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"Health is more a
question of will than wealth"
an
interview with Dr To Kyaw-Myint, Chief, Health & Nutrition Section,
UNICEF
Despite
an improvement in the health indices for children, the overall
global picture looks none too bright. Half of South Asia’s children
are malnourished. In Africa, one of every three children is
underweight, and in several countries of the continent, the
nutritional status of children is worsening. Dr TO Kyaw Myint,
Chief, Health & Nutrition Section, Unicef, Dhaka, Bangladesh spoke
to Kavita Charanji about the health and nutritional status of
children in South Asia, and Bangladesh in particular. Excerpts from
the interview:
On the
common health and nutritional problems among children
T he
main problem in South Asia is that of malnutrition of women and
children. Ninety per cent of malnourished children are found in
sub-Saharan Africa and South Asia. Half of them are in South Asia.
In Bangladesh 52 per cent of children have varying degrees of
malnutrition and one of the main reasons is the high incidence of
children being born small (less than 2.5 kg). This is the result of
the poor nutritional status of women in this country. The situation
is the same in most parts of India, Pakistan and Bhutan.
The
other problem is the lack of micronutrients, namely, Vitamin A, iron
and iodine. About 70 per cent of women in Bangladesh are anaemic, 47
per cent people in Bangladesh have goitre and about 1 per cent
children under the age of one year have night blindness caused by
the deficiency of Vitamin A. These three micronutrients are very
important because anaemia affects productivity, iron deficiency
results in intellectual impairment and Vitamin A deficiency makes
them prone to infections.
On UNICEF’s achievements in South Asia
The
immunisation programme all over Asia is doing quite well, except in
Bhutan and Nepal because access is difficult. We feel that in
another 15 years we will be able to eradicate polio as we have
eradicated smallpox.
However, there are areas where much more needs to be done. Firstly,
even though in 1979, countries signed the Alma Alta declaration of
Health for All by the year 2000, the whole issue of access to
primary health care is not satisfactory. The second weakness is the
inadequate linkage between different levels of health care, for
instance primary health care centres, districts and towns.
As far
as other diseases are concerned, we are doing quite well in
controlling tuberculosis and leprosy. True TB is back, but controls
are getting better. The major problem is that of drug resistance
because people don’t take the full course of treatment. However, we
are finding answers to deal with TB, such as the Directly Observed
Treatment Schedule (DOTS). In this method, the patient takes the
medicine in front of the doctor, rather than at home. Within South
Asia, Bangladesh has the most successful programme.
On the resurgence of old diseases and the emergence of new ones
Malaria is emerging as a big
health problem in Asia. We thought that we had controlled it with
insecticides and drugs, but over the last few years there has been a
resurgence mainly because safe insecticides are very expensive.
What
causes immense concern is the emergence of new diseases such as HIV
and AIDS. The disease occurs all over the world, but particularly in
Africa and Asia. We feel that one of the main reasons HIV and AIDS
are spreading is because of cultural reasons. In our part of the
world, information and education cannot be given as extensively as
in countries such as Thailand. In India, people do talk about it,
but in Bangladesh the society is more conservative.
The
other diseases that cause concern are Hepatitis A and B. The sad
thing is that Hepatitis B could have been prevented if a vaccine had
been available at a cheaper cost. That is happening now and at 14
cents per person, full immunisation is possible.
On the effectiveness of NGOs in providing health and nutrition
facilities
NGOs are now playing a major
role in supplementing government efforts to provide better health
and nutrition facilities. What is good about Bangladesh and,
possibly India, is that governments know their limitations and draw
on the expertise of NGOs. NGOs have done remarkably well in Sri
Lanka, Nepal, India and Pakistan.
The heartening feature is that
governments and NGOs are not in competition anymore but are
complementing each other. Take the case of West Bengal in India.
Here the state government and the NGOs have an easy mechanism for
discussing common issues. As a result, there is less duplication and
more complementarity. Take for example the HIV and AIDS programme,
where there a good relationship between academic institutions,
government and NGOs. Similarly, the family planning coverage
couldn’t have come up to this extent if it hadn’t been for the
cooperation between the government and NGOs.
On the areas that need strengthening
We need to have more South-South
dialogue. This is happening to some extent as, for instance,
Bangladesh closely looks at the nutritional programme in Tamil Nadu.
Likewise, the Integrated Child Development Scheme provides a
learning ground for us. So exchanges do go on but we definitely need
more networking and South-South dialogue. With the electronic media,
in particular, the dialogue should have been much more.
On the future
I am very optimistic that the
health indicators will improve because although we may not have come
to where we want to be, it is more a question of will than wealth.
To take one example, 20 years ago 140 children out of 1,000 in
Bangladesh would die in the first year of life. Now only 97 out of
1,000 die. Similarly, in 1990, 800 women in Bangladesh would die for
every 1,00, 000 births. That figure is now down to 470. This trend
has also been seen in India. So, in the long run, there is room for
a lot of hope and optimism.
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