West Bengal (India) Health Policies - A Tryst With Reality

By Aditya Zutshi and Sehej Buttar, Vinod Gupta School of Management, IIT Kharagpur, EVERY ONE youth campaigner

Photo: Nilayan for Save the Children

The Constitution of India charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties"

But in West Bengal, at least nine districts in the state suffer from arsenic contamination of groundwater, and an estimated 8.7 million people drink water containing arsenic above the World Health Organisation recommended limit of 10 µg/L. 

According to WHO statistics there are over 250 medical colleges in the modern system of medicine and over 400 in the Indian system of medicine and homeopathy (ISM&H). India produces over 250,000 doctors annually in the modern system of medicine and a similar number of ISM&H practitioners, nurses and para professionals. 

But still India suffers from high levels of disease including Malaria, and Tuberculosis where one third of the world’s tuberculosis cases are in India . In addition, India along with Nigera, Pakistan and Afghanistan is one of the four countries worldwide where polio has not as yet been eradicated. Half of children in India are underweight, one of the highest rates in the world and nearly same as Sub-Saharan Africa. India contributes to about 5.6 million child deaths every year, more than half the world's total. According to the World Health Organization 900,000 Indians die each year from drinking contaminated water and breathing in polluted air. Most Indian women are malnourished. The average female life expectancy today in India is low compared to many countries and in many families, especially the rural ones, the girls and women face nutritional discrimination within the family, and are anaemic and malnourished. The maternal mortality in India is the second highest in the world. Only 42% of births in the country are supervised by health professionals. Most women deliver with help from women in the family who often lack the skills and resources to save the mother's life if it is in danger. According to UNDP Human Development Report (1997), 88% of pregnant women (age 15-49) were found to be suffering from anemia. Water supply and sanitation in India continues to be abysmal. Only one of three Indians has access to improved sanitation facilities. As of 2003, it was estimated that only 30% of India's wastewater was being treated, with the remainder flowing into rivers or groundwater. The lack of toilet facilities in many areas also presents a major health risk; open defecation is widespread even in urban areas of India, and it was estimated in 2002 by the World Health Organisation that around 700,000 Indians die each year from diarrhoea. No city in India has full-day water supply. Most cities supply water only a few hours a day. In towns and rural areas the situation is even worse.

What is the organizational structure of the governing body? The Health and Family Welfare (H&FW) Department is organized into a number of directorates whose work is monitored and coordinated by the H&FW Department by the Health Secretary. The department functions under the overall guidance of the Minister-in-charge, Dr. Surya Kanta Misra. The State Health Administration has two arms, the Secretariat and the Directorate of Health. The Secretariat is headed by the Principal Secretary who is a senior officer of the Indian Administrative Service assisted by Special, Joint, Deputy and Assistant Secretaries. The Director of Health Services and ex-officio Secretary heads the Directorate and is the chief technical Advisor to the State government on all matters related to medical and public health. He is assisted by a number of Additional, Joint, Deputy and Assistant Directors. The heath care system has primary health care network, a secondary care system comprising district and sub-division hospitals and tertiary hospitals providing specialty and super specialty care. Each of the seventeen districts is headed by a Chief Medical Officer of Health (C.M.O.H.), assisted by Deputy and Assistant C.M.O.H.s, whose responsibility is to manage the primary health care sector and ensure the effective implementation of the various medical, health and family welfare programmes. The secondary level hospitals are headed by medically trained superintendents who report to the C.M.O.H. and are accountable to a hospital management committee. At the block level, the Block medical officer is responsible for providing services and for monitoring and supervising the primary health centres and health programme implementation. The medical manpower in the State Health System is provided by the State Health Service and in the teaching institutions by the Medical Education Service. The training activities are mainly organised at the Institute of Health & Family Welfare, Salt Lake, Kolkata, and also at various training schools.

Even though the situation is abysmal, there is hope. The West Bengal Clinical Establishment Rules, 1951 mentions that no license for clinical establishment shall be granted unless the licensing authority is satisfied that the applicant and the Clinical Establishment fulfils the conditions mentioned in the Act. All operations should be performed in a fixed centre having OT facilities. The licensee for a temporary camp shall be valid for one month from the date of issue of the license.The license for such temporary camp shall be renewed in any circumstance. West Bengal Nursing Personnel Rules, 2008 assures that no nursing personal will be allowed to  undergo studies as training reserve in any manner other than sponsored as per the rules.  The Regulation and Prevention of Misuse Amendment Act 2002 prohibits sex selection, before or after conception to prevent their misuse for sex determination, leading to female foeticide and for matters connected therewith or incidental thereto. The West Bengal Prohibition of Smoking , Spiting and Protection of Health of Non Smokers and Minor act 2001, State Drug Policy of West Bengal in 2004, Tobacco Law in 2003, West Bengal Registration of Births and Deaths (State Rule 2000) are some of the laws introduced to address some of the health issues. 

There are so many problems to tackle and so many issues to resolve. But then the journey of a thousand miles begins with a single step... In this case, we the dynamic and aware youth are the travelers. We remember a few stanzas from Bruce Springsteen's We Shall Overcome song...

We shall overcome, we shall overcome

We shall overcome someday

Darlin' here in my heart, yeah I do believe

We shall overcome someday

Well we'll walk hand in hand, we'll walk hand in hand

We'll walk hand in hand someday

Darlin' here in my heart, yeah I do believe

We'll walk hand in hand someday

Well we shall live in peace, we shall live in peace

We shall live in peace someday

Darlin' here in my heart, yeah I do believe

We shall live in peace someday

Yes... We do believe... we shall overcome someday... !!!

Delhi through Raghu Rai's lens

“Save the Children sent me to photograph these kids in places I have never been. In fact, these images speak of things we don’t like to see and acknowledge. How can we Indians call ourselves a developed nation if our children are dying? It’s high time we change things.”
 - Raghu Rai

India's contrast

By Ben, EVERY ONE campaign director 

Photo: Raghu Rai for Magnum/Save the Children

India has seen vast economic growth over the last ten years but remains home to one-third of the world's undernourished children. The Prime Minister has called it “a curse” that must be tackled. Even in the nation’s capital, Delhi, you do not need to go far to see what needs to be done. I was in the Sanjay Colony Cluster in North West Delhi, an hour from the centre of the fastest growing city in the world, where people live hand to mouth on the city’s open rubbish tip. People from all over India have moved to Delhi with hopes of a better life but thousands of people are in this cluster with no sanitation or health facilities. The conditions here are shocking and I am relieved that the monsoon season is now over because when it pours with rain the water bubbles up with sewage and flows through people’s homes.

The infant mortality rate in Delhi has doubled in the last two years, according to some reports. Malaria is common and many children suffer from gastro intestinal infections. Save the Children is helping by running a life saving mobile health clinic. The clinic travels to a different location every day including the rubbish tips where the rag pickers rummage through Delhi’s leftovers for any scrap to sell. It is an eerie sight, children and adults rummaging through the mountain of rubbish with large black crows circling overhead.

It is here that you can meet mums like Soni (age 22), Roma Devi (30) and Rita (25). They are trying to raise a family as their husbands work as contract labourers. Rita arrived in Delhi nearly 3 years after her husband. He earns 3000 Rs a month (62 US $) in a tyremaking factory. It is still not enough. Rita says most of what her husband earns is spent on food leaving nothing for any sudden medical bills or financial shocks. Her daughter who is three years old is clearly malnourished.

There is a new report out called ‘Lifting the Curse’ that includes work by more than 20 Indian analysts. The report calls India an "economic powerhouse but a nutritional weakling" where "at least 46% of children up to the age of 3 still suffer from malnutrition." This thought has stuck in my mind as I have been working in this diverse and challenging country and visiting areas like Sanjay Colony Cluster.

In parts of Delhi, the mega city, you can often feel at the forefront of the economic rat race, while in other areas like Rita’s house you witness the very bottom of the ladder. 

After visiting Sanjay Colony Cluster I was in Mumbai chatting to one of the most respected Indian filmmakers who is now supporting our campaign. He was clear when he said “we have malnutrition because people do not want to share their food”. It is a challenging thought for India with all the growth but also for individuals and governments around the world.

India’s invisible mothers

By Shabana Azmi, acclaimed actress and activist and EVERY ONE campaign ambassador

It is a little known fact that Mumtaz Mahal, Moghul Emperor Shah Jahan’s favorite queen died due to complications related to repeated childbirth. The Taj Mahal for all its beauty is a grim reminder of the fact that even today there are thousands of women in the country who continue to die during childbirth.

How many of us note the grimness against the picturesque beauty. Even after 400 years we seem to done little to improve the health of the mothers in our country.

India is a country that lives in several centuries simultaneously and so it is with maternal health.

If statistics are anything to go by - the Maternal Mortality Rate (MMR) in India is 254 to 100,000 – ranging from 95 in Kerala to 480 in Assam. To make sense of these statistics we have more 68000 women in our country dying every year in childbirth which is to say that in India every eight minutes a women dies while giving birth.

On the one hand, we find that India is marching into the 21st century with the head held high and becoming a global power and on the other hand, a new report from Save the Children says that india ranks number 73 on 77 of middle income countries when it comes to the ‘the best place to be a mother’. The Mother’s Index is based on analysis of indicators of women’s and children;s health and well being.

That is really a shocking state of affairs. The number of women we lose due to pregnancy related issues in one week in India is more than all of Europe in the whole year. . If I were to say it in different words, I will say that the number of women that we lose in one year in India due to pregnancy related issues is the same as having 400 air plane crashes.

Can you imagine what would happen? Governments would fall but because it is the poor rural women who are dying, nobody is paying any attention. Surely, this must change. Surely, we need to focus on giving our mothers the best healthcare possible and women need to be put on the frontline of the healthcare if this country is to make true progress.

We know that healthy mothers give birth to healthy children and we have a healthy family. We can neglect mothers at our own peril, at the peril of society. This state of affairs must change. It has been proved that when you have women accessing healthcare and particularly by training for instance dais, the midwives and more female health workers; their health definitely improves.

There is a critical role of female health workers in the fight to reduce maternal, newborn and child mortality. Evidence show that countries that train and deploy more front-line female health workers have seen dramatic declines in maternal, newborn and child mortality.

For instance our neighbours Nepal and Bangladesh have made remarkable progress. Deployment of 50,000 Female Community Health Volunteers has helped Nepal cut maternal deaths by half in 20 years and be on track to meet the U.N. Millennium Development Goal 4 of reducing childhood mortality by two thirds by 2015.

Bangladesh has already cut under-5 mortality by 64 per cent since 1990, and is also on track to meet the goal of reducing child deaths by two-thirds. Female fieldworkers who make home visits have played a critical role in delivering family planning services and reducing the number of high-risk pregnancies in Bangladesh. In another project, supported by Save the Children, home visits by female community health workers offering prenatal and postnatal care reduced newborn deaths by 34 percent in targeted rural communities.

On another note this cannot be dubbed as a health issue alone, we also need to invest in education of girls because there is a definite link between status of women, literacy levels and health. So we need to invest in our girl children and we need a commitment to our mothers because that is the only way our country can move forward in real terms.

What is shocking is that we can often become numb to large numbers and worse still sidelined as ‘women’s issue’. It ends up as nobody’s concern. Who’s agenda should it be – women’s, family’s, or society as a whole? EVERY ONE’s Women cannot wait.

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India’s Past or India’s Future?

By  Ben, EVERY ONE campaign director


Is India - the country with the highest number of children dying anywhere in the world investing enough in public health? 

Health spending as a percentage of GDP is a useful indicator for us to start answering this question. The World Health Organisation (WHO) stated that the global average public health spend is 5% of GDP. Canada currently spends 7%, Spain 6%, South Africa  is at 3%, Sri Lanka 2% and India is trailing near the bottom spending just 1.1% ( both states and the centre combined). It’s incredible to think that this is only just above Sweden’s aid budget which currently at 0.99% of GDP!

What about if we look at health spending per person? According to the WHO in 2009 Canada spends $3763 per person, South Africa about $715, Malaysia $544, Sri Lanka $171 and India…$86.

It is no wonder that more than 70% of all health care in India is paid for by people from their own pocket. But this is putting an increasingly heavy burden on the poor. A recent front page in the The Times of India estimated that in 2004-05, an additional 39 million people were pushed into poverty due to out-of-pocket payments.

Despite these statistics there is progress and India has some excellent schemes such as the NRHM in place but good schemes are not enough unless matched by effective implementation and budget.

Economic growth is certainly helping in India but even neighbours with slower economic growth are making faster progress on cutting child mortality. It is time for urgent action to change this.

So why spend money on health?  Because every child has the right to survive no matter the community or caste to which they are born.  Because when health improves, people have smaller families and a government has more resources per person. Because recent research evidence shows a 5% point reduction in child mortality rates is associated with a 1% point increase in economic growth over the following decade.  Because thousands of parents will lie awake tonight across India having lost a child to preventable illnesses and disease. And quite frankly because the Indian Government promised to spend 2-3% on health and still haven’t delivered.

The question facing the Minister of Finance and the Government of India is whether the high levels of child and maternal mortality are part of India’s past or India’s future. The Government will give an answer to this question on Friday in the budget.  

At the Chief Minister’s residence

By Pragya, EVERY ONE team

Sometimes working behind the scenes can be as interesting as being on the frontlines. This was a big moment for Save the Children India’s EVERYONE campaign: a reception hosted by Ms Sheila Dikshit, chief Minister of Delhi, India’s capital, at her residence.

So there we were, the two of us, ensuring lights, sounds, camera for the EVERY ONE event while her office staff were preparing for the evening dinner, making sure everything was in keeping with the stature of the head of the state.

While the Chief Minister (CM) runs the state, there is an efficient team running her office, including security, logistics and administrative staff, a press office and her personal assistant. They are all powerful in their own ways, sharing a closeness of trust with the seat of power.

Whiskey (yes, that’s what the CM’s dog is called), came prancing around as we set things up. Her daughter accompanied the dog with an offer of fresh lime juice— welcome respite to the sweltering heat.

Before the delegates arrived, we had to brief the Chief Minister about the EVERY ONE campaign, aimed at stopping children under the age of five dying from easily preventable causes. She graciously ambled out of her living room to meet the event/ campaign managers. Yes, that was my five minutes of fame with the CM.

Guests started pouring in, including Ambassadors, CEOs of Save the Children Member countries, corporate honchos and us, to the well-lit lawn.

The chief minister led every one present to sign up their support to the campaign. Placing her thumbprint on a specially-erected wall aimed at mobilizing messages of support for EVERY ONE, the Chief Minister joked that she wouldn’t normally put her thumbprint on a blank wall but was making an exception in this case considering it was a pledge of support to save the lives of children. Her message: “Save our planet, Save the children – Every One of them.”

EVERY ONE making a noise with school children

By Rajdeep, EVERY ONE team


June 19, New Delhi: Save the Children in association with The Tehelka Foundation is reaching out to schools with EVERY ONE. On the hot Saturday evening a group of kids joined hands together to make some noise, a noise to wake up Delhi to issues which “we” blissfully want to be oblivious of. This group consisted of children from contrasting social backgrounds- a homogeneous mix of students of Bluebells School International, an elite school in a posh south Delhi locality and children from Salam Balak Trust, an NGO working with street children in and around New Delhi railway station. These children were brought together and provided with training in street theatre by The Tehelka Foundation, an NGO working on social equity and justice.

With the sun still beating down hard, the excited bunch of children made their way into Dilli Haat, a popular handicrafts bazaar in the heart of Delhi. These children with their infectious energy spread themselves to every nook and cranny of Dilli Haat ushering people to gather around to watch their play with the chant “aao aao, natak dekho” (come with us and watch the play). As the play progressed, the group had managed to gather an audience of about 100-120 in number. The audience included Tarun Tejpal, Editor-in-chief of Tehelka magazine with his wife, representatives from Unicef and Save the Children. 

The street theatre focussed on several issues such as maternal health, child mortality, state of the girl child, female foeticide, family planning, child labour and the plight of the street children. But more importantly, it stressed on the fact that these are not “their” problems and it not just affects “them”, it is “us”. EVERY ONE of us has an important role in addressing these issues. One of the children played the role of a mother who had lost her child because of diarrhoea, establishing the fact that diarrhoea is one of the major causes of child mortality in our country. Another group of children played the role of a family with an expecting mother showing the importance of prenatal care. The audience laughed at the mimicries of the Bollywood actors and occasionally paused with a deep silence as the hard-hitting messages were conveyed by the children in a subtle and simple language. The tapestry of humour juxtaposed with serious messages engaged and enthralled the audience. 

The play culminated with the children reaching out to the audience and distributing leaflets with the key messages of the EVERY ONE campaign. The warmth of the applauding audience more than made up for the unrelenting Delhi heat. So much so, that the excited children repeated the performance at the entrance of Dilli Haat gathering an even bigger audience around them.

Dilli Haat was the first in the series of venues for the street theatre by The Tehelka Foundation. In the month ahead, these children will reach out to more public places such as malls, markets, university campuses; slum clusters and colonies in and around Delhi, making a noise that EVERY ONE of us can save a child’s life.