India’s quest for Health, Education and Nutrition
India as country of 1.4 Cr people (and rising) is moving forward with rapid integration. Conventional problems are being dealt with innovative and exciting approaches. While the National Health Policy 2017 strives for multiple components including Universal Health Coverage(UHC), Elimination of Tuberculosis (TB), Human Immunodeficiency Virus (HIV) and Neglected Tropical Diseases (NTD) and building robust health system capable of sustaining any future shock, merely investing in health may not provide the returns considering social determinants of health and state policies for convergence playing critical role.
'Health' as welfare concept always struggles with health as right. In the recent development where India’s educational policy with broader vision has been released, working on each of the component and integrating systems remain a challenge for a country which is not just diverse but dependent on sectoral financial allocation, conflicting priorities, challenging topographies, differential planning and many other factors.
One state can not be compared with another one, each one is unique in itself. Those who worked on system strengthening and integrating programs (within and outside the health system) have an upper edge.
The demographic transition coupled with changing disease profile- Communicable and non-communicable diseases poses a different challenge in current times. Understanding hinderances for uptake of central and state specific schemes would involve rapid adoption of multisectoral accountability framework. For eg. When one says there are pockets of vaccine hesitancy in the country, do we have granular data to identify reasons and take specific set of actions to address. From national level it may seem impossible but with new tools like U-WIN and ABHA, it can be done given the scientific approach is followed and concern for reduction of such pockets is felt at local level. Who knows that few pockets of such hesitancy may harbor the ground for infection like measles and reduce the chances of India’s drive for measles elimination.
Schools in historical sense are considered temple where knowledge is imparted for overall development but conventional way of providing classes and lectures need to quickly shift towards concerns related with common health ailments which would influence the health of student community. Health of the students, with and outside the schools, need immediate attention and shared responsibility of family, society and academic institution.
While mapping and co-location of Integrated Child Development Scheme (ICDS) centers and primary schools might be the great beginning, the education system needs to take up broader role and move beyond does and don’ts. India’s robust program while focusses on children through Rashtriya Bal Swasthya Karyakram (RBSK) and Rashtriya Kishor Swasthya Karyakram (RKSK), the health promotion component would need to be expanded and move from Ayushman Arogya Mandir to ‘Temples’ of education system. Each child’s nutrition, immunization, mental and social problems can be easily identified by the one who is close to the child. Most of the time it’s the mother or the teacher who can observe, understand and extend the support to the nurturing body and mind. With rapid digitization, childhood obesity and sedentary lifestyle is already setting in.
National Education Policy 2020 mentions need of health card for each student and tracking 100% immunization. Kudos to states like Rajasthan who have digitized student records and are providing Iron and Folic Acid (IFA) tablets utilizing state specific portal. Such initiative can be backbone for tracking other health services including life saving vaccines (like Td and HPV).
It is not unusual for family engaged in mobile, television, computers and other gadgets to ignore the physical mobility or dietary pattern of the child. Unmet needs of child would create more damage and bring social isolation despite of a child’s engagement with or without education system. Schools and ICDS centers needs to adopt to healthy food, healthy environment and promoting physical mobility among students of all ages apart from implementing various safety, sanitation and disaster risk reduction measures.
The one, who are registered with ICDS scheme but not with education system, needs to linked to education system for understanding significant of simple activities that shape health of an individual, and subsequently health of family and society. With limited health resources, burden on Women and Child Development (WCD) and education department are bound to increase.
Initiatives of Punjab and Himachal Pradesh Government for making tobacco free premises/villages and academic institutions are great examples.
Similarly providing IFA tablets and other curative services in academic setting may help but not suffice. The last mile delivery would demand linkage of each beneficiary, a child, an adolescent or an adult to both formal/informal education focusing on health, social skills, competencies for survival and planning for the healthy future. Development partners, health department and education department need to work jointly for ensuring special institution like child care institutions and institutions for disabled children also receive attention for a healthy development.
Integration and convergence are not new terms but creating a system where data, individuals, and program officers of different departments interact and work jointly for creating a healthy society. To our surprise, underemployment is a common phenomenon and affects the mental health. Country still has pockets where children are considered assets for contributing to farming and household work. While the law and rules exist, curbing child labour and bringing an umbrella of social security, nutrition security as well as financial security demand special efforts.
Health cards with unique identity like ABHA (Ayushman Bharat Health Account) are a great way to rapidly expand beneficiary data base and link benefits across the diverse systems- health, education and nutrition however, how a particular state or district administration uses these opportunities and invest in a transparent and accountable system depends on local understanding of influence education and nutrition have on health of an individual. Too tight compartmented systems and concern for data sharing at times would obstruct the holistic approach for individual health management. While the historical verticality is being broken by some of the national health programs and synergies are being establishes, there is still a lot to be done to address the social determinants of health for an individual, family and society.
Maslow's hierarchical pyramid demands apart from providing the bare minimum (basic) health package, each individual needs to know pros and cons of a particular lifestyle and move with greater level of health and overall development.
While the dedicated front-line workers in this robust country toil day and night to bring basic RMNCH+A services closer to individuals, policies of development of such precious ‘Human Resource for Health(HRH)’ also demands taking care of various securities of healthcare workers and community volunteers. Sustainable financing and free health checkup for HRH might provide great return. User friendly systems of HRH will also help in preventing duplication of data of same beneficiary for different health and nutrition programs.
It is not unusual where program managers look at each other and ask ‘who will do it?’ considering system needs to have faith in capabilities and it can’t come overnight. Healthy policies for welfare of providers and beneficiary become prerequisite. Investment undertaken in awareness are often questionable considering impact assessment for awareness campaigns and drives are often missing demanding research to compliment the health education efforts. Tracking a beneficiary for cascade of any disease or condition, like MNCH, TB or Hypertension, would demand ease of data flow and monitoring system to track attrition at each level. Use of Artificial Intelligence and predictive analytics would also help in understanding complex nature of behavior and social context in which such behaviors deviate from the favorable pathways.
India, as a rapidly transforming economy, would need all of government and all of society approach. The concept of ‘Leave No One Behind (LNOB)’ and ‘Bring Back Better System’ would help in sustaining the efforts for a sustainable future beyond 2030.