Chapter-Ill

Health Care (Policy

and (Programmes
in India
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CHAPTER-III

HEALTH CARE POLICY AND

PROGRAMMES IN INDIA

Special attention to health care is provided in different five year plans.

During the First Five Year Plan (1951-56), 725 Primary Health Centers
(PHCs) were established. The target was to cover not only the urban areas but
the rural population on primary bases. In the First Five Year plan it was
targeted that additional resources should be used for preventive actions rather
than curative facilities. At the end of First Five Year plan, there were 12600
hospitals and dispensaries in the country and it was realized that the country
needed more health facilities and infrastructure. In the Second Five Year Plan
(1956-61) different training programmes were launched to improve the
quality of health. The targets of this programme were to fight against
communicable diseases, to strengthen the public health institutions to improve
sanitation facilities and family planning programmes. The maternity and child
welfare services became important part of health planning during this
programme. The family planning centres were established in different parts of
the country. There were 78 institutions teaching indigenous system of
medicine and 549 clinics in urban areas at the end of Second Five Year Plan.
In 1951, there were 8,600 hospitals and dispensaries and about 1,13,000 beds
in the country which increased to 12,600 hospitals and dispensaries and beds
to 1,85,600 in 1960 (Ibid, p. 652). In Third Five Year Plan (1961-66) much
emphasis was laid on preventive public health services as there was a fixed
target to provide safe drinking water in rural areas. A very high priority was
given to family planning programme. The eradication of malaria was also an
important objective.
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The Fourth Plan ((1969-74) specially emphasized on better results of

family planning programmes. For this purpose, a committee on Multi-purpose
workers under health and family planning programme was appointed in 1972.
The Committee suggested that new trained multi-purpose health workers
should be appointed to have more fruitful results (Government of India,
1972).
The Fifth Five Year Plan (1974-79) was based on two main issues. One
of them was to realize the failure of coercive method for family planning as
family planning and nutrition were made a component of ‘Minimum Needs
Programme’ to attack poverty. But these programmes were neglected due to
declaration of emergency.
During Sixth Plan (1980-84), it was targeted that there should be one
male and one female worker for every 5000 population. It was also felt that
alternative method of medicine should also be encouraged so that locally
available medicare would be utilized. Keeping in view all these things, the
central government allocated 40 crore rupees for the expansion of traditional
system of medicine during the Seventh Five Year Plan (1985-90). This plan
takes note of ‘Health for all by 2000 A.D.’ To achieve this goal, Primary
Health Centres were taken as the main instruments of action. The voluntary
organizations and local bodies were encouraged to undertake the
responsibility of family welfare and primary health care services. The special
schemes were introduced for assisting private medical care centres for family
planning work. The emphasis was laid on Maternity and Child Health
programmes by supporting non-governmental organizations, village health
committees, private health services and women organizations (Barn & Nandy,
2008). The Eighth Five Year Plan (1992-97) was mainly based on to
encouraged private health care services at secondary and tertiary level, to
encourage the role of NGO’s in health sector and to make primary level
services more effective and accessible.
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In the Ninth Five Year Plan (1997-2002), Reproduction and Child

Health (RCH) programmes were given special attention. These programmes
also got some external funding, mainly from World Bank. Like some other
plans, the government offered organized, logistical, financial and technical
support to voluntary agencies active in the field of health.
In the Tenth Five Year Plan (2002-2007) emphasis was laid on to
encourage involvement of voluntary and private organizations, self-help
groups and social-marketing organization for improving access to healthcare.
The NGO sectors were asked to support the government in handling
Reproduction and Child Health (RCH) services. The Public-Private
Partnerships (PPPs) were also introduced in several states (Baru & Nundy,
2008).
The Eleventh Five Year Plan (2007-12) was introduced with a new
programme called NUHM (National Urban Health Mission). It was felt that
there should be a programme especially for the people living in urban slum
areas and urban poor people as they were deprived of basic health facilities.
So in the 11 Five Year Plan, NUHM was introduced in conjunction with
NRHM (National Rural Health Mission). The three key elements which were
included in this programme were the provision of “Essential Primary Health
Care Services”, appropriate technology through public-private partnership and
health insurance for urban poors. (Dasgupta & Bisht, 2010).
Different Committees were constituted to analyse the health problems
and status of the country. Some of the important committees are:
Bhore Committee
Before independence the ‘Bhore Committee’ was constituted in 1946
to deal with health issues. Later on, after independence, the context of health
policy making was influenced by two elements. First the report of ‘Health
Survey and Development Committee’, known after the name of its chairman,
Sir Joseph Bhore and the activities of ‘Central Council of Health’ (Jeffery,
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1988). On the recommendation of Bhore Committee, the government adopted

the modem medicine formally as the dominant medicine system for health
care throughout the country. Bhore committee also suggested that services
should be as close to the people as possible (Bhore Committee, 1946). The
National Planning Committee, 1949 and Bhore Committee, 1946 showed
special concern for the poor and deprived population in rural areas.
Mudaliar Committee
A committee known as Mudaliar Committee was set up by the ministry
in 1959 whose function was to review the functioning and infrastructure of
the medical institutions and centres set up during the decade of 1950s. This
committee recommended for the integration and consolidation of the health
care centres (Mudaliar Committee, 1961).
Chadha Committee
To study the arrangements for National Malaria Eradication
Programme and to have a supervision on the results, Chadha Committee was
set up in 1963. This committee recommended that National Malaria
Eradication Programme should be the responsibility of primary health centres.
Mukherjee Committee
In 1965, Mukherjee Committee was appointed to have an analysis of
the strategy for the family planning programme (Report of Mukherjee
Committee, 1965). Along with this, the committee was to analyse the reasons
behind the failure of leprosy, small pox and trachoma programmes. This
committee recommended that health facilities should be provided at block
level.
Jungawalla Committee
A committee on integration of health services was set up in 1964
which was known as Jungawalla committee. This committee was set up to
analyse the problems related to the integration of health services, to have a
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check on private practice by the doctors in government services and to have a

look on the service conditions of doctors (Govt, of India, 1967).
Kartar Singh Committee
In 1973, Kartar Singh Committee was appointed which recommended
that various categories of peripheral workers should be amalgamated in to a
single cadre of multipurpose health workers (male and female) and one
primary health centre should cover a population of 50,000 people which
should be divided into 16 sub-centres and each should cover 3000-3500
population (Govt, of India, 1973).
Shrivastava Committee
During the Fifth Five Year Programme, ‘Srivastava Committee, 1975’
recommended that para-professionals and semi-professionals should be
created so that they can provide more effective, curative and protective health
services needed for the people. It was also suggested that modem medicine
should reach a larger section of population (Government of India, 1975).
Health Programmes
The Government of India has also implemented several health
programmes during different five years plans. Some of these programmes are
mentioned as below :
1. National Malaria Eradication Programme (1953) : Main objective
of this programme was to completely wipeout malaria disease, elimination of
deaths from this disease and to reduce the suffering from malaria.
2. National Tuberculosis Control Programme (1962): Tuberculosis is
mainly characterized by cough and lungs infection. The main objectives of the
programme were to provide preventive care by BCG vaccination and to detect
the active cases at a very early stage so that the disease may be controlled
effectively.
3. National Goitre Control Programme (1962): This disease is caused
due to the deficiency of Iodine. It affects the thyroid gland in the neck region.
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This programme was mainly aimed to survey the areas where the cases of
goiter were frequently found and to resurvey these areas after every 5 years
and to ensure the supply of iodized salts in these areas.
4. Minimum Need Programme (1974) : This programme was aimed at
some basic needs which were to be ensured every year under this
programme. These were elementary education, health, safe drinking water,
rural electrification, rural housing, adult education, nutrition etc.
5. Universal immunization Programme (1978) This programme was
focused on some childhood diseases namely diphtheria, tetanus, polio,
measles, pertusis and tuberculosis.
6. National Laprosy Eradication Programme (1983): It is
characterized by the loss of sensation in the body parts and presence of white
patches on the body. This programme was implemented through different
levels, and units to have quick results.
7. National Health Policy (1983): Not only broad directions emanating
from the Constitution of India (1950) and various committees, particularly the
famous Bhore committee (1946), were the guiding pointes for health sector
reforms, but the health policy (1983) document approved by Indian
Parliament was also the concrete and a visible instrument in conformity with
the health sector reforms and later the efforts in the context of the economic
liberalisation taken up by India.
Sustainability is one of key factors of health sector reforms. The factor
can be noticed when the health policy of India focused on the basis of health
development on needs of its people (Consumer/beneficiaries) and did not just
leave it on mere perception of health care providers, which might have
hindered the equity and affordability dimensions of the economics of health
care. Health Policy (1983) as the policy instrument of health sector reforms in
India clearly mentioned that as a part of the revised 20 point integrated
development planning frame-work to provide universal, comprehensive
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Primary Health Care Services relevant to the actual needs and priorities of
community at a cost which the people can afford. Here the regulated role of
market forces is prescribed.
On the aspects of economizing and bringing allocative and
technoperative efficiency and the optimal investments towards health sector
reforms, the Health Policy document says:
Expenditure should be reduced through fullest possible use of
resources, viz., by use of cheap and locally avoidable building materials. To
reduce government expenditure and also for fully utilising the ‘untapped
resources’, the directions suggest that planning programmes may be relating
these to the micro level requirements and economic potentials to encourage
establishment of practice by private medical professionals. It also calls for
increased involvement of the non-governmental agencies (private and
voluntary organisation in health - (PVOH) in establishing curative centres
and also by offering organisational, logistical, financial and technical support
to the voluntary agencies active in the field. Further, the Health Policy (1983)
with reference to the current and future requirements of super specialties and
their adequate availability etc, within the country suggests reduction of such
expenditure involved in the establishment of super-specialty centres in India.
The efforts are needed to encourage private investments in such fields, so that
majority of such centres, within the government set-up, can provide adequate
care and treatment to the people as a part of free care, leaving the affluent
sectors to opt for ‘paying clinics’.
On the issue of private medical practice, techno-economic reforms in
India indicated that the state has to take steps to initiate the system of private
practice by medical personnel in government service. It might be providing, at
the same time, for payment of appropriate compensatory non-practising
allowances to doctors. In the area of ‘medical industry’, the emphasis is
economic perspective is given on production of drugs under the ‘generic
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names’ and adoption of ‘economical packaging practices’ to reduce unit cost

of medicine, bringing them within the reach of the poorer sections of the
society. Besides, it would sufficiently reduce the expenditure incurred by
governmental organisation on purchase charges.
8. Reproductive and Child Health Programme (1997): Safe
motherhood, family planning services and the survival and safety of newborns
were the objective of this programme. The reproductive and child health
programme was launched in Oct. 1997, incorporating a new approach to
population and development issues, exposed in the International Conference
on Population and Development held at Cairo in 1994. The programme
integrated and strengthened services/intervening under the child survival and
safe motherhood programme and family planning services and added to the
basket of services, new areas on Reproductive Tract/Sexually Transmitted
Infections (RTI/STI). Apart from this, the Ministry of Health and Family
Welfare has a number of schemes to cover the underprivileged sections of
society and help them with maternity, post and neonatal health care and
family planning. These include the Janani Suraksha Yojana, Rehabilitation of
Polio victims and several financial assistance schemes for surgery and other
health problems. Counselling centres are also available across the country as
part of the government sponsored family welfare schemes.
9. National Family Welfare Programme (1999): This programme was
directly related to the population policy. Family Planning was its main

concern.
10. National Health Policy (2002) : Important aspects of this policy are
to increase health sector expenditure to 6 per cent of GDP, training of public
health medical personnels, proper implementation of public health
programmes through local bodies, setting up a Medical Grants Commission
for funding new medical institutions, to improve the ratio of nurses, doctors/
beds etc., to set up the private insurance instruments, enactment of legislation
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to regulate infrastructure and to set up organized urban primary health care

structures etc.
11. Public-Private Partnership for Leprosy Treatment: National
Leprosy Eradication Programme (NLEP) has initiated participation of private
physicians (general practitioners and dermatologists) though Indian Medical
Association (IMA) to accelerate leprosy elimination in India (Dhillon, 2004).
Bombay Leprosy Project in Mumbai tried such approaches as early as 1979 as
a health system research scheme under ICMR. 152 general practitioners in
Mward of Mumbai oriented in diagnosis and treatment of leprosy during DDS
monotherapy (1979-1980). These doctors were provided technical assistance
in their clinics (Ravankar et al., 1982).
12. HIV/AIDS Programme: Support from Global Fund in India, the
HIV/AIDS services have been expanded from 125 centres to 450 including
private clinics. The public-private partnership provides antiretroviral
treatment to 15000 people living with HIV. National AIDS Coordinating
Organization (NACO) would provide 60 per cent of the funds to non­
governmental organizations and more than 20 per cent to private and
academic sectors (Global Fund: 2004).
13. Integrated Disease Surveillance: Integrated disease surveillance
project (IDSP) of Government of India, which is being implemented
gradually in India since the beginning of 2005, is laying stress on
participation of private doctors/hospitals as sentinel centres. This is a system
of prompt reporting of cases of childhood vaccine - preventable diseases,
meningitis, and hepatitis and rabies; together with a sentinel laboratory,
surveillance of cholera, typhoid fever, malaria, HIV infection and
antimicrobial-resistance.
The main objective of this policy is to achieve an acceptable standard
of good health amongst the general population of the country. The approach
would be to increase access to the decentralized public health system by
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establishing new infrastructure in deficient areas, and by upgrading the

infrastructure in the existing institutions. Overriding importance would be
given to ensuring a more equitable access to health services across the social
and geographical expanse of the country. Emphasis will be given to
increasing the aggregate public health investment through a substantially
increased contribution by the Central Government. It is expected that this
initiative will strengthen the capacity of the public health administration at the
state level to render effective service delivery. The contribution of the private
sector in providing health services would be much enhanced, particularly for
the population group, which can afford to pay for services. Primacy will be
given to preventive and first-line curative initiatives at the primary health
level through increased sectoral share of allocation. Emphasis will be laid on
rational use of drugs within the allopathic system.
Increased access to tried and tested systems of traditional medicine will
be ensured. The public health investment in the country over the years has
been comparatively low, and percentage of GDP has declined from 1.3
percent in 1990 to 0.9 percent in 1999. The aggregate expenditure in the
health sector is 5.2 percent of the GDP. Out of this, about 17 percent of the
aggregate expenditure is on public health spending, the balance being out-of-
pocket expenditure. The central budgetary allocation for health over this
period, as a percentage of the total Central Budget, has been stagnant at 1.3
percent, while that in the states declined from 7.0 percent to 5.5 percent. The
current annual per capita public health expenditure in the country was not
more than Rs. 200 (National Health Policy: 2002). Given these statistics, it is
no surprise that the reach and quality of public health services has been below
the desirable standard. Under the Constitutional structure, public health is the
responsibility of the states. In this framework, it was expected that the
principal contribution for the funding of public health services would be from
the resources of the state governments, with some supplementary input from
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central resources. In this backdrop, the contribution of central resources to the

overall public health funding has been limited to about 15 percent (National
Health Policy, 2002). The fiscal resources of the state government are known
to be very inelastic. This is reflected in the declining percentage of state
resources allocated to the health sector out of the state budget. If the
decentralized pubic health services in the country are to improve significantly,
there is greater need for the injection of substantial resources into the health
sector from the central government budget. This approach is a necessity -
despite the formal constitutional provision in regard to public health, - if the
state public health services, which were a major component of the initiatives
in the social sector, were not to become entirely moribund. The NHP-2002
was formulated taking into consideration these ground realities in regard to
the availability of resources.
The paucity of public health investment is a stark reality given the
extremely difficult fiscal position of the State Governments. The Central
Government will have to play a key role in augmenting public health
investments. Taking into account the gap in health care facilities, it was
proposed, under the policy to increase central government expenditure on
health sector to 6 percent of GDP, with 2 percent of GDP being contributed as
public health investment, by the year 2010. The State Governments would
also need to increase the commitment to the health sector. In the first phase,
by 2005, they were expected to increase the commitment of their resources to
7 percent of the budget, and, in the second phase, by 2010, to increase it to 8
percent of the Budget. With the stepping up of the public health investment,
the Central Government's contribution would rise to 25 percent from the
existing 15 percent by 2010 (National Health Policy: 2002). The provisioning
of higher public health investments was also contingent upon the increase in
the absorptive capacity of the public health administration so as to utilize the
funds gainfully.
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In the period when centralized planning was accepted as a key

instrument of development in the country, the attainment of an equitable
regional distribution was considered one of its major objectives. Despite this
conscious focus in the development process, the attainment of health indices
has been very uneven across the rural-urban divide e.g. infant mortality in
rural area was 75 per thousand whereas in urban it is 44 per thousand
(National Health Policy: 2002).
To meet the objective of reducing various types of inequities and
imbalances - inter-regional; across the rural- urban divide; and between
economic classes - the most cost-effective method would be to increase the
sectoral outlay in the primary health sector. Such outlets afford access to a
vast number of individuals, and also facilitate preventive and early stage
curative initiative, which were cost effective. In recognition, of this public
health principle, NHP-2002 sets out an increased allocation of 55 percent of
the total public health investment for the primary health sector; the secondary
and tertiary health sectors being targeted for 35 percent and 10 percent
respectively. The Policy projects that the increased aggregate outlays for the
primary health sector will be utilized for strengthening existing facilities and
opening additional public health service outlets, consistent with the norms for
such facilities.
It is self-evident that in a country as large as India, which has a wide
variety of socio-economic settings, national health programmes have to be
designed with enough flexibility to permit the State public health
administrations to craft their own programme package according to their
needs. Also, the implementation of the national health programme can only be
earned out through the State Governments' decentralized public health
machinery.
Over the last decade or so, the Government has relied upon a vertical
implementation structure for the major disease control programmes. Through
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this, the system has been able to make a substantial dent in reducing the
burden of specific diseases. However, such an organizational structure, which
requires independent manpower for each disease programme, was extremely
expensive and difficult to sustain. Over a long time-range, 'vertical' structures
may only be affordable for those diseases, which offer a reasonable possibility
of elimination or eradication in a foreseeable time-span. This policy envisages
a key role for the Central Government in designing national programmes with
the active participation of the State Governments.
For the outdoor medical facilities in existence, funding was generally
insufficient; the presence of medical and para-medical personnel was often
much less than that required by prescribed norms, the availability of
consumable was frequently negligible; the equipment in many public
hospitals was often obsolescent and unusable, and, the buildings were in a
dilapidated state. In the indoor treatment facilities, again, the equipment was
often obsolescent; the availability of essential drugs was minimal; the
capacity of the facilities was grossly inadequate, which led to over-crowding,
and consequentially to a steep deterioration in the quality of the services. As a
result of such inadequate public health facilities, it has been estimated that
less than 20 percent of the population, which seeks OPD services, and less
than 45 percent of that which seeks indoor treatment, avail of such services in
public hospitals. This was despite the fact that most of these patients do not
have the means to make out-of-pocket payment for private health services
except at the cost of other essential expenditure for items such as basic
nutrition.
Dairy 1 D.Monte (1992), after initiation of process of economic reforms
in India emphasized that it would be a tragedy if under the pretext of
economic liberalization, the government allowed health sector to suffer. Same
way, according to a nation-wide survey of household expenditure on
health-care, it was known that nearly 55 per cent was spent on private doctors
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and it was only 39 per cent on public health care organization.

(Nationai Council of Applied Economic Research: 1992). Health researchers
noted that as much as eight per cent of poor family's income gets spent on
injections. It is estimated that private personal health expenditure, i.e., about
more than Rs. 20,000 crore, works out to be three times that of governmental
spending, inclusive of health and expenditure on water and sanitation.
Currently, the contribution of private health care was principally through
independent practitioners. Currently, non-Govemmental service providers
were treating a large number of patients at the primary level for major
diseases. However, the treatment regimens followed were diverse and not
scientifically optimal, leading to an increase in the incidence of drug
resistance. The increasing spread of information technology raises the
possibility of its adoption in the health sector. In principle, this Policy
welcomes the participation of the private sector in all areas of health activities
- primary, secondary and tertiary. The Policy also encourages the setting up of
private insurance instruments for increasing the scope of the coverage of the
secondary and tertiary sector under private health insurance packages. Under
the overarching umbrella of the national health framework; the alternative
systems of medicine — Ayurveda, Unani, Siddha and Homeopathy - have a
substantial role. Because of inherent advantages, such as diversity, modest
cost, low level of technological input and the growing popularity of natural
plant-based products, these systems are attractive, particularly in the under­
served, remote and tribal areas. The alternative systems will draw upon the
substantial untapped potential of India as one of the eight important global
centres for plant diversity in medicinal and aromatic plants.

14. National Rural Health Mission (2005) : This was aimed at the
primary health care to the rural poor people especially women and children
by improving public health facilities. The National Rural Health Mission
(NRHM) was launched by the Government of India in April, 2005. It seeks to
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provide effective health care to rural population throughout the country with
special focus on 18 states, which have weak public health indicators and or
weak infrastructure. The NRHM will raise approximately 2.5 village-based
‘Accredited Social Health Activists’ (ASHA) who act as a link between the
health centres and the villagers. One ASHA is to be raised from every village,
or cluster of villages, across eighteen states. The ASHA is trained and advises
village populations about sanitation, hygiene, contraception, and
immunization to provide medical care for diarrhea, minor injuries, and fevers,
and to escort patients to medical centres. Other components of the programme
include a village health plan prepared through a local team headed by the
health and sanitation committee of the panchayat; strengthening of the rural
hospital for effective curative care and made accountable to the community
through Indian Public Health Standards.

15. National Urban Health Mission (2007) : A new programme called

NUHM (National Urban Health Mission) was introduced during Eleventh
Five Year Plan. This programme was used in conjunction with NRHM
(National Rural Health Mission). This programme was targeted on urban
poors living in slum areas and homeless people who are migrated from rural

areas.
No doubt, the government is paying high attention towards health
sector, but still there is a long way to go. Still the health financing situation in
India is not very encouraging. In 1993-94 health expenditure as per cent of
GSDP of 14 major states in India was around 1.1. per cent (World Bank,
1997). The public health investment in the country over the years has not only
been comparatively low, but also as a percentage of GDP is continuously on
the decline. The investment which was 1.3 per cent in 1990, has fallen to 0.9
per cent in 1999. The aggregate expenditure in the health sector is 5.2 per cent
of the GDP. This proves that public health spending accounted for less than
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one-fifth of the aggregate expenditure on health (National Health Policy,

2002). In the health budget for 2005-2006, allocation for the Department of
Health and Department of Family Welfare has been increased from Rs. 8420
crores in the current year to Rs. 10280 crores in next year (The Budget, 2005-
06). Also the finance for Integrated Child Development Services (ICDS)
Scheme have been increased from Rs. 1623 crores in the current year to Rs.
3142 crores for 2005-06 (The Budget, 2005-06).
But, the government budgetary allocation to health is still considered to
be less. The health delivery system having components of different levels
need adequate resources to maintain an appropriate balance at various levels
to meet the health care requirements of the population. The low budgetary
allocation in recent times has created serious imbalances at various levels and
has affected certain aspects of a good health care delivery system. No doubt,
cure should be there, but health is not only about diseases and medical care,
but also about the environment around us which influences the mental and
physical state of a person. The health is, in fact, a multi-dimensional
phenomenon. Many subsequent researchers also have built on the concept of
health as a utility. The National Council of Applied Economic Research
(NCAER, 1992) considers health status as an important indicator of the level
of economic development and it includes mainly mortality and morbidity.
In developing countries like India, there are a number of factors that
affect the people’s health status. There are demand side factors such as
income, assets, social practices as a result of ethnicity and religion, life style
and supply side factors such as the health care system and health expenditure
etc. There are also environmental factors and gender inequality related factors
that influence health status. These factors can be poverty, food security and
malnutrition, occupational health problems, reproductive health problems,
household economy and wages, per-capita income, industrialization, literacy
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rates, prices of private medicare and public health care delivery system etc.
(Mahadevia, 2000).
There are two broad categories of diseases, that of poverty and that of
affluence. Poverty leads to malnutrition and resultant diseases, which are
common in the developing countries. The level of nutritional knowledge,
level of literacy, distribution of income and food, unsafe drinking water,
sanitation facilities also affect people’s health.
Improvement in the health status in considered a by product of
economic growth. It is also argued that urbanization improves health status
because there are more medical facilities than in rural areas. But as far as
women’s health is concerned, that is mainly affected by biological and socio­
cultural factors. Illiteracy, religious belief, avoidance of the outer world,
hesitation in telling personal physical problems to the doctors, deliveries at
home are certain factors that affects women’s health. Specially, the rural areas
need more attention as the majority of the population i.e. almost 70 per cent,
lives in rural areas. Above all, the health care system demands more attention
and accessibility. There are issues related to accessibility and use of
subsidized public healthy facilities. A majority of poor households, especially
the rural ones, reside in backward, hilly and remote areas where lack of
medical facilities is a great problem. Neither government facilities, nor private
medical practitioners are available there. They have to depend on poor quality
of medical care provided by local facilities, often unqualified practitioners
and faith healers. Even in those areas, where medical facilities like PHC
(Primary Health Centres) are available, they are either dysfunctional or of low
quality services.
Of the set of commitments that the Indian state made to the people at
the dawn of independence, health care has been ostensibly high on the
agenda. Over the decades the state evolved, in keeping with the developetn
model it pursued, a policy for health which emphasized the creation of health
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care infrastructure - medical colleges, doctors, hospitals etc. - in the state

sector, even as it turned a blind eye to the effects of the working of the private
health sector which grew rapidly. For example, the proliferation of doctors
in the last 20 years has had its own dynamics leading to brain drain in the
initial years and later to the rapid growth of private health facilities, now
being consolidated as corporate sector in medicare (Prakash: 1994). In
consequence, there was little recognition of the tense relationship which was
developing between the state sector and a rapidly spreading private health
care sector, a situation which has become increasingly destructive of the
public system. If today, the state is increasingly shelving its responsibility
even as it openly encourages private hospitals as well as NGO sector, it is a
consequence of the history of health care development in the country. The
ground for the adoption of recommendations made in the health sector as a
component of IMF/World Bank - Mooted structural adjustment programme
had been well prepared.
Increasingly, in the name of preventive health, pressure is being
exercised by international oranisations such as WHO on the Indian
government to allocate public funds for universal immunization with other
vaccines such as hepatitis B and Hib vaccines. Such vaccine policies have
been questioned for their lack of epidemiological justification (Batham et al.,
2007). It has also been pointed out that in post-independence period, the
policies of international agencies and the interests of transnational
corporations have directly or indirectly shaped the research and production of
vaccines (Madhavi, 2007).
Medical technology may be able to prevent a certain proportion of
deaths, the outcomes may not be equitable even if the technologies reach
equitably as they would be tempered by social determinants. However,
ironically, assessing medical care today is becoming an important
determinants for poor health, primarily because of its cost. Health policy
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making in India, while recognizing the need to take the latter, is not paying
much attention to the former. This despite the fact that, conceptually, the
Indian planners did recognize the need to tackle problems of unemployment,
nutrition, social justice, housing, environmental sanitation, etc. along the
developing health services, and made health planning and integral part of the
planning for overall socio-economic development (Banerji, 1985). The
development policies of the government are becoming a source of poor health
of a large majority of our people, and it is no accident that they are the poor
and marginalized sections of the population. In the current context, given the
socio-economic status, specific technology, resources and mechanisms do
exist to reduce ill health. If in the West tuberculosis, fell before the advent of
specific medical technology, in today’s situation, with the availability of
potent drugs and superior epidemiological understanding, the country should
have been able to eliminate deaths and reduce incidence at a much accelerated
rate than the west. Health planning has to take cognizance of both, technology
and the specific socio-economic context through which it mediates for an
effective policy making.