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2016 READ:

Although India has done well to be on track to achieve some of the MDGs like
reduced MMR and IMR, there are still many infectious diseases which the system
has failed to respond to. There is also a growing burden of non-communicable
diseases. Incidence of catastrophic expenditure due to healthcare costs is
growing and is now being estimated to be one of the major contributors to

The 12th FYP aims at ‘Universal Health Coverage’, that assures access to a defined
essential range of medicines and treatment at an affordable cost, which should
be entirely free for a large percentage of the population.


Spending on Health: Public expenditure on health in India is very low (about
1% of the GDP) and has remained at this fraction for about two decades now.
Only 9 countries in the world have a lower ratio. In comparison, China spends
2.7% of its GDP, Latin America 3.8, and the world average is 6.5%.

Overall expenditure on healthcare, on the other hand, stands at 4% of GDP
(as against public, which is 1% => private expenditure is 3%, much higher
than public).

The total spending on healthcare in 2011 in the country is about 4.1% of GDP. Global
evidence on health spending shows that unless a country spends at least 5–6% of its
GDP on health and the major part of it is from Government expenditure, basic health
care needs are seldom met.

In addition to this low public expenditure on health, what stands out is that
public expenditure accounts for only 30% of the total health expenditure (world
average: 63%; most EU countries: over 70%). Thus, India has one of the most
commercialized healthcare systems in the world. This is largely a result of
the fact that the country’s public health facilities are very limited, and quite
often, badly run. Even where the health facilities exist, absenteeism rates among
health workers range from 35-58%.

Private health facilities, given their extensive spread, are virtually
unregulated. About 80% of all outpatient and 60% of all inpatient care comes
from the private sector. About 40% of all private healthcare is provided by
informal, unqualified professionals. 72% of all private healthcare enterprises are
household-run businesses, who provide health services without hiring a worker
on a fairly regular basis.

20%). 2. Bihar. which has 43% of its children as underweight. UP. Measles. as measured by the weight-for-age figures (China. Immunization rates: Immunization rates in India are among the lowest in the world for almost all vaccines (BCG.3 beds per 1000 people in 2010.7 doctors per 1000 people (including nurses. problems with the health sector can be summarized as follows: 1.4%. so the effective ratio is much lower 6. the proportion of underweight children was not much lower in 2006 as compared to 1992. Uttarakhand. Healthcare spend is growing at a much slower average as compared to the growth of national income 3. Regulatory system has been partially defined. only 0. Sub- Saharan Africa. DPT. WHO guideline is 3. global average is 2. all national health programmes were doing badly  Thus. Health workforce inadequate. and infrastructure is inadequate. a high proportion of these are also inactive. NRHM was launched to carry out necessary architectural correction in and strengthen the basic healthcare delivery systems  Special focus on 18 states that have weak public health infrastructure/ indicators (north east. and implementation is still laggard 8. one has to go to conflict-ravaged countries like Afghanistan.5. and Iraq etc. OOPS (out of pocket spending) continues to be high 4. There is also a serious issue regarding a lack of improvement over time.6. MP. Infrastructure gap remains substantial (only 1. for example.Malnutrition: No country for which data is available has a higher proportion of underweight children than India. outside Sub-Saharan Africa.2 / 1000). Overall. 63% of these beds are in the private sector) 5. Health indicators like IMR and MMR continue to lag behind global averages 2. NRHM:  Run by Ministry of Health and Family Welfare  It was seen that where human resource capacities are sub-optimal. Polio. logistics are weak. J&K (‘improvement in healthcare infrastructure in demographically backward states and districts’)  Key components: . and Hepatitis B). the NRHM was launched with much fanfare in 2005 by the then new UPA government. to find immunization rates that are lower than India’s. Rajasthan. About 50% of the existing medical workforce does not practice in the formal health system 7. In fact. PPPs haven’t really taken off Amidst this backdrop. Haiti.

nutrition. immunization. gender and demographic balance  Revitalize local health traditions and mainstream AYUSH  Promotion of healthy life styles  Performance:  NRHM has done well in augmenting depleting numbers of health workers in the public health system. and Nutrition  Prevention and control of communicable and non-communicable diseases. decentralized health delivery system to ensure simultaneous action on a wide range of determinants of health such as water. and institutional delivery of healthcare . and safe drinking water through a District Plan for Health  Seeks decentralization of programmes for district management of health  Goals:  Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)  Universal access to public health services such as Women’s health. including locally endemic diseases  Access to integrated comprehensive primary healthcare  Population stabilization. a concept which matches closely with recruitment pattern in private organizations  A village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat  Strengthening of the rural hospital for effective curative care and made measurable and accountable to the community through Indian Public Health Standards (IPHS)  Integration of vertical Health & Family Welfare Programmes and Funds for optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare  Aims at effective integration of health concerns with determinants of health like sanitation & hygiene. nutrition. sanitation & hygiene. community owned. child health.000 ambulances for free emergency response (helping poor households save on transport costs)  Provided cash transfers to over a million pregnant women annually  Across states. and deployed about 20. ASHAs would not be drawing any fixed salary and would be given performance based compensation. education. water.  The thrust of the mission is on establishing a fully functional. and social and gender equality  Provision of a female health activist in each village (ASHA). major increases in outpatient attendance. sanitation.

Over 75% of communicable diseases are not part of existing national programmes National Health Policy 2015:  Aims to achieve universal health coverage by advocating health as a fundamental right. and not to the wider range of health care services that were needed  The National Rural Health Mission was intended to strengthen State health systems to cover all health needs. Over 75% of communicable diseases are outside their purview and only a limited number of non-communicable diseases are covered  Even if ratified by the parliament. adoption by the different states will be voluntary. gaps between the desired norms and actual levels of achievement were worse in high focus states  Inefficiencies in fund utilization.  However. 115010601238_1. poor governance and leakages have been a greater problem in some of the weaker states  Much of the increase in service delivery was related to select reproductive and child health services and to the national disease control programmes. it remained confined largely to national programme priorities  All the disease conditions for which national programmes provide universal coverage account for less than 10% of all mortalities and only for about 15% of all morbidities. it aims to provide integrated health.html ICDS:  India has one of the highest malnutrition rates in the world (43% are underweight. 48% have a lower than average height for age. since health is a state subject. not just those of the national health programme. and 28% infants are born with a low birth weight)  A child’s nutritional status is hard to correct if it is ignored initially. In practice. however. and pre-school education services to children under 6 through local anganwadis .5% over the next 5 years (public + private is at about 4% currently)  Problems: Currently. which account for less than 10% of all mortalities. given the extent of illiteracy and counter-productive social norms in many areas in India. national programmes provide coverage only with respect to certain interventions such as maternal ailments. whose denial will be ‘justiciable’  Aims to increase public expenditure on health from the current 1% of GDP to 2. adoption might not be uniform across the country. care of young children cannot be left to the household alone  ICDS is the only national programme aimed at children under 6 years of age. and that sort of defeats the purpose  Read: http://www.

in states where ICDS is managed well. this model gives the government an easy opportunity to shrug its shoulders and further wash its hands off the responsibility of providing public health services . ICDS tends to be starved of resources. AWCs atleast open regularly and have an active ‘supplementary nutrition programme’. which entitles the beneficiaries to Rs.000 (maximum annual expenditure for a family of five) of healthcare in an institution of their choice. attention. to reach out to children under 6 Amidst these faltering moves towards consolidation of India’s public health services. Even in not so well-run states (such as Rajasthan. there are several reasons to be deeply concerned about this healthcare model:  Efficiency issues: Since the government will pay the insurance premium. BPL families are enrolled with private insurance companies  Government pays the insurance premium. country-wide infrastructure that makes it possible. there are also developments towards an ever-greater reliance on private provision of healthcare and private insurance. However. even though various major diseases such as cancer. and consider any spending on it to be wasteful  However. Chhatisgarh). whereby the bulk of healthcare is purchased for cash from private providers  Evaluations show that RSBY has gone some way towards increasing the usage of institutional healthcare by the most deprived sections of the population  Despite its attractive sounds. now handled by Ministry of Health and Family Welfare  Under this scheme. and political support  Several people criticize ICDS as a failure. results aren’t all bad  Results show that regardless of how they are run. UP. diabetes etc. 30. This means that India has a functional. it has shown rather good results. in theory. neither the insured patients nor the healthcare providers will have any incentive to contain costs  Accessibility issues: Far-flung rural areas are unlikely to have easy access to quality private healthcare. to be picked from a given list  The scheme is funded in a 3:1 ratio by the central and state governments  RSBY is certainly an improvement over the existing Out-of-Pocket-System (OOPS). This will happen. can be best dealt with by early. pre-hospitalization treatment  Targeting issue: how to identify BPL families?  Further. even with insurance  Distortion issues: Commercial health insurance is likely to be biased against preventive healthcare and towards hospital care. as can be seen by the championing of Rashtriya Swasthya Bima Yojana (RSBY): RSBY:  Was initially handled by Ministry of Labour.

 Other issues included a multiplicity of similar schemes run by various state governments. despite all evidence. the government should run regular information campaigns to inform the citizens about benefits of a health local environment  Secondly. low awareness among beneficiaries about when to use RSBY. in principle. village-level health workers.  Modi government has decided to ban private insurers from RSBY now. rest choose private healthcare providers (many of whom are underqualified)  He says best solution is cash transfers . that India’s transition to good healthcare can be easily achieved through private healthcare and insurance. routine healthcare. medical and public health cadres of services were also merged into a single cadre  This has resulted in neglect of public health services in favor of medical services in India. and most developed countries contribute to well over half of the national health expenditure  Need a renewed focus on PHCs. denial of services by healthcare providers etc. care involving hospitalization or outpatient surgeries. only public sector insurers will be allowed under the scheme Reforms (Sen and Dreze):  We need to stop believing. and minor injuries that are widespread and do not cost very much to treat per episode  Panagariya says government has tried to provide healthcare of this kind to people via PHCs for 50-odd years. and oversight of the health system  Public Healthcare:  Public healthcare system in India is biased towards allocation of health expenditures in favor of medical services rather than public health. human resources. cough. this hasn’t happened anywhere in the world. and there’s not much to show for it (only 20% of rural patients seek routine outpatient care at PHCs. fever. FSSAI (Food Safety and Standards Authority of India) needs to be made more effective  Routine Healthcare:  This includes ailments such as cold.  We need to devote much more resources as a proportion of GDP to public expenditure on health Bhagwati and Panagariya:  Reforms are necessary in 5 key areas: public health. establishment of a separate agency entrusted with public health services with its own separate budget should help boost the provision of these services  Additionally. later. preventive health measures etc. this is a result of the post-independence decision to merge the medical and public health services into a single department.

A host of socio-economic factors like illiteracy.000 women die during childbirth annually. and infants. drugs etc. Maternal Mortality Rate (MMR) has declined from 600 in 1990 to 178 in 2010 (highest declines have been seen in the post JSY period)  Janani Shishu Kalyan Yojana was launched in 2011 to provide service guarantee in the form of entitlements to pregnant women. child marriage. RSBY is on the right track here.RMPs) are under-qualified  Replacing them all with ‘proper’ MBBS doctors might not be feasible in the short run.  Human Resources:  Many of the unregulated private sector healthcare practitioners (Rural Medical Providers. but maybe we can run one-year accreditation courses  Simultaneously. contribute significantly to this Regulation: The Government’s regulatory role extends to the regulation of drugs through the CDSCO. diagnostics.  Major Illnesses are perfect candidates for insurance. diet. low awareness etc. support to the regulation of professional education through the four professional councils and the regulation of clinical establishments by the National Council for the same. about 50. home deliveries  Is a part of NRHM  Largely as a result of JSY. sick new borns. facilities include free transport to and from health centers. need to loosen the stranglehold of the Medical Council of India over new medical institutions in the country Government Schemes Janani Suraksha Yojana:  Was launched in 2004 to promote institutional deliveries as against traditional. . the regulation of food safety through the office of the Food Safety and Standards Authority of India. for free  Despite all this.