Substitutes for action

Updated: Jul 27 2006, 05:30am hrs
In our comment in these columns on Tuesday on 15 years of reforms, we had pointed to inertia and lack of leadership in decision-making, especially in administrative systems, as restrictive factors. A case in point is the news report on the state medical department in Rajasthan having decided on a detailed audit to find why the maternal mortality rate (MMR) is so high. This is bizarre. In India, a woman dies every five minutes from a pregnancy-related cause; the country contributes a fifth of global maternal and child deaths. And Rajasthan has been close to the top of this melancholy list for decades. The subject has been analysed exhaustively, repeatedly: there is, after all, little left to be known on what to do to prevent such deaths. The MMR variation in India itself is huge, with Kerala and Punjab at one end and others like UP and MP at the other; Rajasthan comes somewhere near the UP end. What is it that Jaipurs medical department expects to unearth now

Given that lack of education, access to skilled healthcare and lack of nutrition are key factors in reforming this state of affairs, what the state machinery should be focussing on is clear. The state health minister has said the idea is to form district-level panels, including NGOs, media and panchayat representatives, to study the problem to ensure complete and transparent information. His department says district officials routinely cloak MMR figures for fear of adverse action for failing to prevent such deaths. Why not have a monthly report from panchayat panels on the functioning of primary health centres And on the formally ongoing programme to train midwives to perform clean deliveries

It hardly needs to be added that these reports have to be treated seriously to warrant prompt action; there is no absence of media information or village complaints on poorly-functioning PHCs, for instance. This isnt a problem for the medical department alone to solve: roads, transport and education offices need to be equally involved. If the state machinery is serious on remedial action, it doesnt have to wait for more reports.