Without fanfare, polio may have been defeated in India. January 12th 2012 marked the anniversary of the last diagnosed case. Polio remains endemic in Afghanistan, Nigeria and Pakistan and so India is at risk of the reintroduction of the virus unless everyone is immunised.
When I visited Delhi four years ago as a member of a group advising the Indian government, a task force of 300,000 immunisers were converging on the north-east quadrant of the country where several hundred residual polio cases occurred each year. Consuming half the world’s polio vaccine, India, as reported by the World Health Organisation, requires nearly a billion doses of oral polio vaccine annually to vaccinate more than 170 million children under the age of 5. By this means it is possible to achieve what the epidemiologists call, rather infelicitously, herd immunity. If the vast majority of the population or ‘herd’ are immune, even an isolated case will cause no great damage because it cannot spread to non-immune people.
Three other mighty achievements impressed me when I revisited Delhi in February as part of the same advisory panel reviewing progress with improvement in maternal and child survival. They made up for a dismal season of cricket.
First, while the all-India death rate of mothers in childbirth remains at the tragic level of 212 per 100,000 births, and infant mortality is about 47 per 1000 births, there are marked improvements. The statistics have limited accuracy, especially when collected in poorer regions, but most states have progressed in the past five years albeit with stasis or even regress in the poorer north-east, such as in Assam and Uttar Pradesh.
Five years ago, the concept was gaining currency for the deployment of unpaid married women of standing in rural villages to be trained as social health workers. http://mohfw.nic.in/NRHM/asha.htmTheir task was to help young pregnant women seek care for obstetric problems and to encourage them to deliver in or near a health care facility capable of saving life from post-partum haemorrhage. Each social health worker would receive two weeks of very basic training and be given a mobile phone for calls for help to be received and sent. No big deal, the phone, as there are about 900 million of them in use in India today compared with next to none in 1996.
Training social health workers in Chittagong
There are now 800,000 of these women at work. Of course there are the tongue-clickers who wish to see these women paid, trained in primary care and generally promoted, and in time that career pathway may develop. But for the moment, in a country where 300 million people live in poverty and where the government spends less than 2% of GDP on health, this service is much better than nothing, especially where no medical help is available locally and emergency transport is erratic. The women gain kudos and some skills they can build on and maternal and infant mortality falls.
Second, and equally amazing, is that serious plans are afoot to provide universal health insurance. As with Mexico, Thailand, China and Brazil, India is well on the way to government-funded universal cover. A distinguished medical friend and former colleague, Dr Srinath Reddy, a cardiologist who cares for the heart of the prime minister, was appointed chair of a group to formulate the proposal. Already several of the more affluent states are removing the financial and political barriers to basic and essential care for over one billion Indians would be an astounding achievement. Read more at http://www.lancet.com/journals/lancet/article/PIIS0140-6736(10)61960-5/abstract
The third astonishing I learned this year is that India now has an electronic data base for more than 100 million of its citizens and is moving rapidly to expand. Finger and retinal prints are computerised. A person is assigned a 12-digit number, the first official proof that he or she exists. As The New York Times reported, each citizen ‘can use his or her 12-digit identity number, along with a thumbprint, to identify him or herself anywhere in the country. It will allow him or her to gain access to welfare benefits, open a bank account or get a cellphone far from his or her home village, something that is still impossible for many people in India.’ See
A migrant farm worker has fingerprints photographed and peers into an iris scanner in New Delhi in the first effort to officially record each Indian's identity as an individual.
Employers looking for cheap labour must now identify their employees thus reducing the likelihood of them claiming for people on their payrolls who do not exist.
The capacity to link this massive data base through India’s ever-expanding sophisticated ITC network to assess changing health status in the country is exciting.
Mr. Tendulka may have to wait to score his 100th century, but his nation is heading steadily against immense odds towards a very healthy score.
*Previously published in AusMed
