Malnutrition: Reality behind Govt Health care services...!!!

When the Maharashtra government first recorded the figures of child deaths due to endemic malnutrition in the remote villages of Melghat, shocking numbers were revealed.

Almost two decades later, even though the government figures show a substantial drop in the number of malnutrition deaths, social activists and health-coordinators working in the impoverished area say that the authorities pass off such deaths as still-births.

The reality continues to bite with the data recorded just before monsoon this year, indicating 509 malnutrition induced deaths during past year, until March 2011. Every year, hundreds of children of Korku tribe in the tehsils of Melghat in the Satpura ranges fall prey to starvation and malnutrition. While the government records indicate figures ranging from 400-525 in the last five years, health activists working among the tribals tell a different story.

Madhukar Mane, Health Coordinator with NGO Maitri, which organises monsoon campaigns to prevent deaths in the precarious season, says: "The figures are certainly better than the late 90s but the numbers are still very high in the tehsils of Dharni and Chikhaldhara. Government records child deaths under two categories: still birth and neonatal. What happens is that they write off several deaths as still births so that the infant mortality rate (IMR) could be kept under check.

Maximum child deaths occur during monsoons as the tribals are not able to work and feed their children. Ironically, most government schemes are launched after the monsoons.

About 50 per cent families in Melghat are below poverty line with a high rate of unemployment. Weak mothers often deliver children in grade 1 malnutrition.

It almost instantly deteriorates to grade 2, and then 3 & 4. The nearest emergency health care is about 120 km away that too without a child specialist or medical equipment. About 39 children are suffering from grade 4 malnutrition while 442 fall under grade 3 here.

Jayashree Shidore, coordinating activist with Maitri, says: "Children with a sunken face and a bloated stomach is a common sight in Melghat." Maitri is helping such kids by imparting basic health education, especially to nursing mothers, and lessons in personal hygiene.

 
Malnutrition mars Gujarat's growth story: HDI Report: Despite a shining Gujarat story of high economic growth model applauded by a US Congressional report, the India Human Development Report 2011 points out that the state fares the worst in terms of overall hunger and malnutrition in the country. Taking a dig at the Gujarat model, Union rural development minister Jairam Ramesh, while releasing the report, said, "On nutrition, I am puzzled why the high rate of malnutrition continues to persist even in pockets high economic growth.

105 child malnutrition deaths from April-June in Melghat : AMRAVATI: The Melghat region of Vidarbha is presently a picture of despair and what sounds a discordant note is the cries of kid dying due of malnutrition. A total 105 infants have died between April and June 2009 in Melghat. Despite efforts by the government and non-government agencies and after spending a large amount of money, the infant deaths in this tribal region are unabated. Health department sources said that about 69 children are reported to be in stage IV of malnutrition in Chilkhaldhara and Dharni tehsils of Melghat region.

http://www.dnaindia.com/mumbai/report_child-malnutrition-supriya-sule-to-visit-melghat_1604058

http://articles.timesofindia.indiatimes.com/2009-07-23/india/28197788_1_malnutrition-melghat-infant-deaths

http://in.news.yahoo.com/twelve-infants-die-kolkata-childrens-hospital-123053104.html 

Male breast cancer on the rise - Yahoo! Lifestyle India

If you thought that breast cancer was predominantly a woman’s disease, here is a reality check. If you go by the medical literature one out of ten breast cancer patients is a man. City oncologists believe that though it affects women more than men, lack of awareness and late diagnosis leads to the severity of the disease. Studies show that men with mutation of the BRCA gene are more prone to developing breast cancer and also likely to develop prostate cancer.
Are you sleep deprived?
Though male breast cancer is a relatively rare cancer, it presents a similar pathology as female breast cancer and the assessment and treatment relies on experiences and guidelines that have been developed in female patients. Unlike breast cancer in women, in men the cancer is easily visible. “One should consult a doctor immediately if there is a lump or tumor in the breast. Any kind of ulcer or unhealed wound should be treated immediately,” says Dr Sanjay Sharma, Oncologist at the SL Raheja Hospital.
Want to evade headaches?
A study done by the National University of Singapore revealed that men were more likely to have the disease that had spread beyond the breast by the time they were diagnosed. The data taken from the combined cancer registries from Denmark, Finland, Norway, Sweden, Singapore and Geneva, Switzerland, showed that over the entire time period, men had a 72 percent chance of surviving breast cancer in the five years after a diagnosis, compared to 78 percent in women
Male breast cancer incidence is about 1% of all breast cancers in India. Though a population based data is not available, hospital-based data suggest that there are about 300-400 cases all over India. In USA, they register about 3000 new cases every year. “Men don’t have breasts, so it is neglected most of the times. It may occur in male breast tissue which is in very small quantity in males and is under developed. Its causes are estrogen induced stimulation in men who have family history or are obese or have certain conditions genetically causing excesses estrogen production, or cirrhotic points causing mild liver failure especially in alcoholics,” adds Dr Sharma.
Typically self-examination leads to the detection of a lump in the breast which requires further investigation. Other less common symptoms include nipple discharge, nipple retraction, swelling of the breast, or a skin lesion such as an ulcer. “The main challenge in male breast cancer cases is an early detection. The fear and hesitation in males to get examined is a cause of concern too,” concludes Dr Sharma.

Male breast cancer on the rise - Yahoo! Lifestyle India

World Polio Day - ‘Stop Polio Forever’

October 24, 2011 marks World Polio Day. While the world lauds the success of two decades of committed global eradication programs, that have significantly cut the incidence of the disease, the event is also time for stock taking of what remains to be done to ‘Stop Polio Forever’.

Places under attack in 2008

• 449 cases in India
• 67 cases in Pakistan
• 20 cases in Afghanistan
• 5 cases from Nepal
• 692 cases from Nigeria
• 25 cases from Central African Republic
• 2 cases from Angola

The global polio eradication initiative in India seeks to arrest the transmission of Type 1 polio virus , especially in Western Uttar Pradesh and Bihar.  Campaign is on in full swing in Bihar to improve immunity of the population after the recent floods.

Drive against polio has intensified in the African countries. Addressing the Health Ministers of Africa, WHO Director-General Dr Margaret Chan said: "African countries are again at risk of polio. The most dangerous strain of the disease is affecting the northern states of Nigeria. And this outbreak has already begun to spread to neighboring countries."

Setback to anti-polio initiatives

The anti-polio drive will not see the light of day without the contribution of public health workers who face several odds, even life threatening risks to ensure people from remote areas get access to vaccination. Vaccinators and other polio staff are under danger of attack, risk of murder, and kidnapping, in spite of security measures offered by the UN.  A hostile-free environment is imperative to allow health workers to carry out their tasks efficiently.

In the context, the recent attack on Polio workers in Afghanistan, two of whom lost their lives following the attack, is indeed a setback to the anti polio drive.  Two polio workers in Somalia were also victims of an armed attack, underlining the grave risks faced by polio workers in the region.

The United Nations Secretary-General has strongly condemned these attacks.

Polio unplugged

Polio or Poliomyelitis is a highly infectious viral disease, which targets the nervous system. Its most virulent forms can cause paralysis of the nervous system in just a few hours. The risk is pronounced for children below the age of five. 

Polio virus is of three types -Type 1, 2 and 3. Type 1 and Type 3 still pose a challenge to polio eradication; thankfully Type 2 is no longer a threat. Endemic areas, especially parts of Africa and Afghanistan are vulnerable to the polio virus. 

Transmission of Polio virus occurs via the fecal-oral route, triggered by contact with contaminated surfaces. The virus can spread to a whole group or a community in the presence of improper sanitation and unhygienic surroundings, person-person contact, and consumption of unclean water or food.

Understanding symptoms

Ninety percent of the time, Polio is Asymptomatic or without any symptoms. Symptomatic polio or polio with symptoms occurs only in 10% of the cases. Symptomatic polio is categorized under three distinct types. 

• Abortive polio: Symptoms are very much like flu where the victim feels under weather. Sore throat, diarrhea and respiratory infection, are some of the common symptoms.
• Non-paralytic polio: Neurological symptoms like sensitivity to light and stiff neck show up in almost 1 to 5% of polio victims.
• Paralytic polio:  Affecting 0.1 % to 2% of victims, this acute polio attack causes muscle paralysis. Victims suffer problems with movement of limbs as well as breathing problems. Severe cases also turn fatal.

Diagnosis 

After evaluating the symptoms portrayed, experts advise laboratory evaluations on stool samples, or samples of cerebrospinal fluid or throat secretions. This is the only way to make a confirmed diagnosis.

Plug the virus

Since there is no known cure for this disease, prevention is the best bet.

Adhering to the stipulated immunization programs at specified intervals is the only way to beat the disease. Widespread Pulse Polio Campaign has been a success in offering immunity to large sections of people and has helped check the spread of polio. Stress on sanitation and hygiene is crucial to control the spread of the disease.

Polio Vaccine

Two vaccines employed widely have been a shot in the arm for the success of polio eradication programs. 

• Inactivated Polio Vaccine or IPV as the name suggests contains the inactivated polio virus and is given as an injection. This vaccine has been employed since five decades.

• Oral Polio Vaccine or OPV, which is administered orally, contains a mild form of the active virus.

Polio Immunization Programme

The Polio immunization programme stipulates that four doses of Polio vaccine be administered to children during the period from infancy till 5 years of age.

• First dose is given at 2 months

• Second dose is at 4 months

• Third dose is between 6 to 18 months of age.

• The final dose, labeled as the booster dose is given between 4-6 years of age.

Help Eradicate Polio

To start with, all children must avail their polio immunization as per the schedule, in order to remain protected against this devastating disease.

As informed citizens, let us spread the message in our community, especially amongst the underprivileged about the importance of timely vaccination for children below five. Educate the need to keep the surroundings clean to control spread of the virus.

Eradicating polio is indeed a way to make the world safer and healthier for our children. Though initiatives are on at the national and international level, as individuals we can do our bit to help such initiatives realize its ultimate goal.

Source-Medindia
SAVITHA/SK

Around 25 Lakh People Suffering From Cancer In India: ICMR & WHO Report

The latest report prepared by the Indian Council of Medical Research (ICMR) revealed that there are about 25 lakh cancer patients in India.

ICMR report also said that cancer scenario in the country is quite disturbing as the number of people living with this deadly disease continues to rise.
At a seminar on “New Frontiers in Haematology and Oncology”, Mr. Viswamohan Katoch, Director General Indian Council of Medical Research (ICMR), said, “Cancer scenario in India is not very comfortable and every year there is an increment of 10,000 new cancer patients and the number of total victims stands at about 25 lakh all over.”
The ICMR will back up each and every part of cancer research in the country, Mr. Katoch said that’s why it had been supporting the seminar on cancer, organized by Netaji Subhas Cancer Research Institute (NCRI).
Katoch added that the ICMR has decided to fund a workshop in order to give training to 26,000 rural medical practitioners on the early signs of the disease (cancer) and its prevention over a period of five years through telemedicine system.
“There will be seven centres at Siliguri, Malda, Burdwan, Krishnagar, Bankura, Midnapore and Baruipur, which will be connected with the NCRI,” he said.

NCRI sources also stated that this will help meliorate the health care system relating to cancer care in West Bengal through proper networking.
WHO: Report provides key information for India on cervical cancer, other anogenital cancers and head
and neck cancers, HPV-related statistics, factors contributing to cervical cancer, cervical cancer
screening practices, HPV vaccine introduction, and other relevant immunization indicators. The report
is intended to strengthen the guidance for health policy implementation of primary and secondary
cervical cancer prevention strategies in the country.
India has a population of 366.58 millions women ages 15 years and older who are at risk of developing
cervical cancer. Current estimates indicate that every year 134420 women are diagnosed
with cervical cancer and 72825 die from the disease. Cervical cancer ranks as the 1st most frequent
cancer among women in India, and the 1st most frequent cancer among women between 15 and 44
years of age. About 7.9% of women in the general population are estimated to harbour cervical HPV
infection at a given time., and 82.5% of invasive cervical cancers are attributed to HPVs 16 or 18.
WHO Report on Cancer in India

Child Survival in India: A Serious Issue

The level of child undernutrition remains unacceptable throughout the world, with 90 per cent of the developing world’s chronically undernourished (stunted) children living in Asia and Africa. Detrimental and often undetected until severe, undernutrition undermines the survival, growth and development of children and women, and diminishes the strength and capacity of nations. With persistently high levels of undernutrition in the developing world, vital opportunities to save millions of lives are being lost, and many more millions of children are not growing and developing to their full potential. Nutrition is a core pillar of human development and concrete, large-scale programming not only can reduce the burden of undernutrition and deprivation in countries but also can advance the progress of nations.

Fast Facts: In India 20 per cent of children under five years of age suffer from wasting due to acute undernutrition. More than one third of the world’s children who are wasted live in India. Forty three per cent of Indian children under five years are underweight and 48 per cent (i.e. 61 million children) are stunted due to chronic undernutrition, India accounts for more than 3 out of every 10 stunted children in the world. Undernutrition is substantially higher in rural than in urban areas. Short birth intervals are associated with higher levels of undernutrition. The per centage of children who are severely underweight is almost five times higher among children whose mothers have no education than among children whose mothers have 12 or more years of schooling. Undernutrition is more common for children of mothers who are undernourished themselves (i.e. body mass index below 18.5) than for children whose mothers are not undernourished. Children from scheduled tribes have the poorest nutritional status on almost every measure and the high prevalence of wasting in this group (28 per cent) is of particular concern. • India has the highest number of low birth weight babies per year at an estimated 7.4 million. • Only 25 per cent of newborns were put to the breast within one hour of birth. • Less than half of children (46 per cent) under six months of age are exclusively breastfed. • Only 20 per cent children age 6-23 months are fed appropriately according to all three recommended practices for infant and young child feeding. • 70 per cent children age 6- 59 months are anaemic. Children of mothers who are severely anaemic are seven times as likely to be severely anaemic as children of mothers who are not anaemic. • Only half (51 per cent) of households use adequately iodized salt. • Only one third (33 per cent) Indian children receive any service from an anganwadi centre; less than 25per cent receive supplementary foods through ICDS; and only 18 per cent have their weights measured in an AWC.
Source: UNICEF 

Maternal Health in India: UNICEF

India continues to contribute about a quarter of all global maternal deaths. WHO defines maternal mortality as the death of a woman during pregnancy or in the first 42 days after the birth of the child due to causes directly or indirectly linked with pregnancy. 
Fast Facts
Globally, every year over 500,000 women die of pregnancy related causes and 99 percent of these occur in developing countries.
• The Maternal Mortality Ratio (MMR) in India is 254 per 100,000 live births according to Sample Registration System (SRS) Report for 2004-2006.  This is a decline from the earlier ratio of 301 during 2001-2003.

• In the region, the MMR in China stands at 45, Sri Lanka at 58, Bangladesh at 570, Nepal at 830 and Pakistan at 320 in 2006.

• Wide disparities exist across states in India. The MMR ranges from 95 in Kerala to 480 in Assam.

• MMR has a direct impact on infant mortality Babies whose mothers die during the first 6 weeks of their lives are far more likely to die in the first two years of life than babies whose mothers survive.

• Only 47 per cent of women likely in India have an institutional delivery and 53 percent had their births assisted by a skilled birth attendant. As many as 49 percent of pregnant women still do not have three antenatal visits during pregnancy. Only 46.6 percent of mothers receive iron and folic acid for at least 100 days during pregnancy.
Key Issues
• About half of the total maternal deaths occur because of hemorrhage and sepsis. A large number of deaths are preventable through safe deliveries and adequate maternal care.
• More than half of all married women are anaemic and one-third of them are malnourished

Innovative Solutions to Save Lives

During Women’s History Month, it’s important to stop and reflect on the incredible progress women have made the past few decades. Perhaps nowhere have results been more impressive than in women’s health and the health and wellbeing of their children. I am optimistic this progress will continue as the tools and strategies that have been effective in accomplishing these amazing feats are still improving and rolling out in a number of countries around the world.

Take India, for instance, where I am visiting this week. As a result of its large population and many other factors, India has the highest burden of maternal and newborn deaths globally (22% and 28% respectively) and almost half of the world’s malnourished children (more than 55 million). The rest of the health data paint the same picture.
But what excites me is that India is also a hotbed of innovation. Led by the national government, India has taken an innovative approach to improving the delivery of all key family health services, ranging from antenatal and postnatal care to family planning and immunization.
The National Rural Health Mission (NRHM), India’s flagship national health program targeting rural populations, is a great example. Created in 2005, NRHM has prioritized maternal and child health and empowered health workers to reach women and children in the most remote villages. The program is particularly good at taking ideas and spreading them across India, leveraging innovation at state and local levels. One of those ideas alone, the Janani Suraksha Yojana (JSY)—a conditional cash transfer program for pregnant mothers—has driven millions more women into facilities to give birth, resulting in a proven reduction in neonatal deaths in the country.
The success of NRHM was likely an important factor in the government’s recent decision to increase the overall health budget by 20%.
Submitted by Melinda Gates: http://blog.usaid.gov/2011/03/innovative-solutions-to-save-lives/

Neonatal Health In India : UNICEF

Introduction
Child mortality is a sensitive indicator of a country’s development.  In India, the Infant Mortality Rate (IMR) (under one year) has shown a modest decline in recent years.

The average decline of IMR per year between the years 2004 to 2008 has been about 1 per cent per year.

In 2008, the IMR was 53/1,000 live births. Eight states contribute to 75 per cent of infant mortality: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Andhra Pradesh, Orissa, Gujarat and Assam. 

At the current rate of decline, India will miss the XI plan goal of reduction in IMR and the Millennium Development Goal-4 on child survival.
About 70 per cent of the childhood under-five is caused by perinatal conditions (33.1 per cent), respiratory infections (22 per cent) and diarrhea (13.8 per cent). Malnutrition is an underlying cause responsible for about one third of all deaths in childhood.
Fast Facts
• Averting neonatal deaths is pivotal to reducing child mortality. The Newborn period is the period starting from birth and continues throughout 28 days of life.

• Neonatal mortality rate (mortality in the newborn period) stands at 35/1000 lives births, and contributes to 65 per cent of all deaths in the first year of life.

• Between 2004-2008, neonatal mortality has moved from 37/1000 live births to 35/1000 only.

• 56 per cent of all newborn deaths occur in five states: UP, Rajasthan, Orissa, MP and Andhra Pradesh.

• Three major causes contribute to about 60 per cent of all deaths in the newborn period: pre-maturity and low birth weight, birth asphyxia and infections.

Key Issues
• Most of the causes of deaths in the newborn period can be prevented or managed by households, communities and health facilities. But they often are unable to provide the required care.

• Inappropriate practices such as delayed initiation of breastfeeding, delayed clothing and early bathing, not seeking care when newborns are sick and applying harmful material on cord-stump increase the risk of newborn deaths.

• Health facilities are often ill equipped to provide essential newborn care to all newborn and special newborn care to sick newborns.

Truth about Indian Health System: Facts

Failure of Ministry of Health and family Welfare: What really NRHM Doing????

Source: NDTV

Gender Equity Issues in India

Gender discrimination continues to be an enormous problem within Indian society. Traditional patriarchal norms have relegated women to secondary status within the household and workplace. This drastically affects women's health, financial status, education, and political involvement. Women are commonly married young, quickly become mothers, and are then burdened by stringent domestic and financial responsibilities. They are frequently malnourished since women typically are the last member of a household to eat and the last to receive medical attention. Additionally, only 54 percent of Indian women are literate as compared to 76 percent of men. Women receive little schooling, and suffer from unfair and biased inheritance and divorce laws. These laws prevent women from accumulating substantial financial assets, making it difficult for women to establish their own security and autonomy.

In Rajasthan, all of these problems are aggravated by high levels of seasonal migration. For many men in Rajasthan, migration is required since rural parts of Rajasthan often lack a sufficient economy to provide income for a family year-round. Women are commonly left behind to care and provide for the entire household. This is increasingly difficult because it is estimated that an average woman's wage is 30 percent lower than a man's wage working in a similar position. While these mothers work, they must also tend to domestic responsibilities. This formula for supporting Rajasthani families leaves little resource for the growth and development of women's rights and education levels.

A strong "son preference" exists in the region, as it does throughout the country, and high rates of female infanticide and female feticide plague the area. In 2001, for every 1,000 males living in Rajasthan there were only 922 women (Marthur et. al., 2004). Having sons is economically advantageous to families due to cultural institutions; these institutions serve to drastically devalue the roles women play in the traditional society. Women continue to struggle to achieve equal status to men, making gender equity an issue of particular importance for Rajasthan.

In Rajasthan several NGOs that have hosted FSD participants are instrumental in providing opportunities for women. These organizations help to build networks among women to create financial self-help groups. They introduce ideas about microfinance, allowing women to participate in management activities. Other local NGOs implement projects that export the skills of women abroad to generate significant income. In 2006, Olen Crane, an FSD intern, helped nearly 400 women artisans in the Udaipur area by collecting samples of their textile products and shipping them abroad to sell to American companies. Similar projects have enormous potential to improve the financial and social status of Rajasthani women. Organizing change at a local level and planning participatory action will help to eliminate bias and stereotypes, and generate awareness of the significant gender divide that exists within Indian society.

Child and Maternal Health Issues in India

Since its independence, India has become a world leader in medical advancement due to its incredible medical education system and state-of-the-art private medical facilities. It is now a major provider of health services and contains some of the most highly skilled and qualified medical providers in the world. Quality health care, however, remains inaccessible for many undeveloped Indian regions. For example, in rural communities it is estimated that only 18 hospital beds are available per 100,000 people. Even when medical treatment is available, public hospitals are frequently understaffed and under supplied. The poor are forced to rely on overburdened, unsanitary facilities as their only source of health care.

Lack of national care has produced severe health issues throughout the nation: the highest prevalence of tuberculosis in the world; over 1.5 million children dead each year before their first birthday; and nearly 500 million lacking sufficient nutrition along with the second highest number of people living with HIV/AIDS. Growth of HIV/AIDS is a particular concern since there is not a secure infrastructure to measure the virus’s spread and impact, particularly with women in rural areas. While prevalence is not high, the country is extremely susceptible to a massive epidemic if left unchecked.

This lack of national healthcare infrastructure is having severe and lasting effects on the livelihoods of Indian citizens. In Rajasthan, about half the children suffer from malnutrition, 49 percent of women are anemic, and about one-third of children are born with a low birth weight. Additionally, only 14 percent of children between 12 and 23 months receive the necessary vaccinations to prevent diseases such as small pox and polio. Public hospitals have insufficient funds to support their communities, and since only 15 percent of Indian citizens have health insurance, quality health care remains unattainable for millions in dire need (Bhagat, 2004).

Thousands of public health NGOs are intervening to provide the necessary medical care, support, and treatment. In Udaipur and Jodhpur, FSD collaborates with local organizations that interview the local community to identify weaknesses in rural health care and then provide the underprivileged with the necessary supplies and medical advice. Additionally, FSD supports programs that host educational workshops to promote the importance of hygiene and sanitation, and assists healthcare centers that provide immunizations to at-risk children. FSD partner organizations are working within the communities with the greatest need to ensure that all citizens are guaranteed their basic right to continued health and physical well-being.

The Major key differences between Indian and US healthcare systems

Just a FYI post to understand the basic differences between Indian and US healthcare system. This kind of comparative study can help us understand the good features and flaws in both the systems.

1. In India the total government expenditure as percentage of GDP is as low as 4-5 %. Where as in US it is well beyond world standards, as high as 16.2 % of GDP. With highest per capita expenditure in the world US is ranked on 37th position, which indicates that increasing expenditure on healthcare is not the only solution to improve the health status of the citizens. On the other hand, India ranks quite low and stands at 112 which is well below countries like Sri Lanka(76) and Bangladesh (88)..

2. The Indian Healthcare system can be considered as a Mixed Healthcare System where there is a government health infrastructure which provides healthcare at primary, secondary and tertiary levels. In addition to this there is a strong presence of private healthcare infrastructure which is growing stronger by the day with decline of trust of people in public hospitals. While in US the system is majorly privately funded where the employers are supposed to fund for the employees working with them. There is public funding is available only for unemployed people who cannot afford to purchase health insurance.

3. Out of the pocket payments account for 70% of healthcare costs in India which warrants a work up on strengthening of financing mechanisms like insurance. On the other hand in US the out of pocket expenditure stands at around 10-12%.

4. With the perspective of outcomes, in India the Life expectancy at birth m/f (in years) is 63/66 while that for US is 76/81. Another important factor is Probability of dying under five (per 1000 live births) which indicates the load of infective diseases which affect children and the ability of the healthcare system to deal with them . In India the Probability of dying under five is as high as 66 per 1000 live births while that of US is 8 per 1000 live births.

5. India has a universal health care system run by the local (state or territorial) governments. Government hospitals provide treatment at taxpayer expense. Most essential drugs are offered free of charge in these hospitals. However, the fact that the government sector is understaffed, under financed and that these hospitals maintain very poor standards of hygiene forces many people to visit private medical practitioners.. The United States does not have a universal health care system; it is a proposed reform. The Obama administration health care reform, the Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act of 2010, seeks to have near-universal healthcare insurance coverage to legal residents.

Indian Health Facts: Report by UNICEF

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Approximately 2 million under-5 children die in India every year (UNICEF state of the World s Children Report, 2007). This is about one-fourth of the global burden of infant and child deaths. Adding to this gloomy statistic is the status of maternal mortality in India. Over 70,000 women die in India every year due to pregnancy related issues. This too accounts for almost one-fourth of the world s maternal deaths. India has among the poorest maternal mortality indicators in the world, and child survival has not improved as it should have. Better early care and immunization, along with tackling diarrhoea and pneumonia among children ensure improvements in child survival, and also contributes to reducing the family size and population stabilization in India India faces the enormous challenge in achieving the Millenium Development Goals by reducing infant mortality from 53 per 1000 live births to less than 30 and maternal mortality from 254 per 100,000 live births to less than 100 by 2015. On the face of it, this challenge seems almost unsurpassable in the given timeframe. With just five years to the 2015 deadline for achieving the MDGs the country as a whole will not be on track for a majority of the targets related to poverty, hunger, health, gender equality and environmental sustainability unless concerted national efforts are made by government and all sections of civil-society working in tandem.