Health Status of Madhya Pradesh :

In terms of demographic and health status, Madhya Pradesh ranks below the national average for key health indicators. Although classified as an Empowered Action Group state, Madhya Pradesh has the highest infant mortality rate in the country, after Assam. The Empowered Action Group (EAG) was set up by the Ministry of Health and Family Welfare to facilitate the preparation of area specific programs in eight states – Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Orissa, Rajasthan, Uttar Pradesh, and Uttaranchal – that have lagged behind in containing population growth to manageable levels.

The infant mortality rate is a major cause for concern. The discrepancy between the Sample Registration Survey estimate and the Annual Health Survey estimate seems to indicate that the infant mortality rate is either stagnant or worsening. The under five mortality rate of fifty four per thousand live births also falls short of the targeted child mortality rate in the state. The state is making slow but steady progress. 

The maternal mortality ratio has also declined over recent years, to 230 per one hundred thousand live births. Despite this decline, the ratio is still higher than the national average of 178. The declining sex ratio is also an area of concern for Madhya Pradesh.

Many underlying factors account for the high mortality rates in mothers and infants in Madhya Pradesh. These factors include the lack of available human resources in the state, the shortage of health specialists, the high malnutrition rate, lack of awareness of entitlements and healthy behaviors, particularly among the rural population, and poor access to health services. Lack of facilities to address serious cases at district or block levels and the poor referral system in public hospitals are also factors.

Panna and Satna districts are the poorest performing districts in the state. The maternal mortality rate was 397 in Panna and 336 in Satna. The infant mortality rate, neonatal mortality, and under five mortality rate have declined significantly over the years.

Compared to other districts, immunization coverage in Panna district is low. Only 38.4 percent of children aged twelve to twenty three months are fully immunized, with forty seven percent in urban and thirty six percent in rural areas. Satna also performs poorly in terms of immunization coverage. The district reports that 54.7 percent children receive full immunization. The low rates can be attributed to the difficult geographical terrain, low monitoring and supervision in immunization programs, lack of awareness, cultural issues, and challenges with supply and cold chain in vaccine delivery.

Health Service Delivery :

The uptake of services is better in Madhya Pradesh than in other Empowered Action Groups states. Use of services, particularly of maternal and child care, has been steadily improving in the state. To reduce maternal mortality, some critical aspects of service usage need to be addressed. The data indicate that seventeen percent of women continue to deliver at home. Of those who delivered in an institution, about 21.8 percent stayed at the institution for one day or less following delivery.

Only 16.2 percent of women received full antenatal care, five checkups, with disparities between urban and rural women. More than eighty percent of rural women consumed no iron and folic tablets or syrup for one hundred days of gestation or more. Most rural women had received more than two tetanus toxoid injections. Only 58.1 percent of children age six to thirty five months had received at least one dose of vitamin A, and only 12.7 percent had received the second dose. Overall, health and nutrition indicators for children, particularly newborns and those younger than three years of age, need attention. A third of children younger than five are underweight, and two thirds are anemic. Only about one third are breastfed twenty four hours after birth, indicating a failure of the awareness and counseling program. More than half of married women in the state are anemic. The impact of nutritional status and feeding practices in health outcomes is well recognized and needs to be addressed.

Health Infrastructure and Human Resource Availability :

Health infrastructure and availability of human resources are major concerns in the state. Madhya Pradesh has a shortage in actual human resources relative to the number of sanctioned positions. This shortage is forty two percent in primary health centers, thirty three percent in community health centers, and twenty eight percent in subcenters. The state is relatively sparsely populated, with an average population density of 196 per square kilometer, compared to the country average of 274 per square kilometer. Madhya Pradesh is the second largest state in the country and accounts for 13.5 percent of the total area of India. The state is organized into small hamlets fragmented throughout the state. This geographic arrangement makes it difficult to position and develop health centers in the state.