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The victory over birth-related tetanus owes more to a systems approach than to scientific innovation


August 29, 2015 12:19:53 am

With two landmark achievements in less than two years, public health in India appears to have hit a good patch. In March last year, the WHO declared India free of polio. Now, the prime minister has announced the banishing of another great scourge — maternal and neonatal tetanus (MNT), which used to kill close on two lakh newborns every year in the last decade. Significantly, both successes owe to systems rather than scientific innovation. The polio eradication programme is a global initiative led by the WHO. Its success in India, which last reported a case in 2011, is the result of the cumulative work of a legion of health workers, educators, activists and government staffers, working for over two decades in the oral polio vaccine programme, which was run as efficiently and diligently as an election or a census, and vaccinated 172 million children under the age of five. It was a social rather than medical project, in the sense that the children administered the oral vaccine were not themselves completely protected from polio, but over time, the community as a whole was rendered immune to the disease.

India has been rid of MNT by the National Health Mission using a similar strategy that focused on the administration and delivery of health instead of relying on technical innovation. Pregnant women were given tetanus toxoid, but other measures aimed at behavioural change. Cash incentives for delivery in formal health facilities ensured the basic guarantee of sanitation barriers, the aid of trained attendants and the possibility of referral to better-equipped centres, if necessary. At the same time, a strong communications programme discouraged unhealthy practices involving the care of the severed umbilical cord, which was a frequent source of infection.

This victory over an old killer is also an equaliser, since MNT struck the most vulnerable families — poor, illiterate, unaware of basic preventive health practices and without access to formal health services. A study released by the medical journal Lancet in early August had shown that the death rate in India increases with the distance that patients have to travel to the nearest health centre. That access to healthcare increases the quality and expectancy of life was always known anecdotally. Significantly, while announcing the end of MNT, the PM had also drawn attention to 184 districts with the poorest health outcomes. Indeed, district-level infrastructure development, skilling and outreach could power the next wave in healthcare.

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