Expert Speak Health Express
Published on Oct 14, 2016
RMNCH in India: What needs to be done in the SDG era?

The end of the UN’s Millennium Development Goals (MDGs) was a wake-up call for countries that did not succeed in achieving the set targets. It also paved way for the new development agenda under the Sustainable Development Goals (SDGs), to be completed by 2030. Both the MDGs and SDGs have made health a priority area with most targets focussed on reproductive, maternal, newborn and child health (RMNCH). India’s progress towards the goals play a crucial role in shaping global health status as it is the second most populated country in the world.

The health goals are very important for India given that the country not only has the highest number of child deaths but also bears 15 per cent of the total number of maternal deaths worldwide. Despite significant improvements in maternal and child health since the commencement of MDGs, India failed to achieve most of the core health targets by 2015. The country needs to seriously consider making drastic efforts if it is to accomplish the ambitious SDG goals by 2030. The sorry state of India’s healthcare system was once again made evident in a recent study titled ‘Global Burden of Disease’ conducted by the University of Washington. In this study, researchers created a ‘health related SDG index’ which assessed each country’s performance across 33 different indicators and ranked India 143 out of 188 countries. India’s poor ranking is a reminder of the abysmal state of health care and how unprepared the country is in its path towards the SDGs. In order to meet the SDGs, India needs to overcome three major problems in its healthcare system.

First, India suffers from a weak Monitoring and Evaluation (M&E) system that can potentially hinder tracking its progress towards the goals. The statistical system lacks quality and timely data and core health indicators are available only at the state level and not beyond. In fact, some important indicators are unavailable even at the state level. For instance, SRS covers MMR for only 15 out of 29 states in the country. Long and irregular intervals of data collection further weaken the statistical tracking of progress. The absence of disaggregate data across caste, religion, social groups etc. also make it impossible to conduct any reliable socio economic analysis, which plays an important role in framing policies designed to tackle health issues. Thus, to develop a robust monitoring and evaluation system, data related issues such as quality, availability and regularity need to be addressed.

Second, the quality of healthcare facilities in the country needs to be a top priority. There is a major deficit in healthcare facilities and trained medical staff across the country. Although initiatives such as the Rashtriya Swasthya Bima Yojan (RSBY) have been set up to ease medical financial burden on the poorer sections of society, accessing the health care system would be impossible without enough trained personnel. Additionally, since there have been several reports of obstetric violence in hospitals, it is also imperative to assess the quality of staff behaviour towards patients. While hospital care evaluations by National Health Mission (NHM) take cleanliness and infrastructure into account, they fail to capture quality of staff behaviour. This aspect should be taken into consideration as it has a significant impact on institutional deliveries. Furthermore, while India’s health management information system (HMIS) was set up to supervise the NHM, its records suffer poor quality and inaccuracy in output and outcomes. HMIS also does not take the quality of hospital care into account and this is where India can learn from Mexico’s hospital performance model. To assess the overall performance and utilise investments resourcefully, the hospital performance report identifies gaps in quality and efficiency across hospitals in the country. By doing so, policy makers will have a better understanding of the ground level situation and can make prudent decisions based on the information provided.

Third, India’s low health budget needs to be revised drastically and greater investments are needed from the central and state governments. Public health spending stands at approximately 1.4 per cent, which is among the lowest globally. The improvement of healthcare facilities and hiring of trained medical professionals is contingent on increased health expenditure. One way to improve access and boost investments on infrastructure under challenging budget times is by leveraging public-private partnership to. A good example is the SRL diagnostic and Himachal Pradesh State Government partnership which has successfully set up 24 labs in public hospitals across the state. Besides investment, engagement with private sector can also help in tracking health outcomes since most Indians (72 per cent rural and 79 per cent urban households) access the private medical sector as their first source of treatment.

It would be unfair to ignore the fact that the Government of India has taken several steps in trying to overcome health challenges that confront citizens of the country. Under the NHM, the government is responsible for having launched several major initiatives including the RMNCH+A approach, which essentially looks to address core issue contributing to maternal and child mortality. While these efforts are indeed commendable, there are other pressing issues that the country needs to grapple with in order to transform the state of health care. It is only once the government addresses issues related to public spending, quality of health facilities and builds a strong M&E system that the country can move smoothly on its path towards goal 3 of the SDGs.

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Editor

Aaditeshwar Seth

Aaditeshwar Seth

Aaditeshwar Seth Professor Indian Institute of Technology Delhi and Co-founder Gram Vaani India

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