While UP moves towards better health and nutrition for its population of 200 million, it still lags not only India, but also three other Empowered Action Group (EAG) states: Bihar, Madhya Pradesh and Rajasthan in both child immunisation and nutritional outcomes.
The health of children is critically impacted by the quality of care during the first two years of life. The child immunisation rate is one such indicator of care. It is the lowest in UP among EAG states. The coverage of children receiving full immunisation for UP is 53%for 2012-13. The corresponding figures for Bihar, MP and Rajasthan are 70%, 66% and 74% respectively. Poor immunisation coverage means an increase in case load in hospitals for preventable diseases.
Not only are UP children worst off among those in BIMARU states, their condition has improved slower than that of kids in other poorer states of India.
Immunisation coverage improved by about 58 percentage points for Bihar between 1998-99 and 2012-13. The corresponding improvements for MP and Rajasthan are 44 and 57 percentage points respectively. But UP has just gained 33 percentage points in the same period.
Prioritising health across UP
The Union government initiated the National Rural Health Mission (NHRM) in 2005 to address especially (but not only) maternal and child health concerns, with an emphasis on India's poorest states. UP, in spite of significant progress, has lagged behind the other EAG states in achieving the goals of the NRHM. Home to a sixth of India's population, UP's performance on ensuring the health and well-being of its citizen has a significant national, and by extension, global impact.
But UP has accelerated the pace at which it has progressed on improving its public health landscape. The state's under-5 mortality rate (U5MR), for example, decreased by just nine points between 1992-93 and 1998-99. However, it decreased by 42 points between 1998-99 and 2012-13. This increase in pace is promising and can be boosted further with dedicated efforts to identify and address gaps in service delivery.
It has been well known for at least two decades that India's child malnutrition problem is worse than that in Sub Saharan Africa. UP has the worst malnutrition rates in India. Let's look at child malnutrition based on two anthropometric indices: weight for age (underweight) and height-for-age (stunted). Children who have a weight for age below 2 standard deviations from the mean of the reference population are said to be underweight, while stunting (an indicator of chronic malnutrition) is defined as characterising those children whose height-for-age is below 2 standard deviations from the mean of the reference population. About 34% of children (age 0-5 year) are underweight in UP in 2013-14. The corresponding figures for Bihar, MP and Rajasthan are 37%, 36% and 31% percent respectively.
UP has the worst malnutrition rates in India.
Half of children were stunted in UP and Bihar in 2013-14. The figures for MP and Rajasthan are 42% and 36% respectively. MP and Rajasthan have improved in reducing the percentage of stunted children by 13.5 and 23 percentage points respectively, during 1998-99 to 2013-14. The corresponding figures for UP and Bihar are 10 and 9 percentage points respectively. In other words, not only are UP children worst off among those in the BIMARU states, their condition has improved slower than that of kids in other poorer states of India.
Several challenges need to be overcome, however. At present, only a third of sanctioned physician posts have been filled in the Provincial Medical Service (PMS).The problem is compounded by PMS physicians who resist being appointed to rural posts. At the same time, the shortage of adequately trained paramedical staff remains an issue. This prevents at least half of all public health facilities in UP from functioning round the clock.
Low uptake of government schemes is also an impediment to the improvement of UP's health and nutrition indicators. To this end, it is essential that the community be adequately informed about the availability and far-reaching benefits of existing initiatives and interventions provided by the government.
Together, greater efficiency in the public health sector, along with greater awareness and demand from the community, will help UP accelerate towards better health for all its residents.