|Year : 2015 | Volume
| Issue : 4 | Page : 163-164
Government initiatives for child health care and the role of pediatric surgeons
Nirmal Chandra Bhattacharyya
Principal, Tejpur Medical College, Tezpur, Assam, India
|Date of Web Publication||2-Sep-2015|
Nirmal Chandra Bhattacharyya
Principal, Tejpur Medical College, Tezpur, Assam
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhattacharyya NC. Government initiatives for child health care and the role of pediatric surgeons. J Indian Assoc Pediatr Surg 2015;20:163-4
|How to cite this URL:|
Bhattacharyya NC. Government initiatives for child health care and the role of pediatric surgeons. J Indian Assoc Pediatr Surg [serial online] 2015 [cited 2018 Mar 25];20:163-4. Available from: http://www.jiaps.com/text.asp?2015/20/4/163/164238
With 1.21 billion people, India is the second most populous country in the world; children represent 39% of the total population of the country. According to the Global Report on Birth Defects, 7.9 million births occur annually worldwide with serious birth defects and 94% of these are from middle- and low-income countries. The World Health Organization report reveals that birth defects account for 7% of all neonatal mortality and 3.3 million under-five deaths.  In India, birth defects prevalence has a variance of 61-69.9/1,000 live births but there is inadequacy of data on the burden of birth defects as a whole and the types of birth defect in particular. However, it is estimated that around 17 lakh birth defects occur annually in the country and account for 9.6% of all the newborn deaths.
In recent years, the Government of India has taken several initiatives to address this problem. Rashtriya Bal Swasthya Karyakram (RBSK) is an important initiative of the Government of India aiming at early identification and early intervention for children from birth to 18 years of age to cover the four "Ds", viz., defects at birth, deficiencies, diseases, and development delays including disability. The government machinery aims to reach out to about 27 crore children in a phased manner. It is expected that about 10 crore children belonging to the age group of 0-6 years will be screened at the block level twice a year and those in the age group of 6-18 years (about 17 crore children) will be screened once a year by mobile teams. Surprisingly, these teams are each supposed to comprise two Ayush doctors, one ANM/ staff nurse, and one pharmacist!
There are 30 childhood conditions mentioned, out of which at least seven are surgical conditions including neural tube defect (NTD), cleft lip and palate, club foot, hip dysplasia, congenital cataract, deafness, and congenital heart diseases. There is no mention of congenital hernias, congenital hydrocele, hypospadias, undescended testis, phimosis, syndactyly, hemangiomas, lymphangiomas, lipomas, dermoid cysts, etc., that are the most frequently encountered surgical problems in school-going children. Important problems such as childhood tumors, hepatobiliary anomalies, and urogenital anomalies find no place in this list. Thalassemia that is a major hematological problem in this age group is marked as "optional."
There is no clear guideline about how the surgical conditions will be treated. It is mentioned in government documents that "a team consisting of Pediatrician, Medical officer, Staff Nurses, Paramedics will be engaged to provide services." It is also mentioned that "funds will be provided under the National Health Mission (NHM) for management at the tertiary level at the rates fixed by state governments in consultation with the Ministry of Health and Family Welfare."
In the RBSK program that is going to cover 27 crore children nationwide, nowhere is there a mention about the role to be played by the pediatric surgeon or about how the free surgery is going to be carried out for a large number of children detected to have birth defects. For some of the birth defects included in the list such as congenital heart diseases, the cost of surgical treatment is unpredictable (from one to several lakhs of rupees depending on the condition) and is often not covered by the Central Government Health Scheme (CGHS) rates. As most of the government hospitals are not well-equipped to treat complex cardiac defects in babies, the services of large corporate hospitals will have to be requisitioned. How the government plans to provide the necessary expenditure for these cases will be interesting to observe.
In contrast to this, Janani Shishu Suraksha Karyakaram (JSSK) provides free entitlements for sick newborns till 30 days after birth that has now been expanded to cover sick infants. But there is no particular mention about the free surgical treatment of birth defects. However, the cost of treatment is supposed to be reimbursed from funds available for this purpose with the National Health Mission (NHM). All pediatric surgeons must be aware of the provisions under this scheme so that full financial benefits may be offered to children undergoing surgery for birth defects and also other conditions that require surgical treatment.
Operation Smile is a nonprofit medical service organization based in Virginia Beach, Virginia, USA, founded in 1982.  It has arranged for free surgical treatment of cases of cleft lip and palate (of all age groups). In some states of India, it has done a lot of voluntary work to help these cases. In Assam, with the assistance of the state government, it has set up a permanent "cleft care center" with six operation theaters at Guwahati, where more than 10,000 cases of cleft lip and palate have been operated till now with absolutely no cost to the patients.
Mention must also be made here about another initiative taken by the Government of Assam in the screening and free surgical treatment for congenital heart diseases in children below the age of 14 years.  Till now, more than 3,000 children have been benefited by this scheme. Similarly, another government scheme in this state, fondly named "Sneha Sparsh" (meaning "the touch of love"), provides financial assistance to children in need of liver and kidney transplants, cochlear implant, bone marrow transplant, limb prosthesis, surgery and chemotherapy for childhood tumors, and surgery for NTDs. The pediatric surgeons of the state select the cases to be benefited under this scheme. The government provides funds to the tune of `5.00 crores per year for implementation of this scheme.
The initiative taken by some members of Indian Association of Pediatric Surgeons (IAPS) to start a community pediatric surgeons forum is highly commendable. At the same time, it is the responsibility of the IAPS to apprise the Government of India about taking pediatric surgeons also into confidence while planning the various national programs for dealing with birth defects. Unfortunately, doubts exist about whether the pediatric surgeons of our country are ready to take up the challenge. Inadequate training of residents, improperly organized curriculum and syllabus of Magister Chirurgie (MCh) Pediatric Surgery course in different teaching centers, inadequate exposure to the variety of birth defects during training period, and subsequent practice are some of the loopholes. It is interesting to observe that nongovernment organizations (NGOs) such as Operation Smile would prefer to recruit plastic surgeons to do the job. There is hardly any pediatric surgeon in the country who is ready to treat the large number of children with congenital heart diseases, congenital limb and spinal deformities, or brain tumors. During the annual meets of the IAPS, time must be spared to think about these issues as well. Meanwhile, individual pediatric surgeons should also come forward to take up these issues with the respective state governments and communities.
| References|| |
World Health Organization. Management of birth defects and hemoglobin disorders: Report of a Joint WHO-March of Dimes meeting. Geneva, Switzerland: WHO; 2006.
Christianson AL, Howson CP, Modell B. March of dimes global report on birth defects: The hidden toll of dying and disabled children. White Plains. New York, USA: March of Dimes Birth Defects Foundation; 2006 [Last accessed on 2015 Jul 24].
National Health Mission. Available from: nrhm.gov.in,nrhmassam.in. [Last accessed on 2015 Jul 23].