Recent figures reveal a huge gap in child healthcare in India, at a time when experts warn of the vulnerabilities of young people to COVID-19 in a looming third wave.
Experts expressed misgivings about a severe deficit in child healthcare at primary health centres and community health centres. Per data shared by a parliamentary standing committee, India’s primary health centres register an 82 percent shortage in paediatricians. Community health centres register a 63 percent shortfall. “The situation is already dire, and might worsen due to lack of adherence to COVID Appropriate Behaviour (CAB), insufficient medical facilities and lagging vaccination,” the report warned.
An expert committee under the ambit of the National Institute of Disaster Management (NIDM) cautioned that a third wave may see children be at risk in a similar way to adults. “Paediatric facilities — doctors, staff, equipment like ventilators, ambulances, etc. are nowhere close to what may be required in case a large number of children become infected,” the committee said in its report submitted to the Prime Minister’s Office.
“Preparedness is the key, learning from the past two waves,” said Santosh Kumar, coordinator of the committee of experts and professor head of governance and public policy at NIDM. “We need to take proactive actions now in anticipation of the third wave. States may start enhancing paediatric Covid care facilities for treatment, ICU, paediatric ambulance, medicine, including paediatricians.”
“The remarkable progress seen in maternal and child health (MCH) in India over the past two decades has been impacted by the COVID-19 pandemic,” outlined a study published earlier this year. Nonetheless, “in India, key MCH indicators remain concerning, as evidenced by partially released results from the National Family Health Survey-5 (NFHS-5), which indicate worsening of maternal and child nutrition indicators in several states,” the study authors said. “There is an urgent need to identify targeted approaches to improve the state of MCH in India. While MCH programs in India are weighed down by wide inequities, these challenges have been amplified by the ongoing COVID-19 pandemic…Limitations in the availability of skilled health workers and health system access barriers have led to lower coverage of antenatal and postnatal care services, and routine childhood immunisation services, especially in rural India.
“A recent modelling paper estimated that the disruption and decreased utilisation of routine health services and reduced access to food during the pandemic could lead to an estimated 9.8–44.7 percent increase in under-5 child deaths per month, and an 8.3–38.6 percent increase in maternal deaths per month in LMIC settings.”
Even before the pandemic, as researchers have pointed out, India weathered a deficit in its child healthcare infrastructure. In 2019, Save the Children noted that whilst health indicators have improved, India ranked 113th in a ranking of 176 countries as it pertained to child health. Whilst having made significant advances in areas such as advances in reducing the number of child brides and scaling up immunisation, India’s young people remain embattled by crises such as malnutrition and continued high rates of child mortality as well as those where progress has been made. As Health Issues India reported at the time
“In India, outbreaks of vaccine-preventable conditions occur regularly. Every year, vaccine-preventable diseases kill 60,000 Indian children under the age of five. A mere eighteen percent of Indian children receive the full three-dose course of diphtheria, pertussis, and tetanus vaccine. Just one-third receive the full course of the measles, mumps, and rubella (MMR) vaccine. In the example of measles, Health Issues India reported this year that 2.9 million Indian children missed out on the measles vaccine in the past eight years. This means India is home to the second-highest number of children unvaccinated against measles in the world, behind only Nigeria. The implication of this is being witnessed in measles outbreaks. This year, India reported 7,246 confirmed cases of measles to the World Health Organization (WHO) in just three months. This pours cold water on long-standing targets to eliminate the disease by next year.
“In terms of stunting, India is home to 46.6 million children afflicted with the condition. Globally, progress has been made with 49 million fewer stunted children according to the Save the Children report. India has shown progress in reducing the prevalence of the condition but its stunting burden is still high, at 30.9 percent. This reflects a malnutrition crisis which has led to India often being referred to as the world’s hunger and malnutrition capital.
“Child mortality continues to be a major issue, even as India makes progress. In 2017, the under-five mortality rate had fallen by 66 percent compared to 1990. Nonetheless, the child mortality rate of 39 deaths per 1,000 live births stood higher than targets outlined under the Sustainable Development Goals (SDGs) of 25 deaths per 1,000 live births. Earlier this year, it was reported that India topped the world rankings for child mortality in 2015. Inequality between the states tempered achievements such as reducing child mortality from 2.5 million deaths in 2010 to 1.2 million deaths in 2015. Poorer states record higher child mortality rates compared to their more affluent counterparts – indicative of a broader inequality crisis that plagues Indian healthcare. The implication is that, to meet SDG child mortality targets by 2030, a “giant leap” is needed to reduce both newborn and under-five deaths.”
During the COVID-19 pandemic, advances in child healthcare have been hindered. The coronavirus outbreak led to “the most widespread and largest global disruption in recent history” to routine immunisation services according to The Lancet. As my colleague Nicholas Parry reported for Health Issues India, “an estimated 3.5 million children missed out on their first dose of diphtheria-tetanus-pertussis combined vaccine (DTP-1) in India in 2020,” he wrote. “Three million more children missed their first dose of the measles vaccination. Such were the effects of the initial wave of the COVID-19 pandemic that health systems across the globe were thrown into disruption. Diseases such as polio, the closest disease worldwide to being eradicated, were threatening a resurgence as vaccination campaigns were suspended.”
We are thoroughly behind on advancing towards improvements in child healthcare and the stark deficits during the pandemic as children are poised to be vulnerable to the effects of COVID-19 in India’s third wave ought to be alarming for us all. Multiple states in India are preparing for the third wave with children in mind. “We don’t know how the virus will behave, but we cannot afford to be unprepared this time around,” Suhas Prabhu, who heads the Paediatric Task Force in Maharashtra, said in remarks quoted by Reuters. “No mother should have to run around looking for a hospital bed when her child is sick.” This comes as states work to scale up the availability of paediatric beds, oxygen supply, and other child healthcare necessities. The country is also receiving the help of agencies such as UNICEF.
The notion that children are somehow immune from COVID-19 or its direst effects has been thoroughly debunked. It is indeed true that children are less susceptible to becoming critically ill, but it is indeed true that they are still vulnerable. We do not know what the future holds, but that is no reason to simply close our eyes and hope for the best. We need to be prepared. With an existing gap in child healthcare services which predates the pandemic, this is the moment to reckon with why our child healthcare services are so remiss, so underinvested, and so underfunded. That states are working towards shoring up resources is a good thing – and the Government has launched a range of initiatives targeting issues which disproportionately affect children such as poor sanitation and malnourishment. But, as Health Issues India has noted in the past
“[India] is home to a dual burden of malnutrition that sees swathes of its young people either severely undernourished or dangerously overweight. It grapples with pervasive sex discrimination and gender bias that threatens the health and lives of the country’s girls and women. It bears a high burden of communicable and noncommunicable diseases and health issues linked to maternal, neonatal, and perinatal conditions. Readily accessible and affordable healthcare is not the reality for many of the country’s citizens.”
The time for course-correction is here. The time for burying one’s head in the sand has long since passed. If this isn’t the moment to acknowledge this stark reality, will there ever be one?