india health primer

7/30/2019 India Health Primer

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Preamble

Health is one of the goods of life towhich man has a right; wherever this

concept prevails the logical sequenceis to make all measures for theprotection and restoration of healthto all, free of charge; medicine like

education is then no longer a tradeit becomes a public function of the

State ...


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The Development Paradigm

The notion of the welfare state Socialist pattern of development Limited entitlements approach Support to private capital growth The ruralurban planning divide

CDP and rural development Social sectors neglected Persistence of poverty


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Healthcare Development

The legacy of Joseph Bhore The colonial continuumenclave

pattern of development Constitution: Concurrent Crowding The Centres role

The program based approach andelaborate bureaucracies The rural--urban dichotomy Consolidation of private healthcare


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Heath Policy and Planning

Health policy through 5-year Plansand Committees

Dilution of Bhore recommendations Program based approach Revival under Minimum Needs

Program and post Alma Ata -

reducing the rural/urban gap The first National Health Policy-

1983 The decline of public healthcare


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Health Policy

The big leap of the private healthsector

2002 Health Policy Common Minimum Program Rural Health Mission


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Health System andStructures - Public

Primary Healthcare VHW- SubcentrePHC (rural) VHW- Health posts (urban) National programs

Secondary and Tertiary care Rural Hospitals District and sub-district hospitals

Teaching Hospitals Public Health Administration

Public Health, Medical and Medical Educatn

Financing : General taxes/Socialsecurity


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Health Systems andStructures - Private Private Provision

GPs and Consultants Private for-profit Hospitals

Private not-for-profit hospitals !! Multiple systems unified practice! Unqualified pracxtitioners Traditional practitioners

Financing Out of pocket Private Insurance

Social security


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India Health Profile...

Facts and Figures Doctors (all systems): 1.3 mi. (769 per

doc) Doctors (allopathy): 540,000 (1852 per

doc) Nurses: 580,000 (1724 per nurse)

Hospital Beds: 950,000 (1053 per bed) Public Expenditure: $7 bi. (1% of GDP) Private Expenditure: $37 bi. (5.5% of GDP) Health Outcomes: IMR-72, CDR-9, CBR-24


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Indias Global Share In

%

Population 17Total deaths 17

Child deaths 23

Maternal deaths 20

TB cases 30Leprosy cases 68

Persons with HIV 14


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Country Under 5

Mortality

Maternal

Mortality Ratio

Korea 14 30

Malaysia 14 34

Sri Lanka 19 30

China 43 95

Indonesia 75 390

India 95 440Bangladesh 115 850

Pakistan 127 340

Nepal 131 1500


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33

50

17

64

1818

40

44

16

81

712

Communicable

Non-Communicable

Injuries

India China

Low & Middle

Income HighIncome


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19

6

17

8

50

Infectious and

parasitic

diseases

RespiratoryInfections

Maternal

Conditions

PerinatalConditions

Nutritional

deficiencies

INDIA 1998


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10%

2%

4%

30%

6%

2%

8%2% 3%

7%

26%

A. Malignant neoplasms

B. Diabetes mellitus

C. Neuropsychiatric disorders

D. Sense organ disorders

E. Cardiovascular diseases

F. Respiratory diseases

G. Digestive diseases

H. Musculo-skeletal diseases

I. Congenital anomalies

J. Oral diseases

K. Other noncommunicable

diseases


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Outpatient care share is only 23% andInpatient share is 45%Decline greater in inpatient share

Poor, larger users of PHCs and urbanpublic hospital OPDs

Rich, larger users of inpatient care

Declining public spending andinvestment impacting on utilisation


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Over 75% share for services likechild immunisation,contraceptivesANC and child birth 50% share

Coverage levels for above serviceslowUrban coverage twice better


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Outpatient care nearly 80% shareWide inter-state variationsInpatient care 55% share and growing

rapidlyAcross classes private care is largestcategoryRich use private care in much larger

proportion but rich are also the largestusers of public hospitals for inpatient careVery low preventive care, but increasingshare in ANC and childbirth


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55%

12%

0%

10%

20%

30%

40%

50%

60%

Low Standard of Living High Standard of Living

16%

48%

0%

10%

20%

30%

40%

50%

60%

Low Standard of Living High Standard of Living

Malaria TB


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0 5 10 15 20

Poorest2

0%20%

-40%

Mid

dle20

%60

%-80%R

iche

st20%

Percent With Regular UseSmoking Tobacco (non-smoking) Alcohol


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10.1

13.4

17.8

25.6

33.1

0

5

10

15

20

25

30

35

Poorest

20%

2nd 3rd 4th Richest

20%

Income Quintiles

ShareofPublic

Subsid


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0 10 20 30 40 50 60 70 80

North East

Andhra Pradesh

Tamil Nadu

Karnataka

Bihar

Kerala

Maharashtra

All India

Haryana

Uttar Pradesh

West Bengal

Gujarat

Madhya Pradesh

Rajasthan

Public Private

BELOW POVERTY LINE HOUSEHOLDS


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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100

%

Outpatient Care

Hospitalization

Institutional Deliveries

Antenatal Care

Immunizations

Public-Private Sector Shares

Private Public


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33%

45%

52%

58%

61%

0 500 1000 1500 2000 2500 3000 3500 4000

Poorest 20%

20%-40%

Middle 20%

60%-80%

Richest 20%

Hospitalizations Per 100,000 Population

Public Hospitals Private Hospitals


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Social

Group

No ANC TFR IMR U-5Mortality

CompletedImmunisatn

Delivery byDoctor

LOW 45.1 3.37 88.8 130.0 30.4 15.8

MEDIUM 32.8 2.85 70.3 94.6 43.2 31.1

HIGH 12.4 2.10 42.7 51.5 64.7 60.9

ALL 34.0 2.85 73.0 101.4 42.0 30.3

SC 38.2 3.15 83.0 119.3 40.2 23.5

ST 43.1 3.06 84.2 126.6 26.4 14.5

OBC 34.8 2.83 76.0 103.1 43.0 31.8

OTHER 27.9 2.66 61.8 82.6 46.8 37.3


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Percent Women 15-49 Children < 3 yrs % below -3SDSocial

Group

Below145 cms

Below BMI18.5kg/m2

AnyAnemia

Wt. ForAge

Ht. ForAge

Wt. ForHeight

LOW 17.7 48.1 60.2 25.3 29.8 3.9

MEDIUM 12.5 35.6 50.3 16.5 22.4 2.4

HIGH 7.5 17.3 41.9 6.7 10.7 1.5

SC 17.0 42.1 56.0 27.2 27.5 3.0

ST 13.5 46.3 64.9 26.0 27.6 4.4

OBC 13.5 35.8 50.7 18.3 23.1 3.4

OTHER 10.9 30.5 47.6 13.8 19.4 1.8

ALL 13.2 35.8 51.8 18.0 23.0 2.8


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Life ExpectancyTotal Health

Expenditure

as % of GDP

Public health

expenditure

as % of total

U-5

mortality

Male Female

India 5.0 17 95 59.6 61.2

China 2.7 24.9 43 68.1 71.3

Sri Lanka 3 45.4 19 65.8 73.4

Malaysia 2.4 57.6 14 67.6 69.9

Korea 6.7 37.8 14 69.2 76.3


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Private

Investment/

Insurance

2%

Public-States

10%

Public-Centre

3%

Private Out-of-

pocket85%

I di C t S i


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India Current Scenario:Health

Resurgence of Communicable Diseases Declining Public Investments and

Expenditures in Health and Healthcare

Breakdown of the Public Health System Access to Basic Healthcare Declining Absence of Regulation and Control, and

Quality Standards in Private

Healthcare Corporatisation and Rising Costs of

Healthcare and Changed Character ofthe Economy

d


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India Current Scenario:Disability

Physical disability affects 2% of thepopulation and the trend is upwardswith a worsening economic scenario

Mental disability affects about 3% of thepopulation and another 1% suffersmental illness due to increased stress ofthe changing environment

Social Disability based on caste, genderand community getting worse under thecurrent socio-economic dispensation

Other disabilities like, HIV/AIDS, elderly

etc.


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Minimum Needs Program phaseof expansion

Liberalisation phase for growth

of private capital andstagnation of public investment Enter World Bank and

globalisation Centre Abdicates Responsibility State governments follow footsteps

Reduced Level of Expenditures The impact of the fifth pay

commission


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Health Sector Reforms

World Bank assisted Health Systems

Development Projects in 5 States New public management Systems -

societies, contracting out (missionapproach)

Initiative towards private sectorregulation - quality, accreditationetc.

User Fees Opening up of Insurance to the Private

Sector Collaborations with the Private Sector RCH Approach??


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Health Sector Reforms.

Raising levels of Allocations Improving Allocative Efficiencies Improving Technical Efficiencies Improving Quality of Care Enhancing Access to services

removing rural/urban disparities Improving consumer satisfaction Reducing Costs Regulating the private health sector


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Reforming the ExistingSystem

Restructuring and reforms Organising a system Public-private mix Referral system Standards and regulation

Single payer mechanism

I di F t H lth


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India Future HealthPriorities

Priorities for making it work An Act of Parliament - Health

Authority Tackling the medical profession Licensing, registration, minimum

standards

Integration of systems Continuing medical education Pricing mechanisms Raising additional resources


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Strategies and Approaches

Right to Health and Healthcare Awareness Raising and Participation

of Civil Society Groups Organising and Educating Medical

Profession Healthcare as part of Social Security

Universal Access to Healthcare New Public Management Systems and

Governance Structures

I ti i H lth Fi i

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