CURRENT STATE OF HEALTHCARE-

Over the last three decades, private sector has been making growing
contribution and supporting already heavily burdened public health
institutions at every level. The private sector today provides 58 percent of
the hospitals and 81 percent of the doctors in India. A huge percentage of
children are chronically malnourished in India due to lack of adequate
nutrition. Moreover, out of pocket expenditure (OOPE) constitutes more
than 60 percent of all health expenses, a major drawback in a country
like India where a large segment of the population is below poverty line.
Nearly half of India’s children- approximately 60 million – are underweight,
45% have stunted growth (too short for their age), 75% are anaemic, and
57% are deficient in Vitamin A India has only 1.1 beds per 1,000 persons
compared to the world average of 2.7. Rising dual disease burden (CDs &
NCDs) in India calls for increased capacity building which is only possible
with collaborative approach. Public sector spending in healthcare is only
1.4 percent of GDP: rest (3.3 percent) comes from the private sector.
gap in bed capacity of over 2 million and nearly one doctor per 1000
people are big challenges which can be addressed only in
collaboration with the private sector. Expanding infrastructure with
collective efforts and collaborations can only lead to 1.8 milli on
additional beds, improving the density of beds from 0.9 per thousand
today to 2.0 per thousand in 2025.

CAUSES OF POOR HEALTHCARE IN INDIA-

i. High birth rate and fast growth of population:

A number of health risks derive from high fertility rates in India. When a
large number of people live in poor households located in crowded,
unsanitary’ surroundings, communicable diseases spread easily, high
mortality results therefrom, especially among the children.High mortality
rates, in turn, induce families to have many children so that they can assure
themselves of a few surviving, children. This circular pattern adversely
affects the health standards
Similarly, population growth makes it more difficult to provide safe or
sufficient water supply, garbage disposal and sanitation for the community.
It increases the cost of providing adequately trained health manpower and
medical facilities.

ii. Malnutrition:
Widespread malnutrition contributes to the incidence and severity of health
related problems. It poses a major threat to the children and, in extreme
cases, threatens their lives.Malnutrition creates serious health problems by
contributing to premature births and to abnormally low weight at birth.
Malnutrition is also a major contributing factor in spreading infectious
diseases. By weakening the body response to diseases, malnutrition
reduces acquired immunity.
iii. Unsanitary conditions and housing:
The contamination of food, water of soil with human waste is a cause of a
number of diseases. If water is not safe for drinking, or is insufficient for
personal hygiene and sewage disposal, diseases spread more easily.This
reduces the health status of the country. In addition to poor sanitation and
water supply, very sizeable proportion of the total population of cities lives
in substandard dwellings lacking in space, ventilation and sunlight. Such
conditions tend to increase the incidence of diseases.

Government Initiatives in the Health Sector of India-

1. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is aimed at

reducing maternal and infant mortality rates through safe pregnancies and
safe deliveries. The national programme will provide special free antenatal
care to about 3 crore pregnant women across the country in order to detect
and prevent high risk pregnancies. The nationwide programme will provide
fixed day assured, comprehensive and quality antenatal care to pregnant
women on the 9th of every month. Pregnant women can now avail of a
special antenatal check-up in their second or third trimesters at
Government health facilities provided by gynecology specialists/ physicians
with support from private sector doctors to supplement the efforts of the
Government sector. These services including ultrasound, blood and urine
tests will be provided in addition to the routine antenatal check-ups at the
identified health facility/outreach in both rural and urban areas. One of the
aims is to identify and follow-up on high risk pregnancies in order to reduce
MMR and IMR.
2. Mission Indradhanush- Second phase of MI continued in Jan 2016 in
352 districts. Phase III was implemented from April to July 2016 in 216
districts of the country. During all the three phases, (as on 1st August
2016, 2.08 crore children have been vaccinated of which 54.5 lakh children
have been fully immunized. In addition, 55.4 lakh pregnant women were
vaccinated against tetanus toxoid. According to Integrated Child Health
and Immunization Survey 2016, full immunization coverage has increased
by about 5-7% after the launch of mission Indradhanush.

3. Sarva Swasthya Abhiyan -.

a) National Rural Health Mission:National Rural Health Mission

(NRHM) is an Indian health programme for improving healthcare delivery
across rural India. NRHM was launched to address the infirmities and
problems, prevailing across the primary healthcare system in the country.
The mission aims to provide universal access to equitable, affordable, and
quality healthcare that is accountable and at the same time responsive to
the needs of the people.
b) National Urban Health Mission (NUHM):The NUHM will meet the
health needs of the poor, particularly the slum dwellers, by making
available to them essential primary healthcare services. t This will be done
by in high-calibre health professionals, appropriate technology through PPP
and health insurance for urban poor.

4. National Tuberculosis Control Program (RNTCP) is the state-

run tuberculosis (TB) control initiative of the Government of India. As per
the National Strategic Plan 2012–17, the program has a vision of achieving
a "TB free India", and aims to achieve Universal Access to TB control
services.[1] The program provides, various free of cost, quality tuberculosis
diagnosis and treatment services across the country through the
government health system. It seeks to employ the WHO recommended
tuberculosis control strategy, DOTS(Directly Observed Treatment, Short
Course), to the Indian scenario With progress in achieving objectives
outlined in the DOTS Strategy of the 11th Five year Plan, the program
defined the new targets of Universal Access to TB care. Under the 12th
Five Year Plan of Government of India as the National Strategic Plan for
2012–17. The plan hopes to achieve detection of at-least 90% the total
estimated cases and a cure rate of 90% in new and 85% in re-treatment
case
5. Central Government Health Scheme (CGHS) was started under
the Indian Ministry of Health and Family Welfare in 1954 with the objective
of providing comprehensive medical care facilities to Central
Governmentemployees, pensioners and their dependents residing in
CGHS covered cities. This health scheme is now in operation Instructions
on these various matters have been issued from, time to time for the
guidance of the specialists and medical Officers. The Central Government
Health Scheme offers health services through Allopathic and Homeopathic
systems as well as through traditional Indian forms of medicine such as
Ayurveda, Unani, Yoga and Siddhawith cities such as Bhubaneswar,
Bhopal, Chandigarh and Bangalore.

6. New Health Policy: In January 2015, the government rolled out

their second healthcare initiative, the New Health Policy (NHP). The
plan does not specify any increase in public spending on health
(currently around 2% of GDP). Instead, it emphasises sourcing of care
from the private sector. Public spending on health in India is shared
by the central government and the twenty-nine states, with the primary
and secondary health system being funded by the states, while the
central government funds other healthcare aspects such as population
control, nutrition, medical education, and programmes on
communicable and non-communicable diseases
ROLE OF NGO IN HEATHCARE-
.
a)how much money is spent by them on health?

It is estimated that the current health expenditure of non-governmental

sector in the country was INR 10,091 crore in 2013-14. This constitutes
about 2% of total health expenditure and around 0.09% of gross domestic
product in India with reference period 2013-14. Three major states, namely
Andhra Pradesh, Maharashtra and TamilNadu together account for 40% of
health expenditure by NGOs in India. In spite of having a significant
number of health-NGOs in Rajasthan, the share of the state to total health
expenditure by NGOs is at a moderate level because a majority of those
NGOs are tiny in size. Furthermore, though the state of Uttar Pradesh has
maximum number of NGOs, it appeared fifth in terms of the share of health
expenditure by NGOs since there were fewer organizations with primary
focus on health.

b)What healthcare services they provide?

Preventive care is the most common activity provided by the NGO sector in
India. In most states, other than Kerala and Manipur, maximum funds are
directed towards preventive care. In Kerala, maximum funds are spent for
curative care, with preventive care being the second highest. In Manipur,
health system supportive services in terms of management and financing
dominate other expenses .Expenses for rehabilitative care and ancillary
services (like lab/image test) are not significant, except in a few cases,
such as rehabilitative care in Karnataka and ancillary services in
Rajasthan, Madhya Pradesh, Manipur and Uttarakhand. In the NGO
sector, curative care is found at a moderate level, and constitutes second
highest level of expenditure in most of the states. In curative care
expenditure of NGOs, outpatient care covering hospital outpatient and
ambulatory clinic constitutes the highest share of around 41%, followed by
hospital inpatient care of around 36%

Available from
https://www.researchgate.net/publication/309487015_Role_of_Non-
Governmental_Organizations_in_Healthcare_Sector_of_India.
MAJOR PROBLEMS OF HEATHCARE IN INDIA-

1. Neglect of Rural Population:

A serious drawback of India’s health service is the neglect of rural masses.
It is largely a service based on urban hospitals. Although, there are large
no. of PHC’s and rural hospitals yet the urban bias is visible. According to
health information 31.5% of hospitals and 16% hospital beds are situated in
rural areas where 75% of total population resides.Moreover the doctors are
unwilling to serve in rural areas. Instead of evolving a health system
dependent on paramedical (like bare-footed doctors in China) to strengthen
the periphery. India has evolved one dependent on doctors giving it a top-
heavy character.

2. Emphasis on Culture Method:

The health system of India depends almost on imported western models. It
has no roots in the culture and tradition of the people. It is mostly service
based on urban hospitals. This has been at the cost of providing
comprehensive primary health care to all. Otherwise speaking, it has
completely neglected preventive, pro-motive, rehabilitative and public
health measures.

3. Inadequate Outlay for Health:

According to the National Health Policy 2002, the Govt. contribution to
health sector constitutes only 0.9 percent of the GDP. This is quite
insufficient. In India, public expenditure on health is 17.3% of the total
health expenditure while in China, the same is 24.9% and in Sri Lanka and
USA, the same is 45.4 and 44.1 respectively. This is the main cause of low
health standards in the country.

4. Social Inequality:
The growth of health facilities has been highly imbalanced in India. Rural,
hilly and remote areas of the country are under served while in urban areas
and cities, health facility is well developed. The SC/ST and the poor people
are far away from modern health service.

The table shows social inequality in provision of health in India.

5. Shortage of Medical Personnel:
In India shortage of medical personnel like doctors, a nurse etc. is a basic
problem in the health sector. In 1999-2000, while there were only 5.5
doctors per 10,000 population in India, the same is 25 in the USA and 20 in
China. Similarly the number of hospitals and dispensaries is insufficient in
comparison to our vast population.

6. Medical Research:
Medical research in the country needs to be focused on drugs and
vaccines for tropical diseases which are normally neglected by international
pharmaceutical companies on account of their limited profitability potential.
The National Health Policy 2002 suggests to allocate more funds to boost
medical research in this direction.

7. Expensive Health Service:

In India, health services especially allopathic are quite expensive. It hits
hard the common man. Prices of various essential drugs have gone up.
Therefore more emphasis should be given to the alternative systems of
medicine. Ayurveda, Unani and Homeopathy systems are less costly and
will serve the common man in better way. Concluding the health system
has many problems. These problems can be overcome by effective
planning and allocating more resources.
ACCESS TO HEALTHCARE--

A) IN RURAL AREAS –

Rural areas in India have a shortage of medical professionals.]74% of

doctors are in urban areas that serve the other 28% of the population. This
is a major issue for rural access to healthcare. The lack of human
resources causes citizens to resort to fraudulent or ignorant
providers. Doctors tend not to work in rural areas due to insufficient
housing, healthcare, education for children, drinking water, electricity, roads
and transportation. Additionally, there exists a shortage of infrastructure for
health services in rural areas In fact, urban public hospitals have twice as
many beds as rural hospitals, which are lacking in supplies. Studies have
indicated that the mortality risks before the age of five are greater for
children living in certain rural areas compared to urban
communities. Full immunization coverage also varies between rural and
urban India, with 39% completely immunized in rural communities and 58%
in urban areas across India. Inequalities in healthcare can result from
factors such as socioeconomic status and caste, with caste serving as a
social determinant of healthcare in India.

B) IN URBAN AREAS-

The problem of healthcare access arises not only in huge cities but in
rapidly growing small urban areas hence there, there are fewer available
options for healthcare services and there are less organized governmental
bodies.[27] Thus, there is often a lack of accountability and cooperation in
healthcare departments in urban areas. Additionally, health inequalities
arise in urban areas due to difficulties in residence, socioeconomic status,
and discrimination against unlisted slums.]To survive in this environment,
urban people use non-governmental, private services which are
plentiful.[27] However, these are often understaffed, require three times the
payment as a public center, and commonly have bad practice methods. To
counter this, there have been efforts to join the public and private sectors in
urban areas. An example of this is the Public-Private Partnerships initiative.
. Private doctors tend to be specialized in a specific field so they reside in
urban areas where there is a higher market and financial ability for those
services
PUBLIC-PRIVATE PARTNERSHIP IN HEALTHCARE-

One initiative adapted by governments of many states in India to improve

access to healthcare entails a combination of public and private sectors.
The Public-Private Partnership Initiative (PPP) was created in the hopes of
reaching the health-related Millennium Development Goals.[18] It consists of
three separate projects with different focuses: Fair Price shops which aim
to reduce the costs of medications and treatment options; Rashtriya
Swasthya Bima Yojana which reimburses those under the poverty line; and
National Rural Telemedicine Network which assists with non-medical
costs. Fair Price Shops aim to reduce the costs of medicines,
drugs, implants, prosthetics, and orthopedic devices. Currently, there is no
competition between pharmacies and medical service stores for the sale of
drugs.[18] Thus, the price of drugs is uncontrolledBy the end of the year,
there were 93 stores benefiting 85 lakh people. From December 2012 to
November 2014, these shops had saved 250 crore citizens.[18] As doctors
prescribe 60% generic drugs, the cost of treatment has been reduced by
this program. The largest segment of the PPP initiative is the tax-financed
program, Rashtriya Swasthya Bima Yojana (RSBY).[31] The scheme is
financed 75% by the central government and 25% by the state
government.[18] This program aims to reduce medical out-of-pocket costs
for hospital treatment and visits by reimbursing those that live below
the poverty line.[18] RSBY covers maximum 30,000 rupees in hospital
expensesHowever, even with these programs, high out-of-pocket
payments for non-medical expenses are still deterring people from
healthcare access.
CASE STUDY-

Economic Survey says India's public spending on health well below

global average

NEW DELHI: The country's public spending on health is "little over" 1 per
cent of GDP, the Economic Survey said on Tuesday, adding, "there are
'insufficient' instances of good models in the health sector."."This has risen
to a little over 1 per cent today, but well below the world average of 5.99
per cent," the survey tabled in Parliament. It said that as per Reserve Bank
of India data, expenditure on social services by Centre and states, as a
proportion of GDP was 7.0 per cent during 2016-17 (Budget Estimate), with
education and health sectors accounting for 2.9 per cent and 1.4 per cent
respectively." It said that on state capacity, delivery of essential services
such as health and education, which are predominantly the preserve of
state governments, remains "impaired".". The Economic Survey said that a
second distinctive feature of the Indian economic model is the "weakness"
of state capacity, especially in deliver India's total fertility rate (TFR) has
been steadily declining and was 2.3 (rural 2.5 and urban 1.8) during 2014.
Infant Mortality Rate (IMR) has declined to 37 per 1000 live births in 2015
from 44 in 2011."The challenge lies in addressing the huge gap between
IMR in rural (41 per 1000 live births) and urban (25 per 1000 live births)
areas," the survey said.in essential services such as health and education.
STATE WITH LOWEST EXPENDITURE ON HEALTH-

In 2014-15 Uttar Pradesh has among the lowest per capita income in the
country, at just Rs 72,300. The state also has the highest infant mortality
rates (under five) with 43 deaths per 1000 live births. However, as per the
NHA, the state spends only Rs. 581 per person on healthcare, while the
out-of-pocket expenses are nearly four times at Rs 2396 The doctors
accounted for more than half of all health workers, the highest such
proportion in the country, according to a 2016 World Health Organisation
study, probably a result of not having enough other health workers in the
first place. UP’s average spending is 70 per cent of the Indian average

Bihar lags way behind the rest of the country when it comes to healthcare.
The state spends the least in the country on per capita healthcare – a
meagre Rs 338 – while people from the state need to shell out Rs 1,685
per person on healthcare.Andhra Pradesh is another low spender, at just
Rs 573 per person, of a total health expenditure (THE) of Rs 3720,
accounting for only 15.4 percent of the total share. In contrast, an
individual’s average out of pocket expenditure is Rs 2901 – which is 78

percent.

STATES WITH HIGHEST HEALTH EXPENDITURE-

Himachal Pradesh is the highest spender on healthcare – people from HP

spend only 50 percent out of pocket (Rs 2274), with the rest being funded
by the government (Rs 2016).
 Kerala too have an advanced public healthcare system, which has helped
deal with the rising cases of infections and diseases such as dengue,
malaria and cancer in the state. Out of a total expenditure of Rs 6801 per
person, the government’s health expenditure is Rs 1208, around 17
percent. However, the state also has the highest out of pocket expenditure,
at Rs 5023, which is 73.9 percent. Kerala is working towards reducing this
expense by ramping up primary health care facilities and converting 700
primary health care centres into family health centres with longer working
hours and better facilities. The state government is also working towards
making Public Healthcare Centres more people friendly so that people do
not need to depend on private hospitals for treatment.
In Uttarakhand, where the total health expenditure per capita is Rs 4233,
the government spends Rs 1534, while the out of pocket expenditure is Rs
2545, which is 60.1 percent.

INDIAs HEALTHCARE IN COMPARISON TO NEIGHBOURING

COUNTRIES-

India ranks 145th among 195 countries in terms of quality and accessibility
of healthcare, behind its neighbours like China, Bangladesh, Sri Lanka and
Bhutan, according to a Lancet study.The Global Burden of Disease study,
however, mentioned that India has seen improvements in healthcare access
and quality since 1990. In 2016, India’s healthcare access and quality
scored at 41.2 (up from 24.7 in 1990). India lags behind China (48), Sri
Lanka (71), Bangladesh ( 133) and Bhutan (134) while its health index was
better than those of Nepal (149), Pakistan (154) and Afghanistan
(191).According to the study, India performed poorly in tackling cases of
tuberculosis, rheumatic heart diseases, Ischaemic heart diseases, stroke,
testicular cancer, colon cancer and chronic kidney disease among others.
“These results emphasise the urgent need to improve both access to and
quality of health care across service areas and for all populations;
otherwise, health systems could face widening gaps between the health
services they provide and the disease burden experienced by local
communities,” it said. Subnational inequalities were particularly
pronounced in China and India The study found that China and India had
the widest disparities in healthcare access and quality with 43.5 and 30.8
point differences, respectively
Dear customer,

We are conducting a survey on healthcare. You are requested to fill in the

questionnaire and return it in the earliest, I can assure you that this information will be
confidential and will be used only for present investigation and not otherwise. Your
cooperation is acknowledged most gracefully,

NAME:

GENDER:

PROFESSION:

Q1. Which of the following scheme aims to reduce cost of medications ?

a. Rashtriya Swasthya Bima Yojana c. Central Government Health Scheme
b. Mission Indradhanush d. New Health Policy 2015

Q2. Which state spends the most on health care?

a. Rajasthan c. Uttarakhand
b. Kerala d. Himachal pradesh

Q3. Where do India ranks in accessibility in healthcare at global level?

a. At 150th c. At 145th
b. At 101th d. At 133th

Q4. What is the major problem of healthcare in India?

a. Neglect of rural population c. Social inequality
b. Shortage of medical personnel d. All of the above

Q5. Do you avail facilities from government hospitals?

a. Never c. Sometimes
b. Everytime d. Only once

Q6. What is the reason that you choose a private hospital for services?
a. More facilities c. better servicing
b. Recommendation from others d. never chose

Q7. How much do you spend on your health yearly?

a. Upto 10000 c. Upto 15000
 b. Upto 5000 d. Above 15000

Q8. Have you ever availed the benefit of a government health scheme?
a. Yes I have c. heard but not used
b. Tried but unsuccessful d. no

Q8. How frequently do you visit a doctor?

a. Once In a week c. once in a month
b. After each month d. anytime

Q10. Do you have an insurance policy?

a. Yes c. no
b. Thinking to have d. Don’t want

Q11. What is maximum amount you had spent in a hospital?

a. 0-10000 c. 20000-30000
b. 10000-20000 d. above 30000

Q12. What is the country's public spending on health of the total GDP?
a. 1.4% c. 2.4%
b. 0.9% d. 1.8%

Q13. Are you satisfied with government healthcare programmes?

a. Very satisfied c. Neutral
b. Satisfied d. Unsatisfied

THANK YOU FOR TAKING TIME OFF TO FILL IN THIS QUESTIONARRE. WE WILL KEEP YOU
UPDATED WITH NEWS OF NEW SCHEMES IN HEALTHCARE.