The Annual Report to the People on Health, which was published in September 2010, lists the achievements of the Indian government in the health sector. It however, calls attention to the wide variations across the country in the improvement of key human development indicators, and to the "inequities based on urban divides, gender imbalances, and caste patterns." The National Rural Health Mission(NRHM) has been described as one of the largest and most ambitious programmes to revive health care and has many achievements to its credit. The Rashtriya Swasthya Bima Yojana(RSBY), the health care scheme meant for Below Poverty Line(BPL) now being extended to the above poverty line section, provides Rs.30000/- per family to cover treatment charges. Several States have evolved their own distinctive health insurance schemes.
In spite of the laudable efforts, thousands of rural India’s poor patients have to go without even a semblance of medical care when they desperately need it. Appropriately, the Supreme Court of India, recently, directed government hospitals in Delhi to refer poor patients to private hospitals. The Court also directed the private hospitals to provide necessary treatments, free of cost, pending the preparation of a scheme that would involve private hospital in treating the poor.
Prof. K.S. Jacob, who is on the faculty of the Christian Medical College, Vellore and Member of the Mission Steering Group of the National Rural Health Mission(NRHM), in his presentation at the Dr. Chandrakant Patil Memorial Eastern India Regional Health Assembly, Kolkatta, recently, highlighted the gross inequality in health care in India, and strongly argued for universal health care as a democratic priority. The conference also stressed the bidirectional relationship between economic development and health, which justifies much greater financial input to improve the health of populations.
Despite the increase in the country’s Gross Domestic Product(GDP), its ranking in the Human Development Index(HDI), its indices for maternal and infant mortality and its rates of under-nutrition of its people tell a completely different storey. The burgeoning incomes of the wealthy increase the indices of growth; yet these averages hide much poverty, suffering, loss of livelihoods and life.
The Integrated Child Development Scheme(ICDS) a crucial centrally-sponsored scheme launched in 1975, to address maternal as well as child health and nutrition issues, has not been very effective in tackling the high rate of malnutrition in children. India has 42%, one of the highest in the world, of malnourished children in the 0—6 age group.
Though India has achieved significant gains over the last decade, it has failed to eliminate some of the "world’s most dreaded tropical diseases." A recent report in The Lancet reveals that 205000 people in India, die annually from malaria, mainly in Orissa and the surrounding States of Chattisgarh and Jharkhand, with almost one half of those deaths in children. The State of Bihar alone account for a large percentage of the world’s cases of VL, a serious parasitic infection also known as kala-azar that affects the bone marrow, liver and spleen and is associated with high mortality.
Dr.K.D. Ramaiah of the Indian Council of Medical Research in Pondicherry, has estimated that India suffers almost $ 1 billion in annual economic losses as a result of the neglected tropical diseases. Peter Hotez the author of Forgotten People, Forgotten Diseases has observed that chronic hook-worm infection occurring in over 70 million Indians stunts the growth and intellect of children to the point where a child’s future wage earning is reduced more than 40 per cent. World Health Organisation in its first-ever comprehensive report on neglected Tropical Diseases, released in October 2010, stated that the economic burden of dengue, costs India $ 30 million annually.
Diabetes, hypertension, stroke and cardio vascular diseases, all of which are disabling and life-threatening, have increased in India, silently and relatively unnoticed. Today, they constitute a growing threat to national health and national healthcare systems. As these diseases are costly in terms of long-term care, India need to reprioritise its efforts and funding, says N. Balagopal executive chairman of the Confederation of NGOs of Rural India(CNRI) . Balagopal who also represents NGOs in the Planning Commission, said rural health-care providers and nongovernment organisations working together on a common platform would be a great help in improving the health-care system of the country.
Prof. K Srinath Reddy and his colleagues note that the Indian public health system spends less than 1 per cent of GDP, and 80 per cent of the health expenditures are incurred out of pocket. They called on the government to increase spending to six per cent of GDP by 2020 and out-line actions needed to strengthen the system.
In India, high spending on health is a major reason for people sliding into poverty. The Hindu in a recent editorial said :"If the central government is sincere about building a strong health care system during the 12th Five Year Plan(2012—17), it must accept the primacy of public-funded provision, invest heavily in both preventive and curative spheres, and introduce strong regulation."
Dr. Kuruvilla FRCS, who held faculty position in Indian and foreign universities observed : "Health service in our country is in bad shape. The withdrawal of the government from the service sector has created havoc. Private enterprises and corporate bodies have grabbed this sector. The hardest hit in this game are the poor."
India has the highest number of children under five dying every year due to the shortage of over 2.60 million health workers that the country has according to a study released by the International NGO Save the Children. According to the report, India falls below the WHO health worker threshold of 2.3 health worker per 1000 people. The shortfall of health workers at present is around 2.60 million, which includes doctors at primary health centres, nurses, midwives, anganwadi workers and male multipurpose workers. The report says over 55 per cent children under the age of two do not receive basic immunisation in the country while about 2.7 million children under the age of five receive no treatment for diarrhoea, a major killer of children.
According to Ernst and Young, as of April 2010, there are only 7 beds per 10000 population in India against the world average of 39.60. It is woefully inadequate. The WHO recommend that India increase beds by 100000 every year for the next 10 years, and double the number of doctors and nurses, which are currently 700000 and 800000 respectively. A mere 3 per cent of India’s specialist physicians live in rural areas. Hence, rural areas with a population approaching 700 million, continue to be deprived of proper healthcare facilities. According to a report of the National Rural Health Mission only 10per cent of Indians have some form of health insurance.
Kerala with best public health indicators, is now facing a serious health emergency from communicable diseases. Typhoid, jaundice dengue, leptospirosis, and viral fever, had claimed several lives in different parts of the state. A two member team from National Centre for Disease Control visited the state to study the situation. Dr .B. Ekbal, public health activist and neurosurgeon called for an urgent people’s movement for the clean-up of the state. Meanwhile, the state Health Department has started a month long tour campaign across state to raise awareness about communicable diseases.
A book titled "Morbid Symptom—Health Under Capitalism" edited by Leo Panitch and Collin Leys, convey the message that mindless privatisation of the health care delivery system in various countries, which is the result of neoliberal globalisation is counter- productive to achieving a reasonable level of health.
Aman Gupta, Principal Advisor, India Health Progress, in a newspaper article explained how the "telecom model" could be profitably used to spread health insurance culture to rural areas. Innovative products and pricing strategy would help to make health insurance "really inclusive," he argued.
"Instead of depending heavily on provate health care, we need to strengthen the public health care system at the secondary and tertiairy levels as well, through higher resource allocation and better training an deducation formore health professionls," observed health economist, Dr.Sukumar Vellakkal of the Public HealthFoundation of India. Expert Group on Universal Health Coverage, headed by Dr.K.Srinath Reddy has important task for prioriitising the initatives to betaken up duringthe 12th Five Year Plan.
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