logo.jpg (2912 bytes)
health_banner.jpg


     

July-Aug & Sept-Oct 2002
download.gif (450 bytes)
news_home.jpg
editorial1.gif
lead_story.jpg
briefs.jpg
book_review.jpg
campaign.jpg
letters.jpg
news_arcive.jpg
writetous.jpg
health_home.jpg
cse_home.jpg
join.gif
If you are interested in receiving the copy of the newsletter, do write to us. Join our nework.

 

 lead_story1.jpg (1699 bytes)

Department of Corrections
The problem arises in the way in which programmes and policies are designed in the absence of good data. All health programmes (except infectious epidemics) are target driven. So without knowing how large the problem is, targets and achievement indicators are set. Often a disease may be absent locally but yet work and effort made by the sub-centre and PHC needs to be shown. Take the case of tuberculosis. Policy makers thought that there could be no cooking of data because the treatment protocol involves close monitoring and effort from the health facility. Yet, the health centres need to show a designated number of people in a population. The health workers conduct X-ray examination of lungs, which may or may not be the conclusive tests for TB. In order to meet targets, even non-TB patients are accounted for as TB patients. In the case of leprosy any pale or non-sensitive patch of skin is treated for leprosy. In many states, there is an unwritten rule of not mentioning malaria and meningitis in any report. All these are termed as "fevers". These remain ignored and could arise from any cause like malnutrition, tetanus and heat stress. Health officials can be pulled up for malaria and meningitis deaths but not fever deaths. In Orissa, Chattisgarh and Bihar it is obvious that most "fever" cases are malaria and some meningitis cases. In a recent case in Thane, 20 tribal people died due to malnourishment and the district health authorities conveniently called these deaths as "fever" deaths.8

States too have their limitations. At one end, structural changes and conditionalities imposed by donors like the World Bank has frozen new recruitments and is asking state governments to reduce their large workforce. At another level, programmes have failed because reduced workfroce meant job cuts of grassroots workers which in turn has reduced programme effectiveness. Take the example of the World Bank sponsored Enhanced Malaria Control Programme (EMCP).9 It has suffered in meeting its objectives because in many critical areas, workforce was extremely limited or even absent.

Statistics and data are meaningful only if they are produced and reported, acted upon at the right time. Most data that is reported takes an extremely long time to pass from one desk to any desk, from one office to another, where files make tortuous journeys from district to state to the central offices. Time lag is often several years. How much can one rely upon this data is all a big question mark. Data is presented in the most unintelligent manner, often without any crosschecking and with absolutely no analysis. The Central Bureau of Health Intelligence depends upon the states to give them reports. Not all states send their reports on time. The CBHI seldom crosschecks with state offices, though states often questions district level data in case a certain anomaly is noticed.

All that matters in generating good meaningful data is who is collecting the data, who is using it and how well is it leading into programme strategies. If more immediate data like epidemics, especially those that are expected to occur in a region during a specific season are reported more intensively during a certain period, a better picture on the outbreaks can emerge and more prompt reporting can be made. The problem with outbreaks and epidemics is that they follow the usual course of reporting and lack absolutely any urgency in an emergency situation. In the recent Japanese encephalitis epidemic in Assam a report generated from the local Malaria Research Centre took more than 10 days before any assistance from the Centre could be sent.10 In Bangladesh, the Matlab programme, a community-based maternity-care delivery system, has been conducting long term population based assessments on diarrhoeal diseases found that on an average 3 per thousand people suffer from cholera and in peak season 9 per thousand contract the disease. This would mean that annually at least 300,000 people would suffer from cholera in Bangladesh alone. Yet the annual incidence report for June to August by the Bangladesh health authorities to the Weekly Epidemiological Record and Disease Outbreak News published by the WHO was zero cases of cholera.11,12

Long-term programmes like TB, leprosy and immunisation programmes need to look at trends, while the combination of short-term and long-term assessment need to assess the overall demographic picture. Based on this health facilities and infrastructure and budget need to be designed.

How good data helps
  • Improves efficiency in planning and control
  • Streamlines budget allocation
  • Gives a baseline for future planning
  • Costs only 5-7 percent of project budget
  • Helps prioritise vulnerable sections within the target population
  • Assists in integrating programmes with common goals

Strategies can evolve only when data is presented into information to forecast scenarios, based on which decision can be taken and programmes can be committed. The real shame is that despite famed statisticians and econometricians who set up institutes and chaired committees, they have failed to inspire bureaucrats, make simple formulae and workable methods for grassroots level workers. The Planning Commission, boasting of the finest mathematical minds, today is a organisation bungling outdated data, based on which it designs programmes and policies for ministries. The National Human Development Report-2001 released earlier this year is a prime example of regurgitating old meaningless data and basing policies upon it.13 With little or no data, funding and investment priorities get skewed.

Simply put, what cannot be measured cannot be accounted for, what cannot be accounted cannot be managed, and what is not managed cannot be controlled. Stronger collaborations across ministries can be made to do comprehensive assessments on poverty, land holding, income, food scarcity, nutrition etc., based on which vulnerable areas and populations can be mapped. Several opportunities to re-strategise the Indian health system exist with the government and civil society. The proposed Infectious Diseases Information Surveillance project by the World Bank can revamp data collection and statistics reporting with respect to infectious diseases.14 The AIDS programme is still in its infancy can resolve methods of estimating AIDS in India. Participation from civil society and communities can improve quality of data.

So right from birth, sickness, productivity and growth to death, almost everything is a guesstimate.

References

1. Sanjay Reddy and Thomas Pogge 2002, How Not To Count The Poor, discussion paper, Columbia University, New York, USA, www.socialanalysis.org, as viewed on June 14, 2002.

2. Peter Svedberg 2000, Hunger in India:Facts and challenges, in Little Magazine, The Gnome, Delhi, special issue on Hunger, Vol 10, No 15.

3. Nicholas Eberstadt 2002, The future of AIDS, in Foreign Affairs, November/ December.

4. Vibha Varshney 2001, Faceless Figures, in Down to Earth, Society for Environmental Communications, New Delhi, Vol 10, No 15, p 38.

5. Anon 2002, Health India Directory, Saffola Healthy Heart Foundation, Saroj Ojha, Delhi.

6. P Sainath 1998, Everybody Loves a Good Drought, Penguin Books, New Delhi.

7. Central Statistical Organisation (CSO), www.mospi.nic.in as viewed on August 10, 2001.

8. Pranay Lal 2001, Virus attack, in Down To Earth, Society for Environmental Communications, New Delhi, Vol 10, No 12, p 26.

9. The World Bank 1997, Project Appraisal Document on Malaria Control Project, Report No 16571-IN, South Asia Region, The World Bank, New Delhi.

10. Vas Dev Singh 2002, director, Malaria Research Centre, Assam, July 10, personal communication.

11. World Health Organisation 2002, Disease Outbreak News, issues January to September.

12. WHO Weekly Epidemiological Record, World Health Organisation, issues January to September 2002.

13. Planning Commission 2002, National Human Development Report 2001, Government of India, New Delhi.

14. The World Bank 2001, India-Integrated Disease Surveillance Project, South Asia Regional Office, The World Bank, New Delhi and the Ministry of Health & Family Welfare, Government of India, New Delhi, Report No PID10512, July 9.

Next Page Next Page | Enough to make you sick  1 2 3 4 5 6
past.gif (491 bytes)
 
CHILDREN AT RISK   ASTHMA   POVERTY, HEALTH AND ENVIRONMENT

email.gif