MINISTER of State for Health and Family Welfare Anupriya Patel concedes that hunger and malnutrition remain a “challenge” for India despite the government’s efforts to address the problem. As far as the health sector was concerned, she said the good times had arrived as several programmes, such as construction of 11 new hospitals on the lines of the All India Institute of Medical Sciences (AIIMS) under the Pradhan Mantri Swasthya Suraksha Yojana, were in the pipeline. Excerpts from an interview she gave Frontline :
The Global Hunger Index 2016 puts India in the “serious” category on the severity scale of countries affected by hunger. India ranks 97 in a group of 118 countries. Also, experts estimate that malnutrition, especially low body weight, is responsible for 50 per cent of instances of fatal communicable diseases such as tuberculosis (TB) in India. What strategy has the government adopted to address such severe malnutrition and hunger?
We understand that malnutrition and hunger still remain a challenge for India. In order to address the problem, we are involving various Ministries, Health being one of them. Hunger, poverty, malnutrition and TB form a vicious cycle; they are interlinked. They are the social determinants of health. Through the National Health Mission, we are providing iron folic supplementation for women, vitamin supplements for children, and calcium supplements for pregnant women and lactating mothers. Through the Food Safety and Standards Authority of India [FSSAI], we are laying stress on increasing the supply of micro-nutrients to the malnourished by way of fortification of food. The Ministry of Women and Child Development is also addressing the problem of malnutrition through the Integrated Child Development Services [ICDS] and the midday meal programme.
In the next National Strategic Plan envisaged for TB, we will encourage the States to provide nutritional support to the vulnerable population, including the tribal population. That way, we will be able to address malnutrition and hunger.
You recently spoke about controlling micro-nutrient deficiencies as an “essential part” of the government’s effort to fight malnutrition and hunger. Could you explain the thinking behind this?
A balanced diet has macro-nutrients, micro-nutrients, vitamins and minerals. We have identified five common foods consumed by the general population in India. They are wheat flour, oil, milk, salt and rice. We are going to fortify and enrich them. We are going to ensure that the manufacture, sale and consumption of these fortified foods are encouraged. The FSSAI has laid down the standards and we are giving a big boost to it so that we are able to overcome micro-nutrient deficiency and improve the nutritional status of our citizens. Most of the countries worldwide have adopted fortification of foods. We are giving a big push to this. It is safe and cost- effective and does not require too many changes in your food habits. There is no harm in it. We are encouraging it to address micro-nutrient deficiencies. We are targeting the poor and vulnerable sections—pregnant mothers and their children. We are trying to have a collaborative approach by which these fortified foods are introduced through the ICDS, the midday meal scheme and the public distribution system. That is the only way of reaching nutrition to the poor. All of this is in the planning stages.
A report released by the World Health Organisation (WHO) has said India has “the highest burden of TB disease in the world”. What efforts have been taken to tackle the TB epidemic?
This anxiety needs to be addressed. The WHO report says 27 per cent of the global TB burden is in India; we had 28 lakh patients in 2015 compared with 22 lakh in 2014. It says 1.3 million cases are multi-drug resistant [MDR]-TB cases. We should not worry about these figures because, this is not a real increase, this is an apparent increase. And why this apparent increase has taken place? Because, first of all, the revised estimates, we must understand, they are based on data, facts and figures provided by the Government of India. These figures show an increase because there has been better data collection and analysis by the Revised National Tuberculosis Control Programme [RNTCP]. Now, you may wonder how there is better data collection. That is because we took a lot of steps to ensure more reporting of cases.
One such step was that we made it mandatory for all the health care providers to notify TB cases. And, for this, we even have a Web-based notification system called Nikshay. So, these are some of the steps we have taken. Then there was greater private sector engagement. We actually adopted a model… this was universal access for TB control. And we started a pilot project in four cities—Patna, Mehsana, Mumbai and Nagpur. So when we adopted this model, we found the number of cases notified kept increasing. So, these figures that you are seeing are a result of better data collection and analysis. Actually, what has happened is that the incidence and mortality have both declined. So, you need not worry. Earlier, numbers were smaller because we could not collect; it was all hidden. Now we have collected more. If you are worrying that we are a nation with the highest burden of TB patients, then you need to know that we are a nation that is running the largest TB prevention control programme. No other nation has such a big programme.
The WHO TB report also mentions the necessity of progress towards universal health coverage to attain the Sustainable Development Goals (SDGs) for 2030. The Health Minister has mentioned the need for setting up a special task force to implement universal health care. How long will it take for the implementation of universal health coverage?
You have to understand that universal health coverage is a widely cherished dream of all countries. Everybody wants to have it. But this is not something that you can do overnight. It is a long-drawn process, it is a continuous effort. I think the WHO resolution was in 2005. All the countries came together on a platform to think and talk about it, monitor the progress. Now we have the SDGs and the Agenda 2030. One of the most important components of the SDGs is universal health coverage. It means that we are going to give affordable, accessible and quality health care to all our people. That means all the people must have all the essential health services, without bearing financial hardships. The National Health Mission is like the prime vehicle for universal health coverage. We have started a free drugs and diagnostics programme. Most of the States have adopted it.
Do you not think the challenges highlighted by these indexes in the areas of hunger, malnutrition and TB are impediments to the “acche din” (good times) the Prime Minister is promising?
When it comes to health, acche din have started coming. We have eliminated yaws, maternal and neo-natal tetanus. We have shown declining trends in infant mortality rate, maternal mortality rate and under-five mortality. What does all this signify? We are making a lot of progress. Under the Pradhan Mantri Swasthya Suraksha Yojana, we are doing two important things: building 11 new AIIMS hospitals and upgrading medical colleges in district hospitals. Soon, we will come up with a National Health Protection Scheme.
We will give insurance cover of Rs.1 lakh to every below poverty line [BPL] family and Rs.30,000 to every senior citizen in the BPL family. We hope to start this scheme in 2017. There is so much we are doing to address the shortage of doctors. We are going to run the tuberculosis prevention programme in a mission mode—the way we did with the pulse polio programme. We will focus on the involvement of the private sector. We will focus on active detection and identification of TB patients. A lot has been done, is being done, and will be done.
