A focused solutioning hub could help boost our maternal and infant health programmes
With the coronavirus pandemic sweeping the world, there will be no quick return to life as we know it. But what does the future look like? If there is a lesson to be learned in every experience, Covid- 19 could transform the world of health—for the better—if only we care to remember the takeaways.
Covid-19 is teaching us one lesson, over and over: the power of collective vision and action. As the World Health Organisation (WHO) director-general says: “Every sector and every individual must be involved in this fight.” In India, various wings of the government have come together to offer an integrated response. In tandem, civil society has shown exemplary zeal in helping vulnerable individuals and communities.
Long codified as “Whole of Government” and “Whole of Society” approaches, here political and government leadership facilitates the active participation of civil society, communities, academia, media, private sector, voluntary associations, families and individuals, to take appropriate measures together. This must be our new approach in heathcare.
MOTHER AND CHILD
India’s greatest public health achievements, as well as shortfalls, lie in reproductive, maternal, neonatal, and child health (RMNCH). Tremendous progress has been made with the National Rural Health Mission (renamed National Health Mission). Almost every village now has health workers and health centres. India has the world’s largest frontline health force and universal immunisation programme.
Yet, much still needs to be done. Our neighbours—Sri Lanka, Nepal, Bangladesh—are significantly ahead of us. Over 34 of every 1,000 newborns die before they turn five in India, while 21 die as neonates. About 145 mothers in every 1,00,000 die while giving birth. Around 40 per cent of India’s children are stunted—a key indicator of malnutrition. All this is not so much due to lack of effort, but uncertainty inherent in complex contexts.
REMOVE THE SILOS
Consider childhood stunting: it is caused not just by inadequate nutrition, but a range of issues—from poor sanitation, infection, illness to inadequate care of the mother during pregnancy. India is a country where superstitions, traditional mistrust of modern medicine and social discrimination—even at health centres—often make it difficult for a woman to access the health services.
What’s the way out? Clearly, we have to push the envelope by a targeted response. All preventive and curative services need to be available to the mother and child continuously. Services need to be strengthened, but not just. There has to be an integrated policy response that would engage the civil society to address social determinants.
HUB OF SOLUTIONS
The road ahead lies in innovative solution-ing approach, to borrow an information technology term. Let’s call it the RMNCH Action Solutioning Hub. At its core will be the government units for integrated action, and on every level there will be civil society stakeholders to take care of sustainable healthy behaviours. Guided by the Secretary, Health and Family Welfare, the hub will be driven by a credible technical organisation—to engage, build consensus and devise actionable agendas.
The hub will not replicate, but catalyse government efforts and priorities. For instance, to infuse quality into the mother-and-child initiatives—from LaQshya (quality improvement initiative in the labour room) to the SurakshitMatritvaAashwashan or SUMAN (dignified and quality healthcare at no cost)—to develop a national midwifery cadre, align medical colleges with NHM efforts and so on. The priority will also include sick and small newborns.
PAUSE AND REFLECT
The hub will operate by regularly convening stakeholders to ‘pause and reflect’: identify shared short, medium- and long-term goals, as well as execute strategies. Other than voices from learned bodies—the NHM, MoHFW, Ayushman Bharat and the NITI Aayog—there will be representation from the private sector and the civil society.
The hub will, thus, be an active platform to bring grassroots insights and best practices from the margins to the mainstream of policymaking. Frontier technologies and frugal innovations, which have been very successful in small pockets, can thus be scaled up. This process will create a dynamic environment of learning from each other and devise solutions continuously.
Finally, the hub will be attentive as much to behavioural patterns and healthcare trends, as to the drivers and barriers within social ecosystems—to change unhealthy social norms. Insights from local government and civil society will be run through proven methods of effective and sustainable change toward healthy communities.
THE LAST WORD
Covid-19 is teaching us the power of collective and structured action. Let us translate that learning, with the same urgency, to the well-being of mothers and children—for an India to be ready to seize the future.
(Dr. Rajiv Garg is Professor of Eminence, Ministry of Health and Family Welfare, Government of India (former Director General Health Services), Dr. Rajiv Tandon is Director – Health, RTI International India)