India’s public spending on health as a proportion of GDP is among the lowest in the world. As a result nearly 80 per cent of the health expenditure in the country continues to be in the private sector, which is unregulated
Mohuya Chaudhuri
http://www.tribuneindia.com/2014/20140327/edit.htm
Overburdened: Quality of services provided at health centres remains abysmally poor. Tribune photo
INDIA may be growing rapidly as an economic giant but in the health-care sector it continues to lag way behind many developing nations. In the last few decades, the government spending on health has remained static at close to 2 per cent of the GDP. Even when the country witnessed economic growth to the tune of 9 per cent, spending on health was abysmally low, despite multiple promises made by successive governments to improve it.
The impact has been on health services and quality of care, which continue to be suboptimal. The main challenges are absence of affordable medicines in the public health system as well as poor availability and access to health centres. Families have to travel long distances to access health care and often return without receiving help because there are no doctors. This has forced them to turn to the private sector. Even today, nearly 80 per cent of the health expenditure in India continues to be in the private sector, which is unregulated. Cost of care has increased exponentially and the public is grappling with the burden. It is estimated that each year more than 4 crore people are driven to poverty due to healthcare expenses.
Reproductive health
Much of the modest increase in public spending on health was channeled into the National Rural Health Mission (NRHM). So far, it is the first major national effort to strengthen the health system. In the past decade, there have been marked improvements in the reproductive and child health care. While infant mortality rate (IMR) has declined to 42 per 1000 live births, it is still higher than Bangladesh, where IMR is 33. Maternal mortality rate (MMR) has only dropped from 212 to 178 in 2013. In comparison, the MMR rate in other South Asian countries like Thailand is 48 and in Sri Lanka it is 35.
Despite the fact that NRHM did scale up infrastructure across the country and hired more frontline personnel in low performing states, the goal of achieving universal health care is still a distant dream.
Since it has not been able to reach the most impoverished, marginalised and underserved communities, the gains have been partial. Currently, though institutional deliveries have gone up to 80 per cent yet there are serious concerns about the quality of services provided at health centres. Often women do not return for the next delivery.
Three quarters of maternal deaths are reported in rural areas in states where Empowered Action Groups (EAGs) have been set up and as many as two-thirds of women die seeking some kind of health care.
Malnutrition and vaccination
The figures are even more daunting when it comes to malnutrition and reduction of disease burden, both in communicable and non-communicable diseases. Nearly 48 per cent of children under five are malnourished and even though 70 per cent of children are immunized, nearly one third of children below five, a majority of them belonging to poor communities do not receive vaccines at all. Nearly 15 lakh children under five die every year, mostly due to preventable diseases like measles, pneumonia and diarrhoea. In rural areas, lack of diagnostic labs and non availability of simple medicines like antibiotics leads to much higher mortality rates among infants. The gender bias is still a major challenge. Apart from female foeticide, female infanticide is raising its head once again. Cases of newborn girls being killed in some or the other part of the country are being reported. Besides, fewer girls seek care at facilities. The government needs to prioritise and address these issues urgently.
While there are success stories, such as the eradication of polio, which plagued the country for decades, the government has also had to contend with frequent outbreaks of dengue, Japanese encephalitis, H1N1, Swine flu, drug stock-out for Tuberculosis, controversies over vaccines as well as huge shortage of health personnel across states. As the system continues to grapple with these challenges, new ones are appearing on the horizon.
Misuse of financial schemes
In rural areas, government schemes such as Janani Suraksha Yojana (JSY), and Rashtriya Swasthya Bima Yojana (RSBY), meant to provide financial support to families belonging to the lower economic strata, are being misused in some pockets. In Rajasthan, there have been reports of female infanticide being committed to benefit from JSY funds while in states like Andhra Pradesh, Gujarat, Rajasthan, Chhattisgarh and Bihar, increasingly young women, a majority of them below 35 years, are being made to undergo un-indicated hysterectomies by heath-care providers also to avail RSBY benefits. Clearly, instead of limiting the entitlement only for treatment, health insurance schemes should provide overall health cover for families.
The health system continues to fail the public in many more ways. In rural areas, a large number of health centres are non-functional. So, families are forced to turn to the private sector, which only increases their financial burden. Health related debts are phenomenal in India. Many farmer suicide cases in states like Uttar Pradesh and Madhya Pradesh are related to health expenses. In the unregulated private sector, there is growing instance of unethical practices.
Role of MCI
Doctors often advise interventions to patients, many of which are not required. Patients do not question these decisions since they trust doctors implicitly.
Ironically, bodies like the Medical Council of India (MCI), which is meant to regulate and prevent medical malpractices is itself embroiled in controversies. Ketan Desai, debarred from practicing medicine after several FIRs and two charge sheets were filed against him is aggressively being pitched to be included in the MCI once again. Former Union Health Secretary, Keshav Desiraju, who opposed the decision, was unceremoniously removed from the department in order to facilitate the process. All the progressive plans to strengthen the system planned by him are now on hold.
The net result, the government’s promise of providing Universal Health Coverage is still a distant dream. Meeting the Millennium Development Goals too does not appear possible given the current environment of stasis.
As the country moves closer to the next general elections, political parties, driving their campaigns based on the development model need to take the public health-care agenda seriously because health of the citizens is central to any development model.
Equitable health care
The pursuit of equity in health and health care has been the key feature of health policy in India. But if transformation has to take place, all political parties must rise above party lines and ensure equitable health care for the country. The gaps between communities, especially rural and urban, must be bridged so that those who cannot access the services can do so without having to depend on the private sector and sink deep in debt.
Promises made in the past have remained unfulfilled – most of them are on the backburner, yet to be implemented on the ground. Provision of free medicines for all is still not a reality.
Besides, there is a huge communication gap in the system. Key messages and information related to health and services often do not reach its beneficiary -- the economically weaker sections of society, both in rural and urban settings.
The media, a critical player in disseminating information, continues to steer away from health related issues. It needs to play a bigger role in mediating between the state and the people, if change is to take place.
Messaging between healthcare workers and the community need to be shaped contextually, since it plays a key role in boosting demand and therefore accessing health care at the right time. Prevention must also be factored in along with the provision of quality treatment and care.
The new government must take several key steps for health care in India to transform.
Health budget
Health spending has to increase significantly if the system is to function optimally. The focus has to be in rural and underserved areas where there is an enormous need for better health-care services. Free medicines must be made available at all health centres and, most importantly, medicine stock-outs that are routine at the village and district level must be addressed urgently by a well-chartered monitoring system.
To meet the human resource crisis and to reduce the private sector’s dominance over medical care, more medical colleges, nursing schools and institutions to train frontline workers need to be set up by the government quickly. At the state level, governments must earmark enough funds to hire requisite staff at all levels, from sub-centres to district hospitals, to ensure timely and better delivery of health care. Regulating the private sector and medical malpractices is of paramount importance to end the commercialisation of health care in India.
Under the Constitution, every individual has the right to life and the right to good health. Just like Right to Education and Right of Food is now part of the democratic frame work, the next government must incorporate and implement Right to Health, if India is to achieve its goal of leading globally in the sphere of development.
The writer is an independent journalist.
Adding to the woes
Several flagship programmes such as Janani Suraksha Yojna (JSY), Janani Shishu Suraksha Karyakram (JSSK) and Indira Gandhi Matritva Sahyog Yojna (IGMSY) end up focusing on the same beneficiaries.
Nearly 15 lakh children under five die every year, mostly due to preventable diseases like measles, pneumonia and diarrhoea.
Close to 50 per cent of children under the age of five are malnourished.
Even though 70 per cent of children are immunized, nearly one third of children below five, a majority of them belonging to poor communities do not receive vaccines at all.
Mohuya Chaudhuri
http://www.tribuneindia.com/2014/20140327/edit.htm
Overburdened: Quality of services provided at health centres remains abysmally poor. Tribune photo
INDIA may be growing rapidly as an economic giant but in the health-care sector it continues to lag way behind many developing nations. In the last few decades, the government spending on health has remained static at close to 2 per cent of the GDP. Even when the country witnessed economic growth to the tune of 9 per cent, spending on health was abysmally low, despite multiple promises made by successive governments to improve it.The impact has been on health services and quality of care, which continue to be suboptimal. The main challenges are absence of affordable medicines in the public health system as well as poor availability and access to health centres. Families have to travel long distances to access health care and often return without receiving help because there are no doctors. This has forced them to turn to the private sector. Even today, nearly 80 per cent of the health expenditure in India continues to be in the private sector, which is unregulated. Cost of care has increased exponentially and the public is grappling with the burden. It is estimated that each year more than 4 crore people are driven to poverty due to healthcare expenses.
Reproductive health
Much of the modest increase in public spending on health was channeled into the National Rural Health Mission (NRHM). So far, it is the first major national effort to strengthen the health system. In the past decade, there have been marked improvements in the reproductive and child health care. While infant mortality rate (IMR) has declined to 42 per 1000 live births, it is still higher than Bangladesh, where IMR is 33. Maternal mortality rate (MMR) has only dropped from 212 to 178 in 2013. In comparison, the MMR rate in other South Asian countries like Thailand is 48 and in Sri Lanka it is 35.
Despite the fact that NRHM did scale up infrastructure across the country and hired more frontline personnel in low performing states, the goal of achieving universal health care is still a distant dream.
Since it has not been able to reach the most impoverished, marginalised and underserved communities, the gains have been partial. Currently, though institutional deliveries have gone up to 80 per cent yet there are serious concerns about the quality of services provided at health centres. Often women do not return for the next delivery.
Three quarters of maternal deaths are reported in rural areas in states where Empowered Action Groups (EAGs) have been set up and as many as two-thirds of women die seeking some kind of health care.
Malnutrition and vaccination
The figures are even more daunting when it comes to malnutrition and reduction of disease burden, both in communicable and non-communicable diseases. Nearly 48 per cent of children under five are malnourished and even though 70 per cent of children are immunized, nearly one third of children below five, a majority of them belonging to poor communities do not receive vaccines at all. Nearly 15 lakh children under five die every year, mostly due to preventable diseases like measles, pneumonia and diarrhoea. In rural areas, lack of diagnostic labs and non availability of simple medicines like antibiotics leads to much higher mortality rates among infants. The gender bias is still a major challenge. Apart from female foeticide, female infanticide is raising its head once again. Cases of newborn girls being killed in some or the other part of the country are being reported. Besides, fewer girls seek care at facilities. The government needs to prioritise and address these issues urgently.
While there are success stories, such as the eradication of polio, which plagued the country for decades, the government has also had to contend with frequent outbreaks of dengue, Japanese encephalitis, H1N1, Swine flu, drug stock-out for Tuberculosis, controversies over vaccines as well as huge shortage of health personnel across states. As the system continues to grapple with these challenges, new ones are appearing on the horizon.
Misuse of financial schemes
In rural areas, government schemes such as Janani Suraksha Yojana (JSY), and Rashtriya Swasthya Bima Yojana (RSBY), meant to provide financial support to families belonging to the lower economic strata, are being misused in some pockets. In Rajasthan, there have been reports of female infanticide being committed to benefit from JSY funds while in states like Andhra Pradesh, Gujarat, Rajasthan, Chhattisgarh and Bihar, increasingly young women, a majority of them below 35 years, are being made to undergo un-indicated hysterectomies by heath-care providers also to avail RSBY benefits. Clearly, instead of limiting the entitlement only for treatment, health insurance schemes should provide overall health cover for families.
The health system continues to fail the public in many more ways. In rural areas, a large number of health centres are non-functional. So, families are forced to turn to the private sector, which only increases their financial burden. Health related debts are phenomenal in India. Many farmer suicide cases in states like Uttar Pradesh and Madhya Pradesh are related to health expenses. In the unregulated private sector, there is growing instance of unethical practices.
Role of MCI
Doctors often advise interventions to patients, many of which are not required. Patients do not question these decisions since they trust doctors implicitly.
Ironically, bodies like the Medical Council of India (MCI), which is meant to regulate and prevent medical malpractices is itself embroiled in controversies. Ketan Desai, debarred from practicing medicine after several FIRs and two charge sheets were filed against him is aggressively being pitched to be included in the MCI once again. Former Union Health Secretary, Keshav Desiraju, who opposed the decision, was unceremoniously removed from the department in order to facilitate the process. All the progressive plans to strengthen the system planned by him are now on hold.
The net result, the government’s promise of providing Universal Health Coverage is still a distant dream. Meeting the Millennium Development Goals too does not appear possible given the current environment of stasis.
As the country moves closer to the next general elections, political parties, driving their campaigns based on the development model need to take the public health-care agenda seriously because health of the citizens is central to any development model.
Equitable health care
The pursuit of equity in health and health care has been the key feature of health policy in India. But if transformation has to take place, all political parties must rise above party lines and ensure equitable health care for the country. The gaps between communities, especially rural and urban, must be bridged so that those who cannot access the services can do so without having to depend on the private sector and sink deep in debt.
Promises made in the past have remained unfulfilled – most of them are on the backburner, yet to be implemented on the ground. Provision of free medicines for all is still not a reality.
Besides, there is a huge communication gap in the system. Key messages and information related to health and services often do not reach its beneficiary -- the economically weaker sections of society, both in rural and urban settings.
The media, a critical player in disseminating information, continues to steer away from health related issues. It needs to play a bigger role in mediating between the state and the people, if change is to take place.
Messaging between healthcare workers and the community need to be shaped contextually, since it plays a key role in boosting demand and therefore accessing health care at the right time. Prevention must also be factored in along with the provision of quality treatment and care.
The new government must take several key steps for health care in India to transform.
Health budget
Health spending has to increase significantly if the system is to function optimally. The focus has to be in rural and underserved areas where there is an enormous need for better health-care services. Free medicines must be made available at all health centres and, most importantly, medicine stock-outs that are routine at the village and district level must be addressed urgently by a well-chartered monitoring system.
To meet the human resource crisis and to reduce the private sector’s dominance over medical care, more medical colleges, nursing schools and institutions to train frontline workers need to be set up by the government quickly. At the state level, governments must earmark enough funds to hire requisite staff at all levels, from sub-centres to district hospitals, to ensure timely and better delivery of health care. Regulating the private sector and medical malpractices is of paramount importance to end the commercialisation of health care in India.
Under the Constitution, every individual has the right to life and the right to good health. Just like Right to Education and Right of Food is now part of the democratic frame work, the next government must incorporate and implement Right to Health, if India is to achieve its goal of leading globally in the sphere of development.
The writer is an independent journalist.
Adding to the woes
Several flagship programmes such as Janani Suraksha Yojna (JSY), Janani Shishu Suraksha Karyakram (JSSK) and Indira Gandhi Matritva Sahyog Yojna (IGMSY) end up focusing on the same beneficiaries.
Nearly 15 lakh children under five die every year, mostly due to preventable diseases like measles, pneumonia and diarrhoea.
Close to 50 per cent of children under the age of five are malnourished.
Even though 70 per cent of children are immunized, nearly one third of children below five, a majority of them belonging to poor communities do not receive vaccines at all.
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