India’s main public health programs, aimed at millions of rural poor, have been in disarray for months because the government changed the way that over $1.3 billion in federal funds were distributed, according to data and letters seen by Reuters.

In a bid last year to give India’s states more power, the federal health ministry started sending funds for public health programs to state treasuries, instead of direct transfers to its regional arms.

But poorly-run regional bureaucracies were unable to cope and both the flagship National Health Mission (NHM) and India’s AIDS prevention programs suffered – thousands of health workers were not paid for months and the construction of clinics in rural areas was delayed.

In some cases, state governments temporarily used the funds earmarked for health programs to meet needs of other sectors, health officials said.

The funds involved amounted to about one-third of the total federal spending on health, and led to further deterioration in India’s tattered public health system.

Eleven letters obtained by a Reuters reporter under India’s Right to Information Act revealed the health ministry’s desperate, and failed, attempts to push states to release funds to NHM arms.

The decision last year to route many payments through states, launched by the previous Congress party-led government, affected other sectors as well, but the impact on health programs has been glaring.

India spends just 1 percent of its GDP on public health, less than Afghanistan and Sierra Leone. On Saturday, the federal government increased the annual budget for its main health department by just 2 percent to $4.8 billion.

Still, India struggles to spend all of its allocated health funds because of an inadequate number of doctors and hospitals, and bureaucratic bungling. Data shows the government has only once spent all of its health budget since 2005.

Since April, the federal government has sent more than $1.3 billion to the states for the NHM, which undertakes treatment of diseases such as tuberculosis and malaria, construction of rural health centers and immunisation drives.

No state treasury released the funds to the designated health societies within a stipulated 15-day period, with delays running into months in some cases, according to government data seen by Reuters. More than $180 million is still to be released.

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Several NHM officials interviewed by Reuters said the state health units were deprived of funds for months. Salaries, training and building new clinics were hit.

In the northern state of Jammu and Kashmir, 9,000 health workers have not received salaries for three months and cash incentives for women who give birth in a government hospital have been withheld, said Yash Pal Sharma, the state’s director for the NHM.

Treasuries in the north-eastern states of Meghalaya and Mizoram held NHM funds for 151 days and 79 days, respectively, data as of Feb. 22 showed. In India’s third-largest state Maharashtra, funds sent in June reached the health society in December.

“Outreach programs have been severely impacted,” said a health ministry official in New Delhi. “The entire system has been paralysed, bureaucracy has become bureau-crazy.”

India’s AIDS prevention drive, a program separate from the NHM, was also affected by the new payments system. Workers from high-risk groups, such as sex workers and injectable drug users, who are employed to run programs within their communities are quitting because of irregular pay.

Rama, a project manager in one such community-based program for sex workers in Mumbai, said 17 of her 23 team members have quit because of delayed salaries. New people hired will take months before they can efficiently run the program.

“It takes a lot of time to build trust within our communities. Our HIV testing numbers have fallen by half because sex workers don’t trust new people,” said the 26-year-old, who says she moonlights as a sex worker herself to survive.

India runs more than 1,800 community-based programs for AIDS prevention. The World Bank has estimated India’s policy of targeting sex workers to control AIDS would avert three million infections during 1995-2015.

Government data showed that India’s National AIDS Control Organisation released $67 million to state governments in recent months as a second installment for the overall program, but only $39 million reached its state-level health societies. The first installment of $78 million was released by state treasuries after months of delays.

http://www.stuff.co.nz/world/asia/66911772/indias-health-programs-dented

Her first child survived eight months before succumbing to pneumonia; her second was stillborn; her third, delivered in a rickshaw, gasped for an hour before dying.

When she got pregnant for a fourth time, Juhi, a woman from a South Delhi slum who uses only one name, was spotted by a local health worker and taken to a mobile clinic. A doctor diagnosed severe anemia, gave her iron pills and begged her to eat more.

Juhi listened, and gave birth to a boy, Muhammad Sultan, who has survived his first birthday — a huge milestone in a country with about one-sixth of the world’s population but one-third of all newborn deaths.

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A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the world’s poorest countries. Poor sanitation and a growing tide of drug-resistant infections also affect nutrition.

But an important factor is the relatively poor health of young Indian women. More than 90 percent of adolescent Indian girls are anemic, a crucial measure of poor nutrition. And while researchers have long known that Indian mothers tend to be less healthy than their African counterparts, a new study published Monday in the Proceedings of the National Academy of Sciences demonstrates that the disparity is far worse than previously believed.

By analyzing census data, Diane Coffey of Princeton University found that 42 percent of Indian mothers are underweight. The figure for sub-Saharan Africa is 16.5 percent.

Ms. Coffey calculated that the average woman in India weighs less at the end of her pregnancy than the average woman in sub-Saharan Africa did at the beginning, an astonishing finding.

“In India, people are richer, better educated and have fewer children than those in sub-Saharan Africa, so it’s really surprising that Indian children are shorter and smaller than those in sub-Saharan Africa,” Ms. Coffey said in an interview. “But when you step back and look at the state of Indian mothers, it’s not such a surprise after all.”

Research has shown that genetics play no role in the size differences, leaving environmental factors as the only explanation, Ms. Coffey said.

The reasons for Indian mothers’ relatively poor health are many, including a culture that discriminates against them. Sex differences in education, employment outside the home, and infant mortality are all greater in India than in Africa.

“In India, young newly married women are at the bottom of household hierarchies,” Ms. Coffey said. “So at the same time that Indian women become pregnant, they are often expected to keep quiet, work hard and eat little.”

Mothers also suffer from the same sewage-borne infections that so often kill their babies, made endemic by the primitive sanitation in much of the country, Ms. Coffey said.

“It is likely that infectious disease is responsible for a signification portion of India’s pre-pregnancy underweight problem,” she said.

Dr. Shella Duggal, Juhi’s doctor at the mobile clinic, said that almost every pregnant woman she treats in her visits to Delhi’s slums is severely anemic. Parasites, spread by poor sanitation and dirty water, are a crucial reason, she said.

“So the first thing we do is deworm them and give them iron supplements,” Dr. Duggal said. “And then I tell them to eat.”

It is a prescription many of her patients find difficult to carry out, she said.

“These mothers are the last persons in their families to have food,” Dr. Duggal said. “First, she feeds the husband and then the kids, and only then will she eat the leftovers.”

http://www.nytimes.com/2015/03/03/world/asia/-pregnant-women-india-dangerously-underweight-study.html?_r=0

MALNUTRITION kills 3.1million young children every year – equivalent to one every 10 SECONDS – according to the latest shocking figures. 

Almost half of the 6.3 million worldwide deaths of children under five can directly be linked to having inadequate nutrition. 

That figure is more than the entire population of Wales yet shockingly experts say there IS enough food to go around – it just doesn’t go to everyone. 

Poverty, a lack of appropriate healthcare and education – and often a lack of political will – are among the reasons why innocent children are needlessly dying.

…

“It is rare people actually die of starvation – which is a complete lack of food like the famine in Ethiopia. But they do die of malnutrition.”

The appalling statistics emerged as world leaders recently met to pledge extra money and support for the silent killer. 

Ms Prinzo said it should theoretically be possible to wipe out mortality from malnutrition within a generation but it needs a more targeted approach by governments and aid agencies. 

“We are talking mortality here and that should be the aim for sure,” she added. “We will never reach zero for malnutrition but we have to reach zero mortality. We have to aim that children are not dying.”

Fabricating test results after dumping blood samples in the sink. Stitching up the cervix of pregnant women on the pretext of preventing miscarriage. Labeling healthy people as having diabetes.

When it comes to health providers duping patients to fatten their wallets, Dr. Arun Gadre, a gynecologist-turned-health activist in India, has heard it all, and then some.

Last year he interviewed 78 doctors from across India about the professional malpractice they’d encountered during their careers. His findings, while shocking to outsiders, were less of a surprise to Gadre.

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Details from the interviews appeared online February 24 in the BMJ, alongside two other papers on the lack of effective regulation and whistleblower protection in India’s chaotic health sector.

Most experts agree that healthcare fraud is rampant in the world’s largest democracy, with recent corruption scandals engulfing everyone from doctors to drug companies and health regulators.

Gadre’s work suggests that three types of malpractice are particularly common: kickbacks for referrals, irrational drug prescribing and unnecessary interventions.

One interviewee told Gadre that doctors typically get 30,000 to 40,000 Indian rupees (US$480-640) for referring patients for angioplasty. For perspective, many Indian health providers make less than US$10,000 a year.

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Gadre said that when he started practicing, physicians referred patients to him without expecting a cut. But that changed, and he began to lose business when he refused to pay up.

“As the medical sector became more and more commercialized, the same doctors started asking for commission and the number of patients who came to my hospital started to drop,” he says.

While kickbacks are illegal in India, they are nearly impossible to avoid, health providers say. Young doctors in particular, many with towering student debts, find it hard to survive without them.

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The health sector in India is largely private, and most people pay out of pocket. A 2011 study in The Lancet found that 39 million Indians fall into poverty yearly from medical expenses.

Another theme in Gadre’s interviews is irrational drug use. He tells of a girl who received steroids for red eyes from a homeopathic health provider. She later developed cataracts, a known side effect from prolonged use, and needed surgery.

Alternative practitioners such as homeopaths and Ayurvedic healers are common in India, and many people prefer them over doctors with a diploma in modern medicine. While not allowed to use modern drugs, in practice they do so with impunity, often encouraged by drug company sales representatives.

…

In the so-called “sink test,” the doctor orders lab tests despite not suspecting any medical problems.

“Only a few of the tests are performed, and the extra blood collected is dumped in the sink,” Gadre writes. “Fabricated results are given in the normal range for all tests that were not performed. The patient pays a large sum, which is shared by the referring doctor and the pathologist.”

Other examples include unwarranted C-sections and hysterectomies, he said, or cervical stitches based on false reports suggesting a pregnant woman might miscarry.

Although India’s public health centers are known to be understaffed and dysfunctional, Gadre and many public health experts believe privatization of medical services and education is at the root of the problems.

India’s filthy air is cutting 660 million lives short by about three years, according to research published Saturday that underlines the hidden costs of the country’s heavy reliance on fossil fuels to power its economic growth with little regard for the environment.

While New Delhi last year earned the dubious title of being the world’s most polluted city, India’s air pollution problem is extensive, with 13 Indian cities now on the World Health Organization’s list of the 20 most polluted.

That nationwide pollution burden is estimated to be costing more than half of India’s population at least 3.2 years of their lives, according to the study, led by Michael Greenstone of the University of Chicago and involving environmental economists from Harvard and Yale universities. It estimates that 99.5 percent of India’s 1.2 billion people are breathing in pollution levels above what the WHO deems as safe.

“The extent of the problem is actually much larger than what we normally understand,” said one of the study’s co-authors, Anant Sudarshan, the India director of the Energy Policy Institute of Chicago. “We think of it as an urban problem, but the rural dimension has been ignored.”

Added up, those lost years come to a staggering 2.1 billion for the entire nation, the study says.

…

For the study, published in Economic & Political Weekly, the authors borrowed from their previous work in China, where they determined that life expectancy dropped by three years for every 100 micrograms of fine particulate matter, called PM2.5, above safe levels. PM2.5 is of especially great health concern because, with diameters no greater than 2.5 micrometers, the particles are small enough to penetrate deep into the lungs.

The authors note, however, that their estimations may be too conservative because they’re based in part on 2012 satellite data that tend to underestimate PM2.5 levels. Meanwhile, India sets permissible PM2.5 levels at 40 micrograms per cubic meter, twice the WHO’s safe level.

…

India has a sparse system for monitoring air quality, with sensors installed in only a few cities and almost unheard of in the countryside. Yet rural air pollution remains high thanks to industrial plants, poor fuel standards, extensive garbage burning and a heavy reliance on diesel for electricity generation in areas not connected to the power grid. Wind patterns also push the pollution onto the plains below the Himalayan mountain range.

…

“Everything comes down to a lack of monitoring data in India,” said Guttikunda, who was not involved in the study. “If you don’t have enough monitoring information, you don’t know how much is coming out in the first place.”

India developed extreme air pollution while relying on burning fossil fuels to grow its economy and pull hundreds of millions of people up from poverty. More than 300 million Indians still have no access to electricity, with at least twice that number living on less than $2 a day.

While India has pledged to grow its clean energy sector, with huge boosts for solar and wind power, it also has committed to tripling its coal-fired electricity capacity to 450 gigawatts by 2030. Yet there still are no regulations for pollutants like sulfur dioxide or mercury emissions, while fuel standards remain far below Western norms and existing regulations often are ignored.

To meet its goal for coal-fired electricity, the Power Ministry says the country will double coal production to 1 billion tons within five years, after already approving dozens of new coal plants. That will have predictable consequences for the country’s already filthy air, experts say.

The coal expansion plans through 2030 will at least double sulphur dioxide levels, along with those of nitrogen oxide and lung-clogging particulate matter, according to a study published in December by Urban Emissions and the Mumbai-based nonprofit group Conservation Action Trust.

http://www.wiscnews.com/lifestyles/health-med-fit/article_39e5d127-bcc1-5f02-ac11-f5ecf7f98bea.html