This column discusses some of the fundamentals of public health delivery, as seen from the grass roots. Here are 26 important elements in maternal and child health:
AAA: The three women (accredited social health activists, Anganwadi worker, auxiliary nurse midwife) driving health and nutrition in India’s villages. The problem is they don’t talk to each other.
Breastfeeding: Breast milk contains all vitamins and minerals that a baby needs. To be practised exclusively for a child’s first six months. True for only 54.9% of Indian children.
Community: Service recipients. Have all the answers, seldom asked. Change begins when community is aware, empowered and demands services.
District health society: Ultimate responsibility for managing health programmes in every district. Must ensure inter-sectoral convergence, which remains a constant implementation challenge.
Eligible couples: Married and non-sterilized couples where the wife’s age is between 15 and 49. Constitute 15-18% of the population in an average village.
Facilities: Think hospitals and clinics. India has a tiered system with sub-centres, primary health centres (PHCs), community health centres, district hospitals and so on. Great on paper, broken in practice.
Gestational age: Age of pregnancy from last menstrual period. Early registration for antenatal care (ANC) is key. Over 40% of Indian women do not receive ANC in the first trimester.
Haemoglobin: Protein containing iron responsible for transporting oxygen from the respiratory organs to the rest of the body. More than 50% of Indian women are anaemic as their haemoglobin is below the required level.
Infant mortality: Death of children below age 1. In India, this is 34 out of 1,000 live births.
Janani Suraksha Yojana: Launched in 2005 to get women to deliver in hospitals. Institutional births have increased from 38.7% in 2005-06 to 78.9% in 2015-16.
Kangaroo care: Keeping babies warm through skin-to-skin contact. Benefits the mother and especially the child, ensuring that the latter gains weight.
Low birth weight (LBW): When a child weighs less than 2.5kg at birth. Of children who die in their first 28 days (look at N), 48% were attributed to LBW and prematurity. Cricket fans, no DRS for this LBW.
Maternal death: Women’s death during pregnancy or first 42 days after delivery. Getting some key elements right—early and effective ANC, institutional delivery, ensuring facility preparedness and training of birth attendants—go a long way.
Neonatal mortality rate (NMR): Number of children (of 1,000 live births) who die in their first 28 days. India’s NMR is 28, i.e. 750,000 Indian neonates die annually. Key elements mentioned under “M" along with special care for LBW kids critical.
Obesity: Also a case of malnutrition. Rising rapidly in rural areas.
PHC: Health facility with a doctor that is closest to the village. Each PHC serves 20,000-30,000 people. PHCs typically conduct normal deliveries but not C-sections.
Question: What to do when one is in the community (in addition to listen and observe), and conventional wisdom is off the mark.
RMNCH+A: Reproductive, maternal, newborn, child and adolescent health. Approach used by government to ensure “continuum of care" across key life stages.
Stunting: Why 38.4% of Indians are too short for their age. Not just a poor family’s problem. Stunted children (beyond age 2) become shorter adults who produce and earn lesser than their peers.
Thousand days: Window from pregnancy till age 2 that offers the best opportunity to impact a child’s overall development. The problem—inadequate attention to mother and child at this stage sets the child back permanently.
Under-5 mortality: Instances of a child dying before turning five. That’s 50 out of 1,000 for India (National Family Health Survey IV: 2015-16). The tragedy is that many are preventable.
Village health and nutrition day: Organized every month at the village Anganwadi (pre-school) by the AAA to offer ANC, immunization, counselling and other services.
Wasting: In India, one of five children is wasted, i.e. weight is not proportionate to height.
X-ray: The issue is availability in rural India. Close to half of India’s community health centres have a shortage.
Y: Why must the kids die? Serious question for governments the world over.
Zinc: Important to administer (with oral rehydration salts) to children to reduce prevalence of diarrhoea. Diarrhoea is deadly serious, causing 525,000 child deaths each year.
Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok