The eighth season of the Banega Swachh India initiative stresses on the need to take care of, and consider everyone’s health in India especially vulnerable communities
“We were amazed by the depth and breadth of ideas and these children worked on. They thought of problems we didn’t think existed.”
When we launched this initiative, we were very confident that children across India will be keen to use this platform. Each day of the competition, the number of ideas, problems children were trying to solve kept increasing. The length and breadth of the competition amazed us.
Genome sequencing is technology that we can use to understand the complete sequence and order of a virus. Humans have a 3 billion DNA basis. Virus has 30,000 RNA basis and they are represented as chemical ladders. As it spread from person to person, it was replicating itself. Occasionally it would make an error in that copy like a spelling error and that could have a different meaning. We saw that during spring surge. Delta variant is more transmissible and attaching to human more robustly. Although other variants are also emerging, sequencing allows us to track those.
Technology is actually transferring the way we look at health in many ways. I am glad we are focusing on wellness and not just treating illness. The health of a nation can really improve if we focus on wellness. Now sensors are helping you to track the amount you exercise. Even during pandemic, we used an oximeter to check oxygen levels in the blood. We used so many devices to track our well-being. Today, a lot of technology-led solutions for health are approved by FDA. Technology is not only going to play an important role but is already playing in India where we have a huge deficit of medical infrastructure.
Normal immunisation programme for children has 3 categories – some children take the first vaccine and leave other two. There are myths that vaccines can do so and so thing in our children. In some areas regular immunisation is not possible. For COVID-19 vaccination, Rajasthan has cold chain points, storage centers. Initially, people were scared. Now, 78 per cent have got the first dose and 39-40 per cent have got the second dose.
It all started because nobody knew about how to fight the pandemic. We had a chat with the Chief Minister, few doctors and then we went to Mr Bachchan and made a video to give basic guidance. By April-May, we started losing a lot of cops to COVID-19. We saw almost 95 police persons succumb to the pandemic. It was mainly because they were the frontline workers who could not go home because at that time there was no vaccine and there was less information about Covid. So, we took the initiative and booked eight hotels for the cops to have a safe space to rest after finishing their duty.
These bonds are the first of its own kind in the world. These are called Dettol hygiene impact bonds. If you read the latest statistics, UP has 400 thousand malnourished kids which is the highest. It is important to invest judiciously. You have X number of lives to be saved each quarter. Based on that funding will be there. We intend to take it to all 75 districts of UP. If this model is successful, we will be taking it to other countries through Reckitt.
The basic fundamental is to follow WHO’s 7 point guide which includes – handwashing, sanitation, the introduction of zinc as therapy of diarrhoea. The use of zinc in up among 0-5 kids for diarrhoea treatment has picked up to 7-8 per cent. The kind of water intake also matters. The government of UP is working very positively with us. If this model works well, this will be a model for other funding mechanisms as well.
First is to build up surveliiance system that shares data across the world. We don’t have that right now. This is not limited to genomic data but the number of severe cases, death. in india we have a problem doing that. secondly, be prepared for pandemics by making vaccines. The next pandemic will be a virus. Can be identified by 2025 families of viruses that which will come. One of the initiatives that I am involved is to see if we can make a vaccine in 100 days than 11 months. I think it’s feasible. We have to get everybody connected. When we look at water, sanitation and hygiene sectors, those are the ones that make a difference to society. Households that the ability to have sufficient soap and water and have fewer children getting disease. Less disease means going to school regularly and that means getting educated.
The pandemic has changed the way we look at not only the health part but everything else. People are doing teleconsultation in much more number, doing video call and showing reports. Pandemic has been a disaster but at the same time there has been a silver lining. Ayushman Bharat Digital Mission launched by PM Modi on September 27 aims to use the internet and technology in a better way for the delivery of healthcare services. People can consult doctors through teleconsultation, share their digital records, prescription and purchase medicines. we are creating a health ID and a service where all their medical records will be linked to the health ID. This way longitudinal record will be created. in terms of diagnostic I would like to say that machines can help doctors in analysing various reports. secondly, you can connect with doctors through telecommunication. thirdly, in India we have created digital signature through which you can remotely sig and share documents. then there is digital lockers and digital payments as well. supporting artifacts and work we have done will help us in ensuring the success of ayushman digital health mission. Digitalisation will have to be accelerated. I feel, we have that kind of environment in our country and can further push the digital push that Covid has given and leverage it.
It’s the people who litter and have littered. They create dirt and then suffer and complain about government’s incompetency. Why are you increasing the government’s work? First you yourself are creating a problem and then complaining about it. Why do you throw waste in drains? Why don’t you use dustbins so that garbage collectors can collect it? So, it’s very important for people to create problems for themselves. Either you will say that it’s your neighbor who creates waste. If neighbor does it then there should be a complaint system.
If you are clean then it’s everything. If you are not clean, then you are not healthy. Cleanliness and health are two sides of the same coin. You are healthy because you are clean. If you are clean, you will be healthy and that will lead to more work and earning. But if you are not clean or hygienic, you won’t be healthy and that will result in reduced income. In fact, your money will be spent on your treatment and healthcare. Only if you will stay clean and healthy, Lakshmi, known as the goddess of wealth and purity, will come to your house. Therefore, it is your selfishness to stay clean and healthy. If you start believing in cleanliness, your mentality will also be clean. you behaviour also starts becoming clean. your surroundings also start to become clean. you will talk pure.
India has various programmes and lots of efforts ongoing. In past some years there has been some decline but the rate of decline of malnutrition has not been able to meet United Nation’s Sustainable Development Goal of Zero Hunger. Programmes by governments including the recent announcement on fortification of supplementary food, PM POSHAN will help. Also, extra efforts have been there with regard to PM Garib Kalyan Yojana. Challenge in the context of India has been its republic and diversified population. A lot of people have lost jobs during COVID-19. Availability of food doesn’t equate to accessibility. Production of food has increased from 50 million tonnes to 300 million tonnes but the intake of diversified food has been much lower.
Violence against women is definitely one of the most shameful human rights violations. And we know that it knows no boundaries of geography, culture or wealth, and we’ve seen during the COVID time that violence against women has increased manifold. We need to understand the effect of this violence against women and how it’s affecting women’s health. Especially women who are pregnant. It impacts the health of the woman when she’s pregnant and it increases maternal morbidity and mortality. It can lead to abortions. It can lead to so many other mishaps during pregnancy. And when you look at it, at our country how is it that our sexual & reproductive rights are affected. Right from the womb to the tomb. You know, we find the female foeticide, it starts right from when the girl child is there, female child battery, female infanticide, female abortions. And when the girl is growing up, it can lead to child marriages, female genital mutilation, sexual psychological abuse, incest. And as the child is growing up, we now find that even in adolescence & adulthood, there is dating violence, courtship violence, sexual abuse at the workplace. And sometimes, unfortunately these days we find even cyber crime is also increasing. And we find this has a wide impact on the overall health of the woman. That’s the reason why have to actually sensitise our OB-GYNs and everyone at large, that violence affects a woman’s health at large.
I come from a family of strong women. I think Swasth Bharat has to be a Sampan Bharat because women have to join the workforce. They are strong and capable of working. The DNA of Indian women is to put everybody before her. The focus and communication hasn’t been there and that’s a low hanging fruit. It has to be communicated that pregnant mother has to be looked after in terms of health. I know health is a state subject. Every state has to be mandated to do for women’s nutrition. The drive for vaccination has been at the forefront for women and that has been a pleasant surprise. India has the power of large workforce of being economically self-sufficient. In my dad’s village, they did some amazing thing with women that they stopped alcohol. Health and nutrition have to become a natural coexistence for women and I am sure we can do that.
Worldwide malnutrition outcomes are deeply unfair. There are some people who are more malnourished than others. If you want to really transform the first 1,000 days, it starts from antenatal care till 2 years of age of the child. Good nutrition means good life. For a pandemic-free society, you need malnutrition-free society. Good nutrition can bring growth, improve GDP. For the survival and thrive of the child, the first 1,000 days are important. you also need to invest in the second window of opportunity that is adolescent girls. First 1,000 days build the foundation.
Pregnant mothers need one extra meal, rest, regular check-up and good care. Evidence suggests that mental health has bearing on low birth weight. 80 per cent of rapid brain growth happens in the first two years of life. They need one additional meal because in India around 50 per cent of the total children are born with low birth weight. When a child is born, it is very unfortunate that exclusive breastfeeding is around 45 per cent.
There is a lot that we need to do to sustain the habits. A lot of work has been done and more can be done. Since independence we have relied on public health. I think next 75 years should be about empowered consumers. We need to learn from the best. We have great guidelines from WHO and other countries. We need to continue invest in technologies. We work with governments to skill build and train particularly mothers so that they know health requirements of family.
A lot of what was said earlier still applies to rural women. They are not connected to digital solutions, healthcare infrastructure. They live in 7,500 villages in India. All the barriers women have, these women have as well. Rural women have the challenge of infrastructure. Because of the lack of infrastructure in the capital, it is hard to reach. What has been interesting with working with ‘Sahelis’ is that they are ready for change. They have become health champions, social influencers. They have been saying, give us the opportunity to tackle self-care. We can bridge the gap. Our Sahelis are connected with self-help groups. 165 million women are part of this group. These women are saying, give me the tools, I have the technology.
Talking about granddaughter Navya Naveli Nanda’s initiative to raise awareness about women’s health @SrBachchan said, “She found that many women are thrown out of their house when they are on periods.”
Watch #SwasthBharat, Sampann Bharat telethon on t.co/3oUB8pKgxn pic.twitter.com/8HXq9h8HgJ
– Banega Swasth India (@banegaswasthind) October 3, 2021
Sewagram medical college was started in 1969 and the main objective of the medical college was to create doctors for rural areas. We at Sewagram have previous partnerships with the community and healthcare community system. In these villages we work closely with gram panchayat, nutrition sanitation community, women self-help group and many other groups. For students, we conduct three camps. First is when they join the medical college. Our students stay for two weeks in the Gandhi ashram and are taught Gandhian ideology. For each batch of medical students, we also adopt a village. These students come from urban areas and many have not seen a village in their life. this gives them an opportunity to learn about rural life and their needs, their cultural practices, etc. These students follow up with these families even after two weeks. They learn how to persuade individuals, families for a healthy lifestyle. Then there is a third camp when students are in their third year. We expose them to the rural healthcare system. they meet ASHA, ANW and learn from them.
In 50s, my father Baba Amte, though he was a son of a landlord and used to practice law saw a leprosy patient. He got scared. A turning point can come in anyone’s life – he brought that person with leprosy to his home. Leprosy patient in the house was taboo back then. When Baba started this and gained publicity, the most important thing Baba thought about was how to raise confidence among people begging on roads. So he had the policy of work with people. Though handicapped, people could work. In the initial days, everyone boycotted Baba. But after 10 years, a lot of people started coming. Anandvan became a picnic spot. There was a taboo of deformity. Baba’s contribution was to eliminate taboo and increase confidence. He didn’t limit himself to leprosy but also worked for people with different kinds of disabilities.
‘One Health’ is a concept that has been there for decades. It is now catching up. One health relates to the health of animals, plant, the environment and human. Presently, in COVID-19, one health is in which we need to address a lot of issues with regard to both animals and human beings. We have to ensure early detection. It requires leveraging cooperation of public and private sectors. One health is an issue which is now gaining popularity across the world including in India.
We must see that the artists have really suffered. I am talking on behalf of classical dancers, musicians, painters and other people. The world over, the central and state governments come to the help of artisans. These artists have really suffered because these people live on wage to wage, day to day, performance to performance. I would request to think out of the box and CSR (Corporate Social Responsibility) is the way to go. Companies who are not affected by the pandemic largely should come forward. CSR is the key. How you can use CSR for their promotion, propagation. Some companies are doing it but I would urge more to do. When things become normal and artists return to the stage, I would request the government to eradicate income tax, GST from all performing artists.
Challenges are there but my country is fast changing. The fact that I am a part of this panel shows that we are on the cusp of very good change. Talking about change, I have been listening to ‘access’ to nutrition, health, opportunities, etc., for me, access is challenging. Access will come when you focus on accessibility. I would want to talk about access in the mindset of people- where you accept disability, where a person with a disability doesn’t become an outcast. Then also, access to the digital world; are all websites, applications, software accessible? People who have mobility challenges don’t mean they can’t contribute to the economy.
There is acceptance but then the acceptance at times I find tokenistic. The parliament has passed Transgender Act and there is a transgender policy also but the stigma is so high that till today, people begging at streets, signals, or selling their bodies are stigmatized. Even Laxmi is stigmatised. The whole issue of inclusion is a very big question mark. At times I feel that we do not have to be tokenistic but realistic. We have to make entrepreneurs from the community, make them socio-economically stable where they earn themselves with dignity, have access to home. In Delhi, 60 people were employed at Flipkart by kinnar services. Now Flipkart has opened 500 vacancies for trans people. We need to give equal opportunity.
I think what we just saw is a really good example of giving women more access to infrastructure. Women often don’t have enough opportunities. This is why UN Women concentrates on skilling programmes also to support women who dropped out of school or never able to achieve a diploma in a particular work. We have big skilling work. We also look at women farmers, who may not be registered, how can we help them and get access to government schemes. We also work with national and state governments on improving services to gender based violence. Due to pandemic, a lot of women are experiencing more violence. It is very important to bring women into economic development. India could achieve extra 700 billion dollars economic growth if women were into formal sector like men.
Immunisation is clearly one of the most cost-effective interventions when it comes to return on investment from economic perspective. I think we have achieved a lot over the last many years – reduced Under Five Mortality Rate, maternal mortality but still a lot needs to be done. We have introduced a lot new vaccines in regular immunisation like rotavirus, pneumococcal. We have been the pharmacy of the world. We have seen immunisation take a huge hit during pandemic. for future generations, absolutely important for routine immunisation programmes to work continuously.
I do see the informal workforce of India as a link between health and prosperity. 90 per cent of all workers that is 415 million are in informal. They provide ‘roti, kapda, makaaan’, healthcare, transport, waste management services and more. Their main effort is their physical labour. If they fall ill, their earnings stop immediately. If they are hospitalised, they draw their savings and go deeper into debts. Informal workers live off daily earning and do not have health insurance or paid sick leaves. We have to ensure that they are not left behind going forward. We have to recover the economic impact of Covid in a way that informal workers are included.
Kalbeliya Dance which is a part of UNESCO intangible cultural heritage is Kalbeliya community’s way of life
If you look at the present situation and what we have learned in last 75 years, the biggest challenge that we face even now is having a political dialogue and discourse around health. Health is only 40 per cent with the Government of India and 60 per cent with states but how many elections have been fought with the agenda of health? We have had slogans of ‘roti kapda makaan’ but have we ever thought of slogans like ‘swasth, shiksha’? We have seen everyone coming together in GST because there is political will. The same is required for addressing major challenges like malnutrition, public health infrastructure.
Elimination of polio and a few other vaccine preventable diseases is one of the biggest achievements of the India, thanks to the wonderful expansion of immunization coverage. I still remember when I was a young doctor, I used to see many cases of newborn babies with this tetanus, a horrible disease. Maternal and neo-natal tetanus was eliminated thanks to immunization. So was small pox and polio. So, I would really count that as one of the top achievements. The second one would be in the area of maternal and child health. During the MDG era between 2000 and 2015 in particular, but also if you look back 75 minutes, we’ve come a long way in reducing maternal mortality as well as child mortality.
We have to live with the fact that virus is going to stay with us, I don’t think it will ever get extinguished. All we can hope is to build immunity of people so that they don’t get terribly sick. This can be done by blockade of immunity and public health measures like masking. If we do all this, the virus will become less virulent. Many viruses have altered their behaviour to adopt to human community and co-exist. It is our behaviour that determines its behaviour. We should not become careless nor expect that the virus will go away permanently. Everyone should get two doses. but if we don’t have that comfort right now, we should protect vulnerable population. and give one dose to maximum people. but the moment we have vaccines in abudance, we should go for second dose. The variants can develop and creep back.
I think the world and India have discovered that we must give it back into public health. We now discovered that unless we go into preventive measures, into public health, nations won’t be able to improve public health. How do you rediscover and reimagine public health. Example, India has world’s largest healthcare workers – ASHA and Anganwadi. They are future of India. POSHAN Abhiyaan – world’s largest nutrition programme can only work if there is interface between communities. What to eat, when to eat. For me, the story that came out of Covid is that India needs to strengthen public health at tier 3 – panchayat level, district level and state level.
To answer the question that if we will be able to achieve our aim to vaccinate 185 crore people by December end, I would like to say that right now we are at 90 crore. As far as availability of vaccines is concerned, it is sorted. There is no shortage of vaccine. In six months we have seen that we can administer 1-2 crore vaccine doses a day. There are clusters of unimmunized people. There maybe a cluster of people, mohalla who refuse to take the vaccine. They can create a reservoir and further spread the virus.
It maybe perhaps the most important thing – health and hygiene. I think the whole behaviour change towards good hygiene has happened, we tracked it and saw it. Basic hygiene habits and hygiene around the home have improved. WHO and everyone is focusing on it. 40 per cent of diarrhoeal are caused by lack of hygiene. It is our job maybe in next 2-3 years to keep up with basic hygiene habits that have build up.
As we look at the country and world, what Covid has taught us is that how we all are linked not in problem but solution as well. Technology has moved beyond boundaries. We got to think how we are linked with each other. If we do not vaccinate the world, we will not be able get out of this spiral. Health is the foundation of the economy. Health is linked to hygiene. How do we bring everybody along is the heart of what we are trying to do this year.
There is kind of lack of the realisation that we are one planet and we cannot leave anyone behind. COVID-19 has taught a major lesson that we live on one planet. Now, the world knows no borders anymore. For all of us, it’s a lesson that it is one world, one planet and it’s in self interest of everyone to help.
In the last 8 years, along with NDTV and Reckitt, we have been focusing on the importance of sanitation and hygiene, and health. We started by talking about why a clean nation was an important goal, and now we will focus on why a healthy future is dependent upon this foundation.
Two years ago, what began as a respiratory disease in a small part of the world, has today caused a global pandemic. Our world has changed completely forever, it is not the same world we know anymore. Everyone knows the saying – health is wealth.
We as a nation can only thrive when everyone has equal access to cleanliness and sanitation, nutrition, technology, clean environment, and affordable healthcare. We will have to help each other, especially the most vulnerable communities. We need to bring the LGBTQ community, pregnant and lactating mothers, children and tribal population together. We can not leave anyone behind. This is the Sustainable Development Goal, that we aim to achieve by 2030.
“Only a healthy India can be a prosperous India,” said Banega Swasth India Campaign Ambassador Amitabh Bachchan as he kicked off the 12-hour Swasth Bharat, Sampann Bharat telethon.
It Is One Health, One Planet, One Future-Leaving No One Behind
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