Sunday, March 27, 2011
In the recent past, media reports about West Bengal have generally been negative. Apart from the debates on land acquisition for industrialization, an increasingly strident Opposition has been accusing the government of gross failures on the health front.
But the real picture is very different. Data from the office of the Registrar-General of India, using the Sample Registration System (SRS), show that West Bengal is now one of the best-performing states in the country in terms of the most basic health indicators.
As a result, among the major states, West Bengal in 2008 had the fourth lowest birth rate (after Kerala, Tamil Nadu and Punjab) and the lowest death rate among the major states, even lower than that of Kerala. In 2008, the rural death rate in West Bengal was 6.1 compared to the urban rate of 6.6 (a gap of just 7.5 per cent), whereas, for India as a whole, it was eight in rural areas compared to 5.9 in urban areas (a gap of 26.2 per cent).
Even Tamil Nadu, the state that has otherwise performed very well in health indicators, shows a rural-urban gap in the death rate of 23 per cent. This fact has left doctors and health officials of the state surprised as Tamil Nadu is considered well ahead in health services than West Bengal. Even now thousands of patients throng to the hospitals of Tamil Nadu to be treated.
The infant mortality rate (IMR) —expressed as the ratio of the number of deaths of infants of one-year-old or less per 1,000 live births — is often regarded as the single most important indicator of overall health conditions in a particular area. The relatively rapid decline in IMRs in West Bengal (by 57 per cent, compared to the all-India average decline of 34 per cent) has made it one of the best performing among major states with respect to this indicator.
The IMR in 2008 in West Bengal was 35, putting it in the fourth position after Kerala, Maharashtra and Tamil Nadu. Even going by the data available with the central bureau of health intelligence, West Bengal has been one of the best performing states in most of the basic health indicators. West Bengal has the lowest death rate with 6.2 percent and fourth with an overall birth rate at 17.5 per one thousand but has the lowest urban birth rate with figures of 12.4.
West Bengal is also fourth in maternal mortality rate with figures of 141 whereas the national average is 254. Similarly, West Bengal is the third in fertility rate at 1.9 with only Tamil Nadu and Kerala ahead. The only indicator in which West Bengal has a lot to improve is the case of mortality of children less than five years with figures of 59.6 where the ranks are at seven.
Under the universal immunization scheme, the state government administers TT (PW), DPT, Polio, BCG and measles vaccines. The success rate of 1999 was 90.43 per cent, 98.73 per cent, 100.35 per cent, 105.11 per cent and 84.85 per cent respectively. After ten years, the success percentage has slided marginally. The values for 2009 are 77.73 per cent, 68.62 per cent, 81.48 per cent, 97.78 per cent and 80.67 but the values are very close to the national average.
Further, throughout the decade, West Bengal has had a very low gender gap in IMR. This is also confirmed by other survey data, including the various rounds of the National Family Health Surveys (NFHS), which have found that the gender gap in the IMR in the state is either the lowest or among one of the lowest in the country.
The maternal mortality ratio (MMR) is the rate of maternal deaths per 100,000 live births among women aged between 15 and 49 years. MMRs have been declining faster and are now lower in West Bengal (141) than the national average (264). West Bengal health department can also pat themselves since the Confederation of Indian Industry (Eastern Region) report of 2010 has praised the state government for the sustained 10-year strategic framework.
The report states that the results of the initiative have been excellent, however monitoring by community and decentralization, though easy on paper, are challenges on the ground that need to be worked at continuously. The report further apprehends that with the state elections around and the DFID stopping funding suddenly, the programme may lose its political focus.
Well begun is half done, the report concludes. But health officials feel that more stress has to laid on the sincerity of health workers from doctors to the ground staff. “They lack the sincerity to execute immunization till the end and earlier had a great tendency to file false reports, which has reduced a lot,” complained a senior health administrator.
“In our state, more than 70 per cent of the people come to government hospital unlike in Bihar; so a little bit of more sincerity would help a lot,” he added. Director Health Services Dr Subhamoy Dutta Chowdhury accepted that there were gaps in the immunization programme.
“Since there are gaps, polio cases have been reported but we are working on the gaps. But we also feel that increasing the literacy level of mothers will always ensure that children are properly immunized and a healthy family,” said Dr Dutta Chowdhury.
Health indicators of West Bengal
_Birth Rate: 17.5 (National Average 22.8) Fourth _Death Rate: 6.2 (National Average 7.4) Lowest _Infant Mortality: 35 (National Average 53) Fourth _Total Fertility Rate: 1.9 (National Average 2.7) Third _Neonatal Mortality Rate: 28 (National Average 36) Fifth _Maternal Mortality Rate: 141 (Nat Average -254) Fourth (All figures are out of 1,000 and MMR out of one lakh live births)