Health activists wary
The Uttar Pradesh government has signed a Memorandum of Cooperation (MoC) with the Bill and Melinda Gates Foundation (BMGF) to improve the health, agriculture and financial services to the poor.
The agreement signed on December 13 will use a public private partnership (PPP) model to reduce infant and maternal mortality rates, strengthen infant and young child feeding (IYCF) policies by promoting breastfeeding and increasing number of Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) centres. “In short, the agreement has been signed to meet the goals of the 12th five year health plan”, says Amit Kumar Ghosh, director of National Rural Health Mission in the state. But it is still not clear whether the foundation will roll out programmes or give financial aid.
According to a press statement issued by the state government, the MoC will be valid till 2017 under which the BMGF will provide technical and management support and will form a state technical support team that will report regularly to the principal secretary in the state health ministry.
But the health activists are wary of the move. Uttar Pradesh has the second highest neonatal, infant and child mortality rates in the country. According to the data with the state health ministry, neonatal, infant and child mortality rates stood at 45, 63 and 20.1 per 1,000 live births respectively in 2011. The Uttar Pradesh state human development report maintains that by 2011, only 16 per cent of all children were fully vaccinated on completing a year. The women nutritional indicators show that around 36 per cent of women suffer from Chronic Energy Deficiency (CED), more so in rural areas than urban areas. CED denotes the level of nutritional deficiency in women.
This is the second time that BMGF is investing in India's social sectors on such a large scale, especially in areas like reproductive health, family planning, immunisation, maternal and neonatal care. They had signed a similar MoC with Bihar in 2010. The foundation has invested over a billion dollars in India so far through their support and development work.
Expressing concern over the agreement, Jashodhara Dasgupta, coordinator of SAHAYOG, non-profit based in Lucknow that promotes gender equality and women's health from a human rights framework by strengthening partnership-based advocacy, says, “Foundations like BMGF promote only one point, vertical programmes that weaken the health system, especially in a state like Uttar Pradesh. Moreover, they encourage privatisation and are not accountable to the people of Uttar Pradesh. Even though they bring in vast resources, they have a very narrow focus. What worries us health activists is that these kind of discussions are not transparent and no consultation or discussion is ever done (with us).”
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