Public Health in India: Challenges Ahead

8 Pages Posted: 15 Apr 2014

See all articles by Anuj Sabharwal

Anuj Sabharwal

Amity Law School Delhi - Affiliated to Guru Gobind Singh Indraprastha University

Payal Lamba

Amity Law School Delhi - Affiliated to Guru Gobind Singh Indraprastha University

Date Written: April 14, 2014

Abstract

As the world’s largest democracy and the second most populous country in the world, India has experienced sea change since its independence in various facets of development. However as per public health is concerned, 22% of our population is malnourished, 48% of our nation’s children are stunted (UNICEF report) and which is already responsible for the two-third morbidity burden. Adding to existing glaring difference in access and equity to people, the ratio of beds in hospitals available to population in rural areas is fifteen times lower than that for urban areas. The ratio of doctors to population in rural areas is almost six times lower than that in the urban population. The reduction on public health expenditure and the growing inequalities in health care are taking its toll on the marginalized and socially deprived population. The Infant Mortality Rate in the poorest 20% of the population is 2.5 times higher than that in the richest 20% of the population.

The paper acknowledges the persistence of inequities despite increased investment and some improvements in service provision in recent years. The paper delves into multiple areas such as a) legislative/regulatory issues, b) organization and operational matters and thirdly c) the competing demands for finite resources. In India, however, pre-existing inequality in the healthcare provisions is further enhanced by difficulties in accessing it. These access difficulties can be due to geographical, socio-economic or gender variables. The paper also seeks to provide an overview of some of the issues relevant to equity of access to health and personal social services in Indian context. It also addresses the question of the contribution of health services to health status and further examines the principle of equity which is one of the key principles underpinning the National Health Strategy. Suffice to mention here that while many of the initiatives listed have the potential to improve the public health scenario, coherent implementation and monitoring framework have remained the challenges.

India ranks third in the South East Asia region in highest out of pocket expenditure on health even behind Nepal and Pakistan which have 49% and 41% respectively. The poor state of health of our country is evident from the WHO’s world health statistics 2012, where it was stated that in India 60% of health expenditure was paid out of common man pocket in 2009. These health expenditures are exacerbating poverty with 39 million people going poor every year due to these expenditures. Per capita expenditure on public health is seven times lower in rural areas, compared to government health spending for urban areas. Though the spending on healthcare is 6% of GDP, the state expenditure is only 0.9% of the total spending and the rest of it is from people using their own resources. Thus only 17% of all health expenditure in the country is borne by the state, and 82% comes as ‘out of pocket payments’ by the people. This makes the Indian public health system grossly inadequate and under-funded. Only five other countries in the world are worse off than India regarding public health spending (Burundi, Myanmar, Pakistan, Sudan, Cambodia).

Further this paper will discuss strategies for removing this inequity and how to provide equal access of these health services without creating any burden on them. The basic objective of the reforms to be brought should be to provide the whole nation with basic medical and health services as a public product, and ensure that everyone, regardless of location, nationality, age, gender, occupation and income, enjoys equal access to basic medical and health services. The Government with a similar intention in mind has taken a step forward in introducing the Universal Health Coverage (UHC) in the 12th five year plan. The Public Private Partnership (P-P-P) model is extensively being used to cover the gap between the demands of supply health care and by making the public delivery system (primary healthcare facilities and hospitals) to deliver the agreed service package.

Therefore, until any concerted actions are taken to ensure that health systems are reached to the disadvantaged people more effectively, such inequities will continue. Undoubtedly, the menu of options are long out of which some are untried, but we cannot rely on a particular method since there is no guarantee that such method will be successful.

Keywords: Infant Mortality Rate; World health organization; Maternal Mortality Rate; Mal-Nourished; Stunted.

Suggested Citation

Sabharwal, Anuj and Lamba, Payal, Public Health in India: Challenges Ahead (April 14, 2014). OIDA International Journal of Sustainable Development, Vol. 07, No. 02, pp. 17-24, 2014, Available at SSRN: https://ssrn.com/abstract=2424919

Anuj Sabharwal (Contact Author)

Amity Law School Delhi - Affiliated to Guru Gobind Singh Indraprastha University ( email )

Sector-125
Dwarka
Noida, ND 201 301
India

Payal Lamba

Amity Law School Delhi - Affiliated to Guru Gobind Singh Indraprastha University ( email )

Sector-125
Dwarka
Noida, ND 201 301
India

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