A healthy record

WHEN the Left Front assumed office in West Bengal in 1977, its priorities were land reforms, rural development and democratic decentralisation. Although health and education were considered important, they were not regarded as the immediate priorities. Once the rural economy was revived through major land reforms, it was realised that greater attention would have to be paid to the important human development issues of health and education.

In the last 24 years of Left Front rule, there has been a substantial improvement in the health status of the population as seen from indicators such as death rate, infant mortality rate (IMR) and nutritional levels of the people. While the death rate declined from 11 in 1981 to 7.1 in 1999, the corresponding figures for India for the same period were 12.6 and 8.7 respectively. Among the major States, only Kerala had a lower death rate in 1999. The IMR in West Bengal declined from 91 (all India figure - 110) in 1981 to 52 (all India figure - 70) in 1999, making it occupy the third position along with Tamil Nadu, just behind Maharashtra at 48 and way behind Kerala at 14.

An important aspect of these improvements is that much of it took place in rural areas. In 1981, the rural death rate was nearly double the urban, and the rural IMR more than double the urban. In 1999, the rural and urban death rates were 7.2 and 6.8 respectively. The corresponding IMRs for the same period were 55 and 40. While the birth rate in urban areas declined from 33.2 to 20.7 between 1981 and 1999, the rural rate declined from 37 to 22.9 in the same period.

These improvements and the increase in expectation of life at birth have much to do with policies outside the heath sector such as land reforms which have increased the purchasing power of the poor and enabled them to improve their nutritional levels. However, health policies have also contributed to these achievements, especially the expansion of rural public health infrastructure. Yet West Bengal lags behind Kerala and Tamil Nadu in respect of several health indicators. For instance, in 1996 only 35.9 per cent of all deliveries were performed in a medical institution in West Bengal, while the corresponding figures for Kerala and Tamil Nadu were 97.1 per cent and 64.7 per cent respectively. If one looks at the proportion of all deliveries attended to by a doctor, a nurse or trained birth attendant, West Bengal performs poorly with a figure of 49.5 per cent (Kerala - 98.9 per cent and Tamil Nadu - 85.6 per cent), which is even behind the all-India average of 53.7 per cent.

The Left Front government is clearly seized of these issues and has made health a priority area of attention. Talking to Frontline, Dr. Surjya Kanta Mishra, Minister in charge of Health, who has had an outstanding record as Minister for Panchayats and Rural Development in earlier Left Front Ministries, indicated the priorities of the government in the field of health (see interview). The first priority was decentralisation by involving the rural and urban local bodies. A decision regarding handing over the health centres and hospitals to local bodies along with staff and funds would be taken after examining the technical and legal aspects and looking at the experience of States such as Kerala, he said. However, Mishra said that the basic idea was to implement the slogan of "community's health in community's hands" and to ensure the direct involvement and participation of people in running the health system.

Another plan was to provide some degree of autonomy or latitude to hospitals day-to-day management by putting in place democratically constituted managing committees. These committees may be vested with the power to collect user charges from non-poor users and use the proceeds to improve the facilities. Some may even be authorised to take bank loans for upgradation and repay by collection of charges from users of the upgraded equipment and facilities. Such charges would have to be modest and less than the market rates. A third aspect of health policy under consideration was that of measures to ensure accountability at all levels. There was also an urgent need to strengthen the public health infrastructure.The Minister indicated that initiatives to increase the annual output of trained medical personnel involving non-government players and private sector could also be explored, but not at the cost of making health less accessible to people.