Barriers to accessing treatment for childhood pneumonia

Despite making compelling public health sense to integrate pneumonia prevention, treatment and care services in public sector healthcare facilities as childhood pneumonia is a leading cause of mortality for children below 5 years of age, the reality remains grim. Not only healthcare services in public sector lack quality standard prevention and treatment services but also there is a lack of guidelines so that pneumonia related services can be uniform in private and public healthcare services.

For example, effective pneumonia vaccines are not included in the government-run immunization programme and not provided free in the public sector healthcare facilities. However in private-sector healthcare facilities in some instances high quality pneumonia prevention, treatment and care services are provided at a very high cost which is clearly unaffordable for majority of children who come from poor families and paradoxically are likely to be at higher risk of pneumonia (and least likely to access existing pneumonia services).  In public sector healthcare facilities, pneumonia treatment is available and in some instances competence of paediatricians and other attending healthcare workers is unparalleled. However in Gorakhpur and other smaller towns and nearby villages, the reality check presents an appalling picture.

Said a nurse in a government hospital in Gorakhpur: "Children with pneumonia reach this hospital so late because of poor awareness, lack of resources to go to a city hospital or other reasons. On the first instance usually people either self-treat pneumonia or go to their local pharmacy or doctor. By the time they reach us the child is mostly in a serious condition."

 Said Indravati, a slum resident: "Although my grandson got treatment for pneumonia in government hospital but we went only when there was no response in his condition at the local clinic. Also the cost of going to the hospital which is about 15 km away, leaving our daily labour work, missing out on our daily wage, and attending to the child in the hospital is prohibitive and makes it very difficult for us to access such services upon first instance of symptoms. Usually when nothing else is working we go to the big government hospital. Why else will we go there?"

She is right. Why are healthcare workers in local primary healthcare centre not well equipped to treat pneumonia? Why is pneumonia vaccination not being provided in the national immunization programme run by the Government of India? Why is pneumonia which is preventable and curable - allowed to become the single largest cause of childhood mortality for children below the age of 5 years?

Let us hope that the government's Planning Commission that is currently preparing the 12th Five Year Plan (2012-2017) reviews the immunization programme and integrates pneumonia vaccination as well.

 Jitendra Dwivedi – CNS
(Translation: Bobby Ramakant – CNS)