural nor urban centres, but in peri-urban locations. These locations fall outside of official classifications so they do not get access to municipal services.
The unique vulnerability and dependency of children makes the neglect or violation of their right to health profoundly unethical. Their inability to self-mobilize combined with the various disadvantages of parents who are from the lower socio-economic groups means that civil society organizations must advocate on their behalf.
CSOs have a crucial role in bridging the reality of households and state and national level policy makers. It is CSOs who are able to accurately identify all the barriers to individual children getting access to healthcare, to identify the constraints on the right of children to be capable of being healthy.