First Sundarbans Health Watch asks 'How healthy are the children of the Indian Sundarbans?'

Professors Barun Kanjilal and Rabindranath Bhattacharya
present a copy of the Sundarbans Health Watch - Series 1

KOLKATA, INDIA - On 1 August 2013, researchers, practitioners, policy makers and media represnetatives gathered to gain a better understanding of the key trends in child health in the Sundarbans region of West Bengal, India. In addition to presenting findings from the first Sundarbans Health Watch, various local and international NGOs -- such as Terre des Hommes, Child in Need, CRY, Save the Children and the Riddhi Foundation -- discussed their current activities in the region.The introductory address by FHS India leader, Professor Barun Kanjilal of IIHMR, presented the Sundarbans Health Watch, which asks 'how healthy are the children of the Indian Sundarbans?'. The study is based on intensive surveys conducted in the Patharpratima Block of the Sunderbans and throws light on some alarming – and largely ignored – facts about the health status of the children of the Sundarbans. It also attempts to explore the 'structural holes' in the service delivery of public health care system and the role of informal providers in filling the gaps.

While the vigorous reproductive and child health care initiatives of the state have been able to protect the rights of children and their mothers to obtain preventive health care (such as, immunisations, ante-natal care, etc.), there are glaring gaps in addressing their rights to easily access quality-assured basic curative care and nutritional services. Repeated climatic shocks and geographical adversities, especially in the remote islands, add to the complexities and make it imperative for the local policy actors to adopt a special child-focused lens to fill in the gaps and reach the hard-to-reach children.

Key findings (which can also be viewed as an infographic) of the study include:

• More than one-third of the children are chronically malnourished. More than one-third of the mothers are also malnourished.
• Children of the Sundarbans face an extra burden of morbidity, with data suggesting that 0.3 million children will be ill in a month and 26,000 children will need hospitalisation in one year in the Sundarbans.
• Prevalence of respiratory infection or gastrointestinal disorders among children is much higher in the Sundarbans than the district or state average.
• A quarter of the children (of surveyed households) aged 0-12 months took birth and spent the first week of their lives without any medical supervision from any health worker.
• The available public health care system is grossly inadequate to maintain child health. Primary Health Centres (PHCs) are not only less available, but many of them run ineffectively with shortage of critical inputs.
• Given the failure of the public health care system to cater to child health care needs, a parallel market has cropped up to bridge the huge gap in the curative care market. Unqualified RMPs dominate this parallel market, which is, obviously, a potential threat to child health. But this scenario also offers an opportunity for the government to challenges these sector through training and other innovative strategies.
• 85 per cent of the outpatient treatment for ailing children is provided by the Rural Medical Practitioners (RMPs) of questionable quality.
• There are many NGO initiatives but too few focusing on child health.

Following the report launch, Terres des Hommes presented on their efforts to combat child malnutrition in disaster prone blocks and convergence with state led Integrated Child Development Services. The Child in Need Institute, a national level implementation NGO, also put forth their initiatives for addressing malnutrition. CRY argued for a child rights approach in addressing child health, while Save the Children called for linking up livelihood and health initiatives especially in climatically challenged zones. The Riddhi Foundation called for an effective and judicious usage of information and communication technologies (ICTs) both in ascertaining the demand and supply of health services in disadvantaged regions for betterment of child health.
Based on these presentations, the former Additional Chief Secretary, M. N Roy, called for close collaboration of the panchayat and the health system for effective delivery of the health services to the children of the poor families in the Sundarbans islands. Additionally, Dr Abhijeet Choudhur, the founder of the Kolkata chapter of Liver Foundation, called for training of the rural medical practitioners (RMPs).

Participants in the meeting agreed that, to improve the lives of children in the Sundarbans, a series of initiatives engaging all types of service providers and innovatively putting pieces of interventions together was required. These initiatives need to come together to create a big push and reach a sustainable, equitable and high level of delivery system. Participants insisted that the time has come to acknowledge the uniqueness of the health care needs of the complex, climatically vulnerable, topographically challenged and economically underperforming region called the Sundarbans and focus on them with special attention.

There have been numerous media reports of the event. The Hindu, for example, notes that 'Sunderbans children highly susceptible to diseases, says study'. And several news organisations, including the Business Standard, carried the story 'Climate change affecting health in Sundarbans'.

Originally posted on the Future Health Systems blog