Gujarat health sector: A lurking rural-urban gap

By Rajiv Shah
Latest data of the Sample Registration System (SRS), operating under the Census of India, suggest that Gujarat suffers from a huge rural-urban divide in infant mortality rate (IMR) rate compared to most other Indian states. Statistics offered by the SRS Bulletin, finalized in September 2014, show that Gujarat’s rural IMR is 43 per 1000, as against the urban IMR of 22 per 1000, suggesting a whopping gap of 21, higher than 20 major Indian states, with the exception of Assam.
Interestingly, the gap remains high despite the fact that well-known experts have been pointing towards poor state of rural infrastructure in Gujarat for the last several years. Apparently, their voice is not being heard. The CEPT University’s Prof Darshini Mahadevia, pointed towards this in 2007, when she wrote that the main problem with Gujarat’s IMR was a very high rural IMR compared to urban IMR. “Other states have shown far better improvement in rural healthcare than Gujarat. This neglect of rural health and the rural sector in general is a reflection of the distorted development ideology being pursued by the state since a long period of time”, Prof Mahadevia had commented.
Prof Mahadevia, who co-authored “Gujarat Human Development Report 2004” – published by a Gujarat government body, Mahatma Gandhi Labour Institute, and carries a message from the then chief minister Narendra Modi – said, “The IMR improvement … in rural Gujarat has stagnated because of the continued high incidence of neo-natal mortality (NNM), which is death of infants within the first month of birth. The reasons for NNM are unsafe delivery and lack of vaccination for the newborn. These factors have to do with the primary healthcare system, which is the responsibility of the state government.” Instead of stressing on healthcare as its prime responsibility, she regretted, “Gujarat has privatised child birth facilities through the Chiranjeevi Yojana, but its success has not been seen in the tribal areas.”
In 2010, Prof Dileep Mavalankar, who was previously with the Indian Institute of Management-Ahmedabad, and is currently director, Public Health Foundation of India, Gandhinagar, noted that despite all the economic development in the state, the rural IMR remained high, and the main reason behind this seemed to be issues related with diarrhoea, which the rural health system in the state was “still not able to solve.” Then, last year, Smita Bajpai of the Centre for Health, Education, Training and Nutrition Awareness (CHETNA), Ahmedabad, which has worked in coordination with the Gujarat government on health and nutrition of women and children, said, woeful lack of medical facilities, particularly in the rural areas, was one of the reasons behind high IMR in the rural areas of Gujarat.
“Another reason”, she said, was lack of specialists. “Even if a family wants to get its new born baby girl treated they will most of the time have to travel long distance and even then there is no guarantee that a specialist doctor would be available. Most of the specialists are only available in district hospitals.”
Assam tops in the rural-urban IMR gap – it has 56 IMR per 1000 in rural areas as against 32 in urban areas, suggesting a gap of 24, and Gujarat and Rajasthan next, with a rural-urban gap of 21. While the all-India rural-urban gap is 17 (44 rural and 27 urban), much lower than Gujarat’s, the lowest gap is that of Kerala, just about four (13 rural and nine urban). Indeed, Gujarat’s poor rural IMR is pulling Gujarat away from achieving the UN Millennium Development Goal for IMR – 27 per 1000 in 2015. According to the United Nations Children’s Fund (UNICEF), only six states, “namely Kerala, Tamil Nadu, Maharashtra, Punjab, Himachal Pradesh and West Bengal, are likely to achieve the goal by 2015.” Clearly, Gujarat does not figure in the list, thanks mainly to poor rural IMR.
Gujarat officials have noted a huge success in reducing IMR during the last decade – reaching 41 (rural plus urban) in 2011 from 60 in 2001 (see HERE). While this improvement may be laudable, what it fails to note is the continuing rural-urban gap. Indeed, inter-state comparison suggests that Gujarat is one of the best performers as far as urban IMR is concerned, ranking fourth among 20 major states – the SRS Bulletin data show, as many as 15 other states have a higher IMR than Gujarat’s (22 per 1000). The best performing state in urban IMR, according to the SRS, is Kerala (nine), followed by Maharashtra (16), and Tamil Nadu (17). Uttarakhand equals Gujarat with 22 IMR per 1000. The worst performers are the so-called Bimaru states with Chhattisgarh, Odisha and Uttar Pradesh each having an urban IMR of 38. Clearly, urban Gujarat has already more than achieved the UN’s Millennium Development Goal.
However, it is the rural IMR which should the main concern of the state’s policy makers. While here Gujarat performs a little better than the national average (Gujarat’s rural IMR is 43 per 1000 as against the national average of 44), this should not be any consolation. Two Bimaru states, Bihar and Jharkhand, significantly, beat Gujarat showing a better performance on this score. In fact, at 43 IMR per 1000, Gujarat ranks No 11, and is placed worse than as many as 10 major states out of 20. These are Kerala (13), Tamil Nadu (24), Maharashtra (29), West Bengal (32), Karnataka (34), Uttarakhand (34), Himachal Pradesh (35), Jharkhand (38), Jammu & Kashmir (39), and Bihar (42). Thanks to poor IMR of its rural areas, the overall IMR (rural plus urban) of Gujarat is pulled down to 36 per 1000, which is worse than seven other states.

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