Public health is squarely a state responsibility and particularly so in a developing country. It has to go hand-in-hand with sanitation, drinking water, health education and disease prevention. The challenges facing India’s health sector are mammoth. They will only multiply in the years ahead. Surprisingly many of the challenges are neither a result of the paucity of resources nor of technical capacity. These hurdles exist because of a perception that the possible solutions may find disfavour with voters or influential power groups. The first malady has been the utter neglect of population stabilisation in states where it matters the most. The second is the monopoly that an elitist medical hierarchy has exercised for over 60 years on health manpower planning. The result has given a system where hightech speciality services are valued and remunerated far higher than the delivery of public health services. The latter ironically touches the lives of millions. Related to this is the third big challenge — how to make sure that doctors serve the growing needs of the public sector when the working conditions are rotten, plagued by overcrowding, meagre infrastructure and a virtual absence of rewards and punishments. Divergent Attitudes to Birth Control. In the aftermath of the 1975 Emergency and the odium of forced sterilisations, the emphasis on population control shrivelled in most of North India. While countries like Korea and Iran which then had fertility rates far higher than ours, embraced the joys of planned parenthood, India dodged the subject. In 1994 the country adopted a target free policy and the states were encouraged to implement a “cafeteria approach” while supplying contraceptives. However the southern states of Kerala and Tamil Nadu unlike the rest of the country went full force to make family planning their top-most priority. No matter which party came to power, political support was there in abundance. In the mid- eighties the programme was spearheaded by no less than the state Chief Secretary of Tamil Nadu, Mr.T V Anthony, (nick-named Tubectomy-Vasectomy Anthony )which speaks for itself. With enthusiastic politicians, civil servants and doctors joining hands, Kerala and Tamil Nadu reduced fertility rates to equalise European levels. That was more than 20 years ago. Meanwhile, North India (where most of the emergency driven sterilisations had taken place) recoiled from the very mention of family planning- a mind-set that persists even to this day.
The Challenge of Reducing Maternal and Infant Mortality There is a clear correlation between the health of the mother and maternal and infant mortality. In the northern states more than 60% of the girls and boys (respectively) are married well before the legal ages of 18 and 21. The repercussions of early pregnancy and child birth have not even dawned on the pair when they wed. The first child arrives within the year when most adolescent girls are malnourished, anaemic and poorly educated. With no planned spacing between the births, another child is born before the young mother has rebuilt her strength or given sufficient nutrition and mothercare to the first born. These are among the main causes of high deaths of young women and infants. The chart and tables below clearly show the regional difference in maternal, infant and child mortality. Narrowing the gaps poses one of the biggest health challenges. Regional Variations: Maternal Mortality Ratio* (MMR)
Extract from – Special Bulletin (June, 2011) on Maternal Mortality in India 2007-09 (Sample Registration System) Office of Registrar General, India *MMR: Maternal deaths per 1,00,000 live births The regional variations in the deaths of mothers in the states of Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh, Chattisgarh, Odisha, Rajasthan and Assam show that the percentage of maternal deaths is 6 times higher than in the Southern states.
The following are the major problems of health services:
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 allocating 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 funds.