Reader Comments

Post a new comment on this article

Baby steps to a better future..

Posted by plosmedicine on 30 Mar 2009 at 23:58 GMT

Author: Ramesh Vidavalur
Position: Dr/Physician
Institution: Division of Neonatology, University of Connecticut Health Center, Farmington, CT06030
Additional Authors: Praveen Vijayakumar
Submitted Date: August 23, 2006
Published Date: August 29, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

The article on new initiative for newborn health in India by A Fernandez and D Osrin (1) outlines an innovative approach to tackle alarming global burden of infant mortality with an estimated 8 million annual deaths with in the first month of life (2), majority being in third world countries. Dr. Fernandez rightly focuses on challenges and the possible innovative, yet effective, interventions to improve maternal and infant health.

Historically, it almost took 50 years to reduce infant mortality rate (IMR) in India by 50% (151 in 1951 to 69 in 2001) and the policy makers are optimistic about further decreasing it to 30 by 2010 and Maternal Mortality from the present 4/1000 to 1/1000 by the same time (3). As the majority of reproductive, childhood morbidities and mortalities can be reduced by primary prevention and early intervention strategies, large scale adaptation of community intervention strategies will be particularly useful as they help next generation to have a head start in good health because the expected population in 15-59 age group will massively increase from 519 million to 800 million by 2016 in India (4).

Health spending in India at 6% of GDP is among the highest levels estimated for developing countries. In per capita terms, it is higher than in China, Indonesia and most African countries but lower than Thailand. Public spending on health in India has itself declined from 1.3% of GDP in 1990 to 0.9% in 1999. Individual states have cut down health budgets from 7.0% to 5.5% in spite of Bhore committee recommendation of 15% (5) The lack of resources, infrastructure, awareness can further hinder the balance of health and disease and puts considerable burden on poor, rural Indian population.

In recent years, a growing constituency of non-governmental organizations have drawn attention to maternal and child health, supplementing government's relatively recent initiative Child Survival and Safe Motherhood (CSSM). As Dr Fernandez et al rightly points out the demand and supply sides, India is not likely to be in a position to afford institutional care for all births even if this was considered a desirable goal. So the supply side should be strengthened through birth attendants(TBAs), community education, micro-level organizations and effectively integrating traditional and modern health care systems. One of the best ways to do this is identifying and strengthening NGOs that have high motivation, social commitment, and sensitivity to poor, flexibility and innovativeness. They can mobilize, empower, and increase awareness through their grass root workers from the communities.

It has been proven in numerous trials that community based interventions like home based neonatal care (HBNC); usage of (TBAs) can significantly reduce IMR and improve maternal health. (6).

At present, India is in the midst of an epidemiological and health transition wherein multiple factors like urbanization and migration; changing lifestyles; democratic decentralization have an enormous impact on the above issues. Now is time for the governments and policy makers not only to put out feasible plans in place with short term goals of achieving targets, but also ensuring adequate human resources, strengthening community ownerships, improve information dissemination through media, investing in health systems research and lastly continuously monitoring progress for healthy future.

1. Fernandez A, Osrin D (2006) The City Initiative for Newborn Health. PLoS Med 3(9): e339
2. Save the children. State of the Worlds Newborns. Washington DC: Save the Children; 2001.
3. Government of India. National population policy. New Delhi: Ministry of health and Family Welfare, Government of India; 2001
4. Registrar General of India, SRS Bulletin April 2004.
5. Planning Commission report, Government of India, 2003.
6. Bang AT, Bang RA. Background of the field trial of home-based neonatal care in Gadchiroli, India. J Perinatol 2005; 25:s3-10

No competing interests declared.