Health in India

India has a universal health care system run by the constituent states and territories of India. The Constitution charges every state with "raising the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties". The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002. High Level Expert Group on Universal Health Coverage Formation and mandate The High-Level Expert Group (HLEG) on Universal Health Coverage (UHC) was constituted by the Planning Commission of India in October 2010, under the chairmanship of Prof. K. Srinath Reddy, with the mandate of developing a framework for providing easily accessible and affordable health care to all Indians. Recommendations of the High Level Expert Group (HLEG)

Increase public expenditure on health to at least 2.5 percent of GDP by the end of the 12th Plan and to at least 3% of GDP by 2022. Ensure availability of free essential medicines by increasing public spending on drug procurement. Purchase of all health care services under the Universal Health Coverage (UHC) system should be undertaken either directly by the Central and state governments through their Departments of Health or by quasi-governmental autonomous agencies. All government funded insurance schemes should, over time, be integrated with the UHC system. All health insurance cards should, in due course, be replaced by National Health Entitlement Cards. The technical and other capacities developed by the Ministry of Labour for the Rashtriya Swasthya Bima Yojana should be leveraged as the core of UHC operations and transferred to the Ministry of Health and Family Welfare. Develop a National Health Package that offers, as part of the entitlement of every citizen,essential health services at different levels of the health care delivery system. Reorient health care provision to focus significantly on primary health care. Strengthen District Hospitals. Ensure adequate numbers of trained health care providers and technical health care workers at different levels by

a) giving primacy to the provision of primary health care b) increasing Human Resources for Health (HRH) density to achieve WHO norms of at least 23 health workers (doctors, nurses, and midwives).

Introduce All India and state level Public Health Service Cadres and a specialized state level Health Systems Management Cadre in order to give greater attention to public health and also strengthen the management of the UHC system. Establishment of National Health Regulatory and Development Authority(NHRDA). National Drug Regulatory and Development Authority (NDRDA): The main aim of NDRDA should be to regulate pharmaceuticals and medical devices and provide patients access to safe and cost effective products.

Twelfth Five Year Plan

Strategy Following are the 12th plan period strategy: 1. Substantial expansion and strengthening of public sector health care system, freeing the vulnerable population from dependence on high cost and often unreachable private sector health care system. 2. Health sector expenditure by central government and state government, both plan and non-plan, will have to be substantially increased by the twelfth five year plan. It was increased from 0.94 per cent of GDP in tenth plan to 1.04 per cent in eleventh plan. 3. Financial and managerial system will be redesigned to ensure efficient utilization of available resources and achieve better health outcome. 4. Increasing the cooperation between private and public sector health care providers to achieve health goals.. 5. The present Rashtriya Swasthya Bhima Yojana (RSBY) which provides cash less in-patient treatment through an insurance based system should be reformed to enable access to a continuum of comprehensive primary, secondary and tertiary care. 6. In order to increase the availability of skilled human resources, a large expansion of medical schools, nursing colleges, and so on, is therefore is necessary and public sector medical schools must play a major role in the process. 7. The multiplicity of Central sector or Centrally Sponsored Schemes has constrained the flexibility of states to make need based plans or deploy their resources in the most efficient manner. 8. A series of prescription drugs reforms, promotion of essential, generic medicine and making these universally available free of cost to all patients in public facilities as a part of the Essential Health Package will be a priority. 9. Effective regulation in medical practice, public health, food and drugs is essential to safeguard people against risks and unethical practices. 10. The health system in the Twelfth Plan will continue to have a mix of public and private service providers. Criticism While the HLEG report recommends an increase in public expenditure on health from 1.58 per cent of GDP currently to 2.1 per cent of GDP by the end of 12th five year plan it is far lower than the global median of 5 per cent. The lack of extensive and adequately funded public health services pushes large numbers of people to incur heavy out of pocket expenditures on services purchased from the private sector. Out of pocket expenditures arise even in public sector hospitals, since lack of medicines means that patients have to buy them. This results in a very high financial burden on families in case of severe illness. Instead of developing a better public health system with enhanced health budget, 12th five year plan document plans to hand over health care system to private institutions. The 12th plan document express concern over Rashtriya Swasthya Bhima Yojana being used as a medium to hand over public funds to private sector through insurance route. This has also incentivized unnecessary treatments which in due course will increases costs and premiums. There has being complaints about high transaction cost for this scheme due to insurance intermediaries. Even though these things are acknowledged in the report, no alternative remedy is given. Quality The quality of Indian healthcare is varied. In major urban areas, healthcare is of adequate quality, approaching and occasionally meeting Western standards. However, access to quality medical care is limited or unavailable

in most rural areas, although rural medical practitioners are highly sought after by residents of rural areas as they are more financially affordable and geographically accessible than practitioners working in the formal public health care sector. Health issues According to a 2005 report, 42% of Indias children below the age of three were malnourished, which was greater than the statistics of sub-Saharan African region of 28%. Approximately 1.72 million children die each year before turning one. Diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs. India is ranked 3rd highest among countries with a high rate of HIV-infected persons. Diarrheal diseases are the primary causes of early childhood mortality. These diseases can be attributed to poor sanitation and inadequate safe drinking water in India. India also has the world's highest incidence of Rabies. Poor sanitation As more than 122 million households have no toilets, and 33% lack access to latrines, over 50% of the population (638 million) defecate in the open. This is relatively higher than Bangladesh and Brazil (7%) and China (4%). Inadequate safe drinking water Only 26% of the slum population has access to safe drinking water and 25% of the total population has drinking water on their premises. This problem is exacerbated by falling levels of groundwater caused mainly by increasing extraction for irrigation. Rural health Rural India contains over 68% of India's total population, and half of all residents of rural areas live below the poverty line, struggling for better and easy access to health care and services. Health issues confronted by rural people are many and diverse from severe malaria to uncontrolled diabetes, from a badly infected wound to cancer. Health care system Public and private sector According to National Family Health Survey-3, the private medical sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. National Rural Health Mission The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India. The goal of the NRHM was to provide effective healthcare to rural people with a focus on 18 states which have poor public health indicators and/or weak infrastructure.