As world leaders and members of the global community gather at the United Nations to decide on the post-2015 development goals, they will build on the momentum generated by the >Millennium Development Goals (MDGs) .
India has made remarkable progress in achieving the MDG health-related targets. The country has been able to substantially reduce its under-five mortality rate from 126 deaths per 1,000 live births in 1990 to 53 deaths per 1,000 live births in 2013. Smart initiatives, such as the Call to Action, India’s Newborn Action Plan and the Integrated Action Plan for Pneumonia and Diarrhoea, have paid tremendous health dividends. >But there is still a long way to go.
Of the nearly six million children under the age of five who die from preventable causes every year around the world, 21 per cent are from India. Many of these children die because of malnutrition and infectious diseases.
The challenge is enormous, but not insurmountable.
These deaths could be prevented by adopting a comprehensive and integrated approach to child health, one that focuses on nutrition, safe water, improved sanitation, micronutrient supplements and vaccination against preventable pneumonia and diarrhoea.
However, to truly reach the children most likely to die before their fifth birthday, India will have to focus on its most vulnerable children — >children who are poor, live in rural areas or face discrimination because of ethnicity, caste, gender or disability.
The recently launched >Mission Indradhanush seeks to do just this . This programme aims to increase national immunization coverage rates and expand the reach of the Universal Immunization Programme (UIP), which is already the world’s largest immunization initiative.
By 2020, Mission Indradhanush aims to immunize at least 90 per cent of the children and women who have so far remained unvaccinated or did not receive the full recommended doses. It focuses on 201 high-priority districts and marginalized population groups where immunization coverage is low, exclusion and dropout rates for routine immunization are high, and the risk for disease outbreaks, including polio, is only too real.
By focusing on those who are traditionally left out of the public health system, such as children from tribal communities, child labourers, street children and children living in informal settlements, the Mission Indradhanush programme offers a model of how investment and interventions can serve the children who most need the help.
With a country as geographically vast as India, providing affordable and accessible health services to all citizens can be a challenging proposition. Extending immunization coverage and introducing vaccines against rotavirus diarrhoea, Hib (haemophilus influenza type b) and pneumococcal pneumonia could help India transform a vicious cycle of poverty, ill-health and deprivation into a virtuous cycle of good health.
Vaccine barriers The Indian government must seek solutions to barriers that prevent children from receiving vaccinations. These barriers include gender disparities, procurement and delivery challenges, too few frontline health workers and lack of information or misinformation on the benefits of immunization.
Though India’s leaders have expressed their commitment to immunization efforts, multilateral institutions such as GAVI, a global vaccine alliance, the World Health Organization and UNICEF can complement the government’s efforts by providing vaccine supplies in underserved areas, and strengthening health systems, planning, monitoring, research and logistics.
India has made significant progress in child survival in the last decade. But as the world looks to chart the next development roadmap, the country’s leaders need to renew their commitment to safeguarding the right to health for every child, particularly the most marginalized. The world is watching — and waiting. It is up to India to lead the way.
(Geeta Rao Gupta is a Deputy Executive Director at UNICEF, overseeing the Programme, Supply and Emergency Operations Divisions)
