From an IMR—a measure of how many die within the first year for every 1,000 live births—of 33 in 2004-09 , Delhi has progressed at a crawl to touch the current IMR of 28. The Delhi Human Development Report (DHDR) 2013 pointed out that much larger states like Maharashtra and Tamil Nadu had achieved IMRs of 25 and 22 respectively despite having substantial rural populations, higher levels of poverty and a less intensive network of public health infrastructure. In the Delhi Development Goals set in 2006, the target was to achieve an IMR of 15 by 2015.
Segregating infant deaths shows that most happen in the early neonatal period (up to seven days after birth). The decline in postneonatal (28 days to one year) deaths, has been cut by 62%, compared to declines in neonatal (less than one year) and early neonatal deaths of 35% and 26% respectively. The major reasons for this scenario have been identified as inadequate neonatal care in health facilities and the significant proportion of deliveries still happening at home-—about 20%—which kept women out of the coverage of essential maternal health services. The report argued for urgent efforts to ensure improved coverage of maternal and child health services in Delhi.
Despite substantial expansion of public health facilities in Delhi, the public health system is still hobbled by the lack of adequate facilities at the primary level and skewed distribution and shortage of health personnel . Yet, the Perception Survey carried out for the DHDR revealed that across different socio-economic groups a large chunk used the public health system, the proportion varying from over 75% in low income groups to 45% in high income groups.
According to the survey, people liked public health facilities for affordable cost of treatment, effectiveness of the treatment and competence of doctors and staff. However, people were most dissatisfied with the overall cleanliness of public health facilities and the level of courtesy and friendliness of doctors and staff, long waiting time and lack of privacy or overcrowding during consultation.
Interestingly, six in 10 respondents were unhappy with the waiting time in private facilities, too, and a good proportion of them considered the cost of treatment too high in the private sector. The private sector definitively scored over public facilities on overall cleanliness and the bedside manners of doctors and staff.
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