25 Jan, 11 | by BMJ Group
In 1945 my father had just been released from prison after taking part in India’s freedom movement and wanted to travel to the US to study economics. One week before he was due to leave he went to see Mahatma Gandhi and asked for his blessing. The old man looked at my father for a few seconds and then uttered just one sentence: “If you want to study economics go to the villages of India.” My father quietly left and tore up his travel documents and admission papers. Within a month he was living in a village in the same district. Forty years later when my wife Rani and I returned to India from the US as trained public health doctors, Mahatma’s words were still ringing in my ears: “Go to the villages of India” and that is exactly what we did. We selected a poor, remote district, Gadchiroli, for our life mission and named the small organisation we started “SEARCH.” We were literally searching for the path.
What we saw and heard when we went to the tribal villages of Gadchiroli was that many children were dying within days and months of being born – and the majority of them from easily treatable illnesses like pneumonia, diarrhoea, and infections in low birth-weight babies. The story is the same in villages across the globe; every day newborn babies are dying, 3.6 million every year, because their parents live in a health care desert, too far away from the nearest clinic or without properly qualified health workers to support and guide them.
But in our small corner of India we have proven that by educating and working with the local people there is a way to save children’s lives that doesn’t involve hospitals or expensive equipment, or even doctors or nurses, just ordinary women who are mothers themselves who, after training, can provide basic care, treat urgent life-threatening illnesses and advise mothers in their village to get further help when really necessary.
When we introduced this home-based newborn and child care model in targeted villages in the 1990s everybody laughed. For 20 years the World Health Organisation had been advocating hospitalisation for sick newborns and whilst hospital is the best place for seriously ill babies to receive medical treatment, there was no real alternative for mothers living in remote, rural areas, hundreds of kilometres from even the most rudimentary health care facilities, not to mention the fact that in some cultures and traditions, it is simply not acceptable for women to go to hospital.
We trained 39 women, one from each village, with the only proviso that she had to be literate and a mother herself. Every two weeks a doctor would visit the villages to supervise the women’s work. Our home-based newborn care – which cost $155 (approx £100) per village to set up and $118 (approx £75) to maintain per year after that – lead to a 62% reduction in neonatal deaths in just three years.*
While the overall infant mortality rate (IMR) in India remained high, in our 39 villages, from the baseline rate in 1988 of 121 infant deaths per 1,000 live births, our approach reduced the figure to just 30. Now the Government of India has decided to roll out the approach in hundreds of thousands of villages, it is being introduced in other countries across Asia and Africa, and the World Health Organisation, UNICEF, US-AID and Save the Children endorsed the approach in 2009.
Ten years ago world leaders made a historic commitment to reduce child mortality by two thirds by 2015. As time runs out, it is clear that without concerted effort the Millennium Development Goal (MDG) will not be met and India’s role in achieving it is crucial. With the highest number of absolute child deaths in the world, the world will fail if India does.
On Monday, Save the Children launched an ambitious campaign to dramatically reduce the number of children who die every year before the age of five – currently more than eight million. The aid agency, which has supported the spread of our work for a decade, is calling for more funding for trained health workers and investment in essential healthcare that is free at the point of use. As we have proven in Gadchiroli it is not a technological breakthrough that is needed, but real commitment, training, support, and expertise. This can only be delivered across India and around the world with a real political will and support for saving children’s lives.
*Figures from 2001 to 2003
Competing interest: Save the Children has funded Abhay Bang’s work for the last decade.
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