The Indian government joined hands with the Bill and Melinda Gates Foundation this week in launching “All Children Thriving", an initiative to ensure healthy childbirths. The initiative has been undertaken as a part of Grand Challenges, a campaign run by the Gates Foundation focusing on health issues. In an interview, M.K. Bhan, founder chairman of the Biotechnology Industry Research Assistance Council that’s a part of the “All Children Thriving" programme, said India was not investing enough in its children and more focused research is needed on the subject.
How is “All Children Thriving" different from programmes already addressing this issue?
We have run several programmes on child survival for the last decade. While there has been some impact on deaths in the first one week, we still cannot touch practices in the first day or two, where the bulk of deaths occur. Our national programmes are not achieving what is achievable. There are many inter-generational constraints for having low birth weight or high child mortality and these factors (like environment, nutrition, etc.) may not end with one generation. We cannot say economic development will solve this problem. Survival is fine, but our children need to thrive. As a policymaker, I am rarely effective if I am not clear.
In health, we haven’t seen great successes... We need science which is grounded in population—that is where good innovation comes in. We need to quickly figure out what is a right package of intervention for expecting women. Neo-natal mortality is a huge challenge for our government. Almost 20% babies have low birth weight and the rate of decline in stunting, despite intensive efforts through national programmes, is 1% per year—too slow for us to accept. Through “All Children Thriving"...we want to focus bright scientists on the problems of the poorest and deliver results quickly.
Does the dependency on donor funding worry you?
We are investing very little money from India on our children... The Indian Council of Medical Research’s total budget is ranges between ₹ 5,000 crore and ₹ 6,000 crore. It is absurd to expect the organization to run a health research programme on that little money. We, our policies, have made India dependent on donor money. The attention is focused on global world, and this is the biggest tragedy of innovation in India. As a nation, we pay more attention to nationalism than on national responsibility. Today, we need research. We need quick research... We need science embedded in the community—context-sensitive research, which helps us produce results by overcoming current barriers.
At present...policies are just confused and confusion can be spread, but it cannot be implemented. We need a stable clear agenda which everyone believes in—intense, efficient research. And for now, if Grand Challenge is the way to provide this stability, then that is the best way forward for us as a nation.
What clarity does this partnership bring to Indian policies?
“All Children Thriving" is an exclusive programme which will look at intensive campaigning for breastfeeding during first six months and improve our rates of coverage. One of the big focus areas of this challenge is equitable participation from the community. We need behavioural change from people as we have too many sub-cultures—all of which have different traditions and practices during pregnancies and birth. This programme is an attempt at creating a first-class pregnancy surveillance, which reaches 90% of our expecting mothers.
Currently, we are faced with a few fundamental questions. We need to define the best package of intervention for pregnancy. We need to be sure about the best time to intervene—pre-conception, early conception, late conception... Or do we need a policy that intervenes during all three stages?
So far, we have had individual interventions with sporadic impact—interventions focusing only on gestation, or only on growth or breastfeeding campaign. We need a comprehensive policy that addresses a child and a mother’s needs from the time a baby is conceived to the first 1,000 days of life. All our programmes are designed for pre-school kids. Below two months, kids are just not available at a facility. We need a new design of programme to get to these children.
How will this plan work with the currently existing policies targeting children?
This new government has made two commitments—the India Newborn Action Plan will reduce our child mortality to single digits by 2030. That target is eminently realizable if we put our house in order. Secondly, the government is committed to standardized and affordable care delivery. The contours of that are still being worked out. We have not defined the role of the market, or of health assurance, etc., so far. That is a priority area.