Reviving confidence in health care

THE LATEST DISCLAIMER issued by the United Nations International Children's Education Fund (UNICEF) in the ongoing controversy over the alleged causal link between the world body's anti- blindness campaign in Assam involving the administration of Vitamin A and the deaths of 15 children besides sickness and nausea among thousands notwithstanding, the Government must take a close look at various stages of the sequence of events leading to the tragedy, principally with a view to restoring public confidence in vital health initiatives. The Centre's swift response in asking State Governments to suspend forthwith mass campaigns on Vitamin A nutrient and concentrate instead on routine immunisation programmes may indeed be appropriate considering that a vast administrative machinery is necessarily involved in largescale operations and this could render any corrective interventions especially challenging. Expediting the enquiry into the real causes behind the deaths of children in different districts of the State during the past fortnight is an important measure to set at rest fears among the public about the real and imagined risks of the pulse Vitamin dose. Additionally, particular emphasis should be laid on dispelling falsehoods regarding the fatal consequences of an overdose of Vitamin A. Toxicity and other harmful effects of an excessive dosage of Vitamins A and D is after all common knowledge and the lay public should be made aware of the likelihood of side effects in a small number of cases. The plain truth is that instances of nausea among over a thousand infants in a massive operation which reportedly involved twenty-eight lakh children is but a small percentage indeed. Spelling out these implications in plain terms may be inevitable in view of the fear psychosis generated following the mishap.

At a broader level, the unfortunate developments in Assam should lead policy planners in public health to rethink existing strategies of conducting the Vitamin A programme in the campaign mode. Perhaps, the UNICEF, which has been a longstanding partner in the Government of India's public health endeavours, should more seriously consider the wisdom behind official thinking which for sometime now has indicated a preference for incorporating the anti-blindness drive as part of regular immunisation programmes. The campaign strategy may, after all, not be the best approach for achieving diverse public health objectives. For instance, while the mass campaign mode may be an effective strategy in the case of immunising the public against a communicable disease such as polio, administering Vitamin A, which has inherent risk of side effects is probably better achieved through primary health care delivery mechanisms.

The stakes for Indian society in ensuring the success of public health initiatives in the areas of polio immunisation or the battle against malnutrition are indeed immense. Whereas the pulse polio campaign has run into rough weather in recent years, Vitamin A deficiency continues to be a critical factor behind the onset of blindness among children and India accounts for a high percentage of the world's population partially or totally impaired in vision. Viewed in this overall light, public perceptions regarding the state of health care delivery, as well as the effectiveness of specific health-related objectives in India, may warrant improvement rather urgently.

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Section  : Opinion
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