While the Rapid Survey on Children points to substantial progress in fields that have become a focus of serious action, such as safe delivery, it also highlights the penalties of inaction in other fields

The recent release of summary findings from the Rapid Survey on Children (RSOC) has generated remarkably little interest in the mainstream media. The main focus of attention so far has been the indifferent performance of Gujarat in matters of health and nutrition — nothing new there. Related to this, there has also been some speculation about the reasons for the Central governme

nt’s apparent reluctance to release the findings. The substance of the findings, however, has passed largely unnoticed.

This is unfortunate, because there is much to learn from the survey. In fact, RSOC can be regarded as some sort of substitute for a fourth National Family Health Survey (NFHS). It may be recalled that the third NFHS was conducted almost ten years ago, in 2005-06. Prolonged delays in the completion of the fourth NFHS have created a huge gap in India’s social statistics, even as all other South Asian countries conducted regular national health and nutrition surveys. Fortunately, the RSOC survey (conducted in 2013-14) seems to be modelled on NFHS, generating a wealth of health and nutrition statistics that can be usefully compared with the corresponding findings from the third NFHS.

Overall, the RSOC findings look like relatively good news. They suggest a marked improvement in many aspects of maternal and child nutrition between 2005-06 and 2013-14. But the progress is uneven — fairly rapid in some fields, slow in others.

At first glance, the biggest change relates to safe delivery. The proportion of institutional deliveries among recent births shot up from 39 per cent in 2005-06 to 79 per cent in 2013-14, and the proportion attended by a skilled provider rose from 47 per cent to 81 per cent. At least part of this trend is likely to reflect the impact of Janani Suraksha Yojana, including cash incentives for institutional delivery. This leap forward, however, has not been accompanied by a general breakthrough in maternal care. For instance, the proportion of pregnant women who had at least three antenatal checkups was not much higher in 2013-14 (63 per cent) than in 2005-06 (52 per cent). Similarly, the proportion who consumed Iron and Folic Acid tablets for at least 90 days was very low in both years: 23 per cent and 24 per cent respectively. Even the sharp increase in institutional deliveries needs to be taken with a pinch of salt: in some States, many women deliver in health centres for the sake of cash incentives, with very limited real benefits in terms of natal or postnatal care.

Another area of substantial progress is vaccination. The proportion of children with a vaccination card rose from 38 per cent in 2005-06 to 84 per cent in 2013-14, and vaccination coverage rose from 59 to 79 per cent for measles, 55 to 75 per cent for DPT3, and 44 to 65 per cent for “full immunisation”. Even with these improved figures, India has some of the lowest child vaccination rates in the world, and lags far behind Bangladesh and even Nepal. But at least there is a hint of accelerated progress, after an alarming phase of near stagnation in routine immunisation. As with institutional deliveries, this pattern can be plausibly attributed to recent health policy initiatives, such as the appointment of Accredited Social Health Activists (ASHAs), who are now actively involved in immunisation programmes along with Anganwadi workers and Auxiliary Nurse Midwives (ANMs). Quite likely, these initiatives can also take credit for a substantial improvement in breastfeeding practices: the proportion of children breastfed within an hour of birth rose from just 25 per cent in 2005-06 to 45 per cent in 2013-14.

Turning to other health and nutrition indicators available from these surveys, most of them point to moderate progress between 2005-06 and 2013-14 — more rapid than between NFHS-2 and NFHS-3 (conducted in 1998-99 and 2005-06 respectively), but nowhere as fast as one would hope to see in a booming economy. To illustrate, the proportion of undernourished children declined from 48 to 39 per cent based on height-for-age criteria and from 43 to 29 per cent based on weight-for-age criteria. This is a significant improvement over the preceding period, when child undernutrition was declining at a glacial pace. Yet, much faster progress is required if India is to overcome this colossal problem in a reasonable period of time.

Finally, there are worrying signs of stagnation in some important fields. One of them is access to safe drinking water: 88 per cent in 2005-06 and 91 per cent in 2013-14. The shortfall from universal coverage may not look large, but considering the vital importance of safe water, it is alarming that close to 10 per cent of households are still deprived of it (the corresponding figure in Bangladesh was just 3 per cent in 2007). No less alarming is the slow progress of sanitation: the proportion of sample households practicing open defecation declined from 55 per cent in 2005-06 to 46 per cent in 2013-14, or barely one percentage point per year. At that rate, it will take at least another 40 years for India to eliminate open defecation.

It is useful to read these figures in comparison with similar data (e.g. from the periodic Demographic and Health Surveys) from other South Asian countries, especially Bangladesh and Nepal. These comparisons tend to place India in a poor light. For instance, despite being about twice as rich as Bangladesh in terms of per-capita GDP, India lags far behind Bangladesh in terms of child vaccination rates, breastfeeding practices, incidence of open defecation, access to safe water, and related indicators. The same point applies if we compare India with Nepal, which is even poorer than Bangladesh. This gap reflects India’s resilient neglect of health and nutrition matters over a long period of time. The RSOC findings suggest that, in some respects at least, India is finally catching up with its poorer neighbours. They also suggest that the areas of rapid progress (example, safe delivery and vaccination) are those where serious action was initiated during the last 10 years or so. The need of the hour is to consolidate these initiatives and extend them to other domains where there is still no sign of rapid progress.

Alas, the Central government is going in the opposite direction. Financial allocations for the Integrated Child Development Services were slashed by 50 per cent or so in the last Union budget, sending a disastrous signal about policy priorities (no matter what compensation State governments may be receiving in the form of higher tax revenue). Health policy is a morass of confusion and inertia, with the Health Ministry and NITI Aayog talking at cross purposes. The Central government is brazenly ignoring its legal obligation to provide for maternity entitlements under the National Food Security Act. Even the sanitation budget has been quietly reduced, soon after the Prime Minister made tall promises of India being open-defecation free within five years.

The Central government is effectively palming off social policy to the States, with little regard for the consequences of undermining centrally sponsored initiatives that play a critical role in the field of maternal and child health. This does not augur well for another leap forward in the near future.

( Jean Drèze is Visiting Professor at the Department of Economics, Ranchi University.)