Children's Day: COVID-19 showed us glaring holes in the public health system that risk the health of our children

Over 100 children under five die every hour in India — that is one child’s life snuffed out every minute. India has among the highest rates of infant mortality and malnutrition. It also accounts for a third of the world’s stunted children according to the Global Nutrition Report 2018. Girls and children from the Adivasi, Dalit, Muslim and other marginalized communities are, particularly at risk.

This is not surprising given the state of public health in India.

Almost 50 percent of all deaths below five can be prevented by providing skilled health care at birth and quality postnatal care for the mother and baby. Despite undeniable, but gradual progress in addressing child nutrition, undernutrition continues to be associated with 50 percent of all under-five deaths.

India’s primary healthcare system is in disarray. There is a shortage of facilities, workers and other essential facilities, particularly in rural areas where the majority of Indians live. We face an 83 percent shortfall of paediatricians in the country which in turn effect the most vulnerable — the children.

At the heart of the problem is inadequate financing for healthcare. As Oxfam’s Commitment to Reducing Inequality highlights, India’s spending on public health is the fourth lowest in the world. This pushes people to pay for healthcare to survive. Almost 65 percent of the health expenditure in India is out-of-pocket, pushing 57 million people into poverty every year. India’s children and their mothers are a particular risk, particularly the poor. Maternal healthcare costs exceed the capacity to pay of all households in the poorest income group and 99 percent in the second poorest decile, compared with only six percent in the richest decile. This places new mothers and their children from poor families at high risk in cases of complication. India’s poor and marginalized communities bear the worst brunt of this system, to a large extent because discrimination and inequality are embedded in the system.

Risks from the COVID-19

The pandemic has been an economic, social and health shock that has not left anyone unaffected. According to the IMF, COVID-19 has pushed four crore people into extreme poverty in India. According to a report by the International Labour Organisation and the Asian Development Bank, nearly 4.1 million Indians have lost their jobs during this time. Loss of wages risks creating a loss of nutrients on children’s plates and restricting food choices available to the food grains provided through PDS and relief packages, assuming the family can access it. Families are less likely to be able to afford healthcare when they are in financial crisis. This would impact the very young and vulnerable, the hardest. In 2017-18, the economic shock caused by demonetization appears to have contributed to significant reversals in infant mortality. COVID-19 risks creating another similar setback.

The lockdown, furthermore, contributed to a severe disruption of healthcare services. Many of those that died were not impacted by the infection. Between Jan-May 2020, some 100,000 children died due to diarrhoea. Parents and health workers both found travel difficult amidst the lockdown. The result is an impact on healthcare delivery where access to routine healthcare was ignored, placing children’s health at risk. Thus, some early rapid surveys during the pandemic suggest that babies missed routine vaccinations because of travel restrictions or unavailability of health workers.

The closure of schools has put the nutrition of 115 million older children at risk. Research suggests that as much as 40 percent children may not be receiving midday meals despite government orders to ensure an uninterrupted supply. Similarly, the supply of food for even younger and more vulnerable children through the Anganwadi system was also impacted. This is unfortunate since for a majority of India’s youngest citizens, this has been the mainstay of their food supply, which should have been critical to sustain at the time of an economic crisis.

An additional impact is in terms of children’s own mental health. For children, the lockdown, distancing requirements, separation from their friends, the sense of social isolation and changes in routine have appeared arbitrary and inexplicable. The shift online for school education has added additional challenges for India’s children, especially those who are on the wrong side of the digital divide.

As if this was not enough, we are now also seeing the seasonal growth in pollution in Northern India. Last year, outdoor and household particulate matter pollution contributed to the deaths of more than 1,16,000 Indian infants in their first month of life in India. This year, COVID-19 and air pollution have formed a particularly toxic combination that places children’s lives doubly at risk.

Of course also the disease itself. Recent research highlights that children themselves can get COVID-19 infections and spread it; according to some studies, children and young adults in India account for the transmission in a third of cases.

Where do we go from here?

The pandemic is something of a teaching moment for everyone, highlighting the need for a robust public health system. While the pandemic continues to spread, it is critical for parents, children and teachers to take action to prevent the spread of the pandemic through ensuring distancing requirements and mask-wearing, among others. It is also important to ensure that proper health education is strengthened in schools.

However, in the long run, there is only one solution — investment in a more robust public health system that addresses the needs of the most vulnerable. India needs a stronger public health system, more doctors and public health workers and a stronger focus on prevention. It is also time for the government to legislate a Right to Health, making access to good healthcare a right for everyone particularly those who are young and vulnerable. It is no longer acceptable that the survival of young citizens in this youthful and rising superpower is dependent on their parents’ ability to pay.

The author works with Oxfam India in the field of education, health, and inequality. She also coordinates the Fight Inequality Alliance in India.

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Anjela Taneja