India is the home of one sixth of the world’s population occupying less than 3% of world’s area. India is fast growing raising to the status a major economic power in the world. On its march towards development India has recorded many achievements in different fields. India’s progress in the health care system has made significant progress over the last fifty years. A close look at the Health Care System of India will provide clear picture of the status of health care in the country.
India has achieved substantial progress in its health indicators. Life expectancy has gone up, infant and maternal mortality has come down. The progress of the National Health Programmes is improving year after year. However, the progress and development is not equal all over the country. It is quite uneven. Some states have made wonderful progress in health care services whereas some others are lagging behind. In some states it is shockingly dismal.
India has witnessed higher economic growth rate in the recent past. The GDP growth rate is more than 6.1 percent and it is aimed at 8 per cent in the present five year plan. However, India’s rank in the UNDP Human Development Index is 126th among 177 countries. Similarly, in terms of UNDP Gender Development Index (GDI) India occupies 96th position among 177 countries. In spite of these, India has registered a positive trend in both increasing life expectancy decreasing the infant mortality rate. India has the life expectancy of 63 years for men and 67 years for women. Infant mortality rate has also declined to 57 out of 1000 births in 2006 from 80 in 1991. The literacy rate has increased to 65% in 2001 from 52% in 1991. These do have a positive impact on improving the health conditions in the country. Keeping the Millennium Development Goals (MDG) as target, India has made some improvements.
The major health problems
According to the report released by World Health Organization, India is facing major challenges in the health care. The major problems are Cardio-vascular diseases with a prevalence of 3422 out of 100,000 (2005), Diabetes prevalence of 2792 cases out of 100,000 population. HIV prevalence is about 910 cases among 100,000 among the people who are in the group of 15-49 years of age. Among the children health problems are Diarrhoes, Anemia are the major health problems. Nutritional problem is the major one among children.
Human resources for health
According to the available data there are 503,900 physicians in the country giving a ration of 5.2 per 10000 populations. The number of registered is around 600,000. In the last decade the number of medical colleges has increased with undergraduate and post graduate courses in medical sciences. The medical education in India has got reputation for its high standards. India has a rich pool of talented physicians. All India Institute of Medical Sciences is the premier national medical institution supported by a number of medical colleges all over the country. The high demand for the admission into the medical colleges reflects the demand for good doctors. Medicine is one of the most opted courses for students in India.
Financial Resources for Health
The total health expenditure is just 5.1% of GDP which is very low by any standards. Out of this public expenditure is 18% in the total expenditure on health. The government expenditure on health is 5.6% as a percentage of its total government expenditure. Though the budget outlay for the medical expenditure is growing gradually, it not sufficient to meet the medical needs of millions of poor people. India is most privatized health markets in the world. It is estimated that nearly 20 million people are falling below the poverty line each year because of indebtedness due to healthcare.
India has witnessed the construction of huge infrastructure facilities over the years. At present the government is concentrating more on consolidation and optimization of the facilities it has already created since 1990. It has set up to have one female health worker and one male health worker for a population of 5000 in the rural areas. At the Primary Health Centers, one medical officer and other paramedical staff are appointed for a population of 20,000 including hilly and tribal areas and other backward areas.
The Community Health Centers have hospitals with 30 beds and basic specialties for a population of 80,000 to 120,000. These hospitals are plagued with problems like the shortage of skilled health workers, poor infrastructure facilities and in some cases lack of enough medicine supplies. The mounting costs of construction have forbidden the further construction of new buildings for these hospitals. It should be noted that nearly one quarter of population are living in the urban areas. Out of these nearly 40% of people are living in metropolitan or large cities. Most of them are slum dwellers without proper medical care.
There is no study conducted on the availability of drugs and essential medicines at the Primary Health Centers and Community Health Centers. The government has developed a list of 300 drugs for use at different levels of health care. The list serves the base for procuring those medicines by the state and central government hospitals. Many of the drugs in India are available at a low cost and government has declared price control over 78 essential drugs. In addition to these, various international organizations like the UN agencies WHO and the World Bank have come forward for a partnership with the public health services.
Corporate and Private Hospitals
As mentioned above, India is a huge market for medical services. There are excellent service providers in the health care industry. The Apollo Hospitals and other corporate hospitals have advanced the medical services in India especially in Metro India. The hospital facilities match the best in the world and have gained a reputation for high quality medical service.
The System of Health Governance
The country has most organized health administrations. The Ministry of Health & Family Welfare comprises two departments:
- Department of Health & Family Welfare
- Department of AYUSH (Ayurvedic, Unani, Siddha and Homeopathic Medicines)
The Department of Health & Family Welfare gets technical support from the Directorate-General of Health Services. These departments supervise health at the central level. The state governments have also got their own Ministry of Health and Family Welfare. In India, health comes under both Central and State Governments; hence both the governments have set their own health administrative systems.
Directorate of Health Services provides technical assistance. Some states have a separate Directorate of Medical Education & Research. Some states have got different directorates for Ayurvedic, Unani and Homeopathic Medicines. Urban areas have nearly 3,500 urban centers and 12,000 hospitals in the public sector. The private hospitals and nursing homes and private practitioners also provide good medical service. At the district head quarters the district hospital and medical college hospitals provide referral care. A large number of health facilities are run by industry for their employees. For example, the railways have their own network of hospitals.
In the organized sector workers are covered by Employees State Insurance,
- Central government staff members are covered under the Central Government Health Service Scheme. In addition to these there is a strong force of more than 7000 Voluntary
- Organizations working in the area of health care.
Who pays for health care?
Indian health care system is still in the process of development. The hospital bills are mostly paid by the people directly from their pockets. The health insurance coverage has not spread widely across the country. It is only in the organized sector like the government employees and corporate employees are covered under health insurance schemes. Their medical bills are paid either by their organization or the insurance companies. According to the WHO reports, nearly 75% of the expenditure is met by private sources only. Out of these 70% is borne by the households and 6% by the corporate sector. Social security is popular only in the organized sectors. Nearly 40% of the hospitalized Indians either borrow heavily or sell their assets to meet their medical expenditure. This clearly illustrates the lack of proper medical planning by the people in India.
Reforms and achievements in health system
There are many programs that are run by the government in providing better health care to the people. A series of policies have been designed and introduced to address the health problems of millions of people. The revised National Health Policy (2002) and the National Policy on Indian System of Medicine and Homeopathy (2002) are the most important.
These policies are intended to accelerate the decline in infant mortality and childcare. The recent announcement of National Rural Health Mission to improve the availability of and access to quality health care by the people, especially those residing in rural areas, the poor, women and children. For effective monitoring of the system the Ministry has set up a task force under the Chairmanship of the Director –General of Health Services to review and streamline the health information with the feedback mechanism.
The Ministry of Health and Family has collaborated with the World Health Organization to document every reform process in health care sector. The Public Health Foundation of India was recently launched to focus on management of health rather than of disease. It is aimed at filling the gap in human resources appropriate for the health problems India is facing. This is a good example of public private partnership.
The health system has recorded certain great achievements. The most notable among them are the marked increase in the literacy rate, the gradual decline or disappearance of gender disparity. The decline in the under five mortality rate is one the commendable achievements.
Constraints and challenges
Shortage of funds is the major constraints for the Indian Health Care System. It is very clear from the annual budget allocation for Health and Family welfare. It is just around 5% of the GDP which is not at all sufficient for meeting the medical needs of millions of people. In Indian Health Care System, it is the private sector that is largely financing the health care. The non availability of funds is the main reason for the lack of proper facilities in the state run hospitals.
As a result, the provision of essential drugs and medicines also remain inadequate. In addition to the financial constraints, there are certain other things which play an important role in the health care. It is the gender disparity. It is very in almost every segment of health. The inadequate budgets and the high pressure to achieve targets have affected the Primary Health Centers. The narrow spaces and the small rooms converted into labs and labor rooms and sometimes into operation theatres make the atmosphere unhygienic and unhealthy.
It is note worthy that some people in the states of Orissa and Madhya Pradesh could not get any medical aid because of the location of the hospitals. The utilization of the facilities is not optimum. They are under utilized as there is no required skilled man power to use those facilities. The general tendency of negligence and carelessness lead to ineffective implementation of rules and code of conduct which seriously affect the work at the hospitals.
Among the challenges nutrition is a major one. The babies born are underweight and some are stunted in their growth. Nearly three out of four children suffer from anaemia. Anaemia is prevalent in women as well. Unless this problem is addressed there will not be much improvement in the child health system. Nutrition is the biggest challenge that needs to be addressed immediately. Child mortality is still not under control, though there are some signs of improvement. There is an immediate need to change the plan in reducing the child mortality in order to meet the Millennium Development Goals. Infections, diarrhoeal are the most prevalent diseases among the children. This has to be overcome in order to improve the condition in the mortality rate.
The habits of the people and their life style also affect the health of the people. Tobacco and alcohol addicts are increasing in number day by day. They have ruined many happy and healthy lives. The lack of enough physical activity is causing obesity and the fast food culture are affecting the general health conditions of the people. The lack of exercise and the junk foods are leading to coronary problems in the heart. The various programs and projects of the government have not given the expected results as there is a big gap between planning and implementation of these projects. This could be due to lack of enough man power and general indiscipline. The number of doctors and medical staff is very low for a given population of 1000. The condition of the deprived people in the rural areas is worse than it is in the small towns.
Lack of accountability is a major reason for the Indian public health system. The public hospitals have lost their reputation as the places of medical service. The productivity of the public health sector has been dismal. The idea of private partnerships has come into vogue, but it has not taken any proper shape yet. In India, 80% of the curative care is provided by the private hospitals and nursing homes which are run by private practitioners. As the private hospitals charge huge amounts they have become places beyond the reach of common people. It is only the rich and the above middle class people who are able to afford the treatment at these private hospitals and corporate hospitals.
Among the medical practitioners in India, 45 % of the registered doctors are allopathic doctors. The allopathic doctors are located in towns and cities and their services are available only for those who can afford. The non-allopathic doctors like the Homeopathy and Ayurvedic doctors are located in small towns and villages. It is doubtful whether every private nursing home or hospital is a registered one or not.
The private hospitals are playing a key role in administering immediate medical treatment. As they are located in towns and cities people who need their services come to their place to get treatment. According to the latest estimate almost 70 % of hospitals are in the private sector only. Nearly 40% of beds are in urban areas under the private sector hospitals. The private sector hospitals unlike the government hospitals provide only curative care.
The private sector hospitals are highly commercial and there is no regulation over them. In the absence of any regulatory mechanism, the private sector hospitals are minting money exploiting the innocence and ignorance of millions of people.
“India’s performance is poor even among the low and middle income countries in the region. Even based on conservative estimate of 407 maternal deaths per 100,000 by Sample Registration System in 1998, more than 100,000 women die of pregnancy related causes every year in India, which was about 18 percent of global maternal deaths.” (WHO)
The health care system is still in the early stages in India. The picture of health care system in India is disappointing in many areas, though it has shown progress in some areas. The health care system is in a transitory stage and it requires to be streamlined. However, the picture is not altogether bleak and hopeless. The growing number of medical colleges and hospitals and the increasing number of students who are pursuing medicine keep the hopes of the country alive.
The goal is to achieve optimal health for the people, which would allow them to lead socially and economically productive lives. The health care system envisaged would have a public-private mix, with the latter encouraged to take a greater share of secondary and tertiary health care services. (WHO)
- India – National Health System Profile http://www.searo.who.int/LinkFiles/India_CHP_india.pdf