In India, 42.5% of children are underweight for their age, only 38.7% of mothers give birth in a medical institution and only 43.5% of children are fully immunised. For socially excluded groups these figures are much worse. PACS has been working to increase the knowledge and ability of socially excluded groups to access and monitor quality, non-discriminatory health and nutrition services.
Why is health and nutrition an issue for socially excluded groups?
Most health and nutritional indicators show that socially excluded groups have a lower quality of health in comparison to national averages. For example, whilst 42.5% of Indian children are underweight for their age, this figure is 43.1% for girls, 47.9% for children from Scheduled Castes and 54.5% for children from Scheduled Tribes.
The reason for this disparity in health and nutritional standards is multi-faceted:
For women, India ranks second from bottom for women’s health and survival in the 2014 Global Gender Gap Survey, coming 141 out of 142 countries. Only 52% of women access ante-natal care and for every 100,000 live births, 767 mothers die. Other health and nutritional indicators – such as body mass index and under-5 mortality rate – show that men and boys are better off than women and girls. This is, in part, due to the cultural preference (and therefore better treatment) for boys.
In Scheduled Caste (SC) communities, under 5 mortality is substantially above the national average – 88 out of 1000 children from SC groups die before their 5th birthday, whereas the national average is 74 out of 1000. This is due, in part, to the fact that health workers are usually from higher castes and often deny SCs (dalits) treatment or refuse to touch them due to their historical status as “untouchable”. If treatment is provided, quality of care is often poor and unacceptable attitudes are frequently encountered.
Under 5 mortality for Scheduled Tribe (ST) groups is also substantially above the national average: 96 out of 1000 children from ST groups die before their 5th birthday (the national average is 74). This is due, in part, to the fact that tribal communities often live in remote areas making access to healthcare institutions difficult. Language barriers also make it difficult to interact with health workers and a lack of understanding and education make tribal groups wary of accessing modern medicine.
The 2006 Sachar Committee report noted that the level of service provision, including water, sanitation, and public health facilities, were in short supply in Muslim areas. Indeed, only 36.3% of Muslim children are fully immunised (in comparison to the national average of 43.5%) and only 33% of women have institutional deliveries (the national average is 38.7%).
Many of the major causes of disability in India are preventable, caused by a lack of sufficient and accessible health care services. For example, many people have a physical disability caused by polio – a now treatable virus. As well as a lack of access to health institutions, there is also a lack of health resourcing spent around disability, especially on mental health.
One common factor for all the socially excluded groups is the discrimination that they face as a result of their social identities. Whether it is caste, ethnicity, religion, gender or disability, the negative connotations that pervade in Indian society affect their access to health and nutrition services and, ultimately, this leads to poorer health and nutrition for these groups.
What work has PACS done on health and nutrition?
PACS has been working on the theme of health and nutrition with 41 Civil Society Organisation (CSO) partners in all seven PACS states. Projects have specifically focused on the following three government schemes:
Increasing the number of Below Poverty Line (BPL) households registered for and accessing RSBY health insurance services.
What impact has PACS health and nutrition work had?
351,181 children received their full entitlements to nutrition under the ICDS scheme.
5431 Anganwadi ICDS Centres were supported to function more effectively.
240,713 women were supported to give birth in an institutiton under JSY (or similar State-level maternal health schemes) and 209,314 of these women received full benefits (such as ante-natal and post-natal care).
2424 RSBY Mitras have been trained to help BPL families to understand and access their right to health insurance under this scheme.
7491 training and sensitisation events have been held on the subject of health and/or nutrition, attended by a range of people including PACS partner staff, government officials, the media and CBO members.
2830 advocacy meetings have been held with government officials and other stakeholders on the subject of health and/or nutrition, leading to 175 recommendations on health and nutrition being proposed.