HEALTHCARE IN INDIA

1st five year plan (1951-1956) to 5th five year plan (1974-1979)
The 1st to 5th five year plan were based on the recommendations of the Bhore committee (1946), Mudaliar committee (1961) etc.
1st five year plan defined health as- health is fundamental to national progress in any sphere. In terms of resources for economic development, nothing can be considered of higher importance than the health of people. For the efficiency of industry , and of agriculture the health of worker is an essential consideration. Health is a positive state of well being in which the harmonious development of physical and mental capacities of individual lead to the enjoyment of a rich and full life.
All India institute of medical science (AIIMS), Delhi was established in1956 as an institution of national importance by an act of parliament with the object of teaching in undergraduates and post graduates.

6th five year plan (1980-1985) to 11th five year plan (2007-2012)
The main focus during this period was improving the availability of HEALTH HUMAN RESOURCES building rural health infrastructure, improving the availability of medicines and other services.

NATIONAL HEALTH POLICY 1983 & 2002-

* Indias first national health policy.

* Main objective to achieve an acceptable standard of good health.

* The NHP 2002 noted that the central government will have to play a key role in augmenting public health investments as the state governments were in difficult fiscal situations, and active planning between centre and state government.

NATIONAL RURAL HEALTH MISSION (healthy village)-

* Launched in April 2005.
Objectives-

* Accessible

* Affordable

* And quality healthcare to rural population
Important feature-

* involvement of communities in planning and monitoring

* provision of untied grants to healthcare facilities and the communities annually

* placing a trained female activist in each village for 1000 population known as ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA) to act as a link between the public health system and the community and bottom up planning
Programme is continued till 12th five year plan and following initiative are being taken-

* Janani Suraksha Yojana (JSY)

* Conditional cash transfer of Rs.1400 on institutional delivery in rural area and rs.1000 in urban area.

* Cash incentive for ASHA for promoting safe care in pregnancy and facilitating access to institutional care.


* Janani Shishu Suraksha Karyakarm (JSSK) pregnant women delivering in public health institution will have absolutely free and no expense on delivery, including caesarean section, medicines, food,diagnostics,transport from home an back and even blood if needed.

* Mother And Child Tracking System (MCTS)

* It is a tool to reduce MMR/IMR/TFR and track the health service delivery at the individual level.

* To keep a track on sex ratio

* Monitors the efficiency of the maternal and child health services in terms of needs, effectiveness and capacity.

* To avail the facilities every mother need to register themselves at CHC or PHC. All the registered mothers are provided information through short message service (SMS) not only about their vaccination but about the type of diet they are supposed to take during and after the pregnancy.


* Universal Immunization Programme (UIP) The UIP protects infants against six vaccine preventable diseases viz tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles.

* Operationalisation of 24 *7 facility at PHCs-

* 24 hours facilities like

* new bone corner

* Delivery service in presence of medical officer and nursing attendant.

* Village health and sanitation committee-

* It comprises a panchayat member, civil society representative,anganwadi worker, and auxiliary nurse midwife.

* It is expected to prepare village level health action plan

* Grants are given through NRHM



NATIONAL URBAN HEALTH MISSION (healthy cities)- focuses on the health needs of urban poor, particularly the slum dwellers by making available essential primary health care services.


PRADHAN MANTRI SWASTHYA SURKASHA YOJANA (PMSSY)

* launched in 2006

* Objective- to correct imbalance in availability of affordable/ tertiary level healthcare in country and to augment facilities for quality medical education in the underserved states.

* It envisages setting 8 AIIMS like institution.

AYUSH- engrained in local temperament. Its huge resource of hospital bed and health workers can play an important role in achieving the NATIONAL HEALTH OUTCOME GOAL.

12TH five year plan(2012-2017) towards comprehensive health care
Planning commission constituted the HIGH LEVEL EXPERT GROUP (HLEG) on universal health coverage (UHC) under the chairmanship of Dr.K. Srinath Reddy to draw and design a comprehensive strategy for health of 12th five year plan. Some of the recommendations of HLEG are

* Equitable access to affordable, accountable, appropriate health services of assured quality as public health services.

* Increased government expenditure on health from 1.2 % of GDP to atleast 2.5 % by the end of 12th plan and to at least 3% by 2022.

* Availability of free essential medicines.

* Use general taxation as the principal source of funding healthcare.

* Three year bachelors degree for rural health.

* Setting up of 187 new medical colleges and 382 new nursing schools over the next 10 years in underserved district

* Regulation of public and private sectors to ensure provision of assured quality and rational pricing of health care system.

* Reducing IMR/MMR.

* Access to public health services for every citizen.

* Prevent and control communicable and non- communicable diseases.

* Improving child sex ratio for 0-6 years.

* Control population as well as ensure gender and demographic balance.

* Encourage a healthy lifestyle and alternative system of medicine.

* Clean drinking water, sanitation, and better nutrition and childcare

* Improve quality of NRHM services vs. quantity of NRHM infrastructure.

* Health insurance cover should be expanded to all disadvantaged groups.

* Focus on women and children, ICDS needs to be revamped.

FINANCING HEALTHCARE-
Since health is a necessity of social welfare, it becomes imperative for the state to provide for it through collective payments ( public budget), in addition to private sector.

* INTERNATIONAL EXPERIENCE-
In most developed countries , public financing accounts for around 80% of health expenditure.in contrast in most developing countries the reverse is true i.e. 70-80% of health expenditure is met by individuals from their private resources.


* HEALTH EXPENDITURE IN INDIA-




Health expenditure in india is dominated by private spending to a large extent this is a reflection of inadequate public spending that has been a constant, unfortunate feature of indias development in the past half century. More recent estimates suggest that the role of household has increased in the recent period. According to the report of the National Comission on Macroeconomics and Health, 2005, household undertook nearly three fourths of all the health spending in the country. Public spending was only 22% and all other sources accounted for less than 5%.

CURRENT BUDGETING ON HEALTHCARE-
The share of health in the union budget increased from 2.1 % in the current year to 2.4% in 2011-2012. But the increase in its share of the GDP was negligible from 0.32% in the current year to 0.34% in 2011-2012. The total public expenditure on health is around 1% of GDP.
Key points in budgeting-

* Allocation on NRHM has increased by 19% which is still not adequate

* Key public health programmes have also been given short shrift.

* Allocation for various national disease programmes declined by 14%.

* UIP covered just43.5% population still reduced for funds

* Anomalies in public health allocations

* Budget cut compared to2009-2010 has also hit national TB control programmes.

* Budget 2011 ignored geographical spread and incidence of vector borne diseases such as malaria, dengue, chickunguniya, and Japanese encephalitis

* Extension of rashtriya swasthya bima yojana to cover the unorganized sector workers in hazardous mining and associated industries like slate, slate pencil, dolomite, mica and asbestos but the budget was drastically reduced compared to previous year.

INDIAS HEALTH-

* About 75% of health infrastructure is located in urban area where only27% of populationlives.

* Life expectancy 63 years.

* Infant mortality rate 54/1000 live births

* Maternal mortality rate 254/100 000 live births

* Lack of community ownership of public health programmes impact level of efficiency, accountability and effectiveness.

* Lack of integration of sanitation, hygiene, nutrition and drinking water issues.

* There are striking regional inequalities.

* Population stabilization is still a challenge

* Only 10% of Indians have health insurance mostly inadequate.

* Lack of capital investment in health for prolonged period of time.

* Ensuring delivery of safe drugs is a major challenge.

* Lack of human resources.



THREE TIER STRUCTURE OF INDIAN HEALTH CARE SYSTEM-

URBANHILLY/ TRIBAL/RURAL

SUB CENTRE5,0003,000

PRIMARY HEALTH CENTRE30,00020,000

COMMUNITY HEALTH CENTRE1,20,00080,000


SUBCENTRE-

* The subcentre is closest to the common man and becomes the first point of contact in the three tier system

* One female health assistant/auxiliary nurse midwife(ANM) and one male health assistant manages one subcentre.
PRIMARY HEALTH CARE CENTRE(PHC)-
PHC was conceptualized in 1946, three decades before the Alma Ata declaration, with the recommendation of Bhore Committee, that laid emphasis on social orientation of medical practice and high level of public participation.

* Each PHC is a hub for six sub centres.

* A PHC typically has a four to six beds for addressing immediate and basic health care necessities.
COMMUNITY HEALTH CARE CENTRE(CHC)-

* A CHC has one surgeon, one physician, one gynecologist, and one pediatrician along with 21 paramedical staff.

* CHC is a 30 bed facility.

* One CHC for four PHCs.

PROGRESS OF HEALTH STATUS IN INDIA-



CHALLENGES IN HEALTH SECTOR-

* To reduce Infant and maternal mortality rate.

* Health management and manpower planning.

* The challenge to establish national council for human resources in health( NCHRC).

* Best utilization of allopathic and AYUSH doctors

* Challenge to retain doctors.
ISSUES TO BE ADDRESSED-

* Shortage of funds is a major drawback in public sector for rural health , this lead to non availability of health infrastructure, provision of inputs, drugs etc. at the grass root level.

* There is sub optimal utilization of health centres due to inadequate human resources and lack of availability of drugs and good laboratories.

* In rural areas improving nutrition seems to be the biggest challenge.

* A large number of legal provisions exist in the health sector such as no smoking, it is unfortunate that the level of legal provision is very poor. There is need to strengthen the implementation mechanism.

* Actual implementation of innovative schemes and programmes launched.

* The number of doctors , nurses and paramedical staff is low.

* To assess the development in the field of medical relief in public health, the union health ministry has constituted committees such as Bhore committee,Dr. A.laxmanswamy mudiliar and Swami mudaliar, central expert committees under the Indian council of medical research(ICMR) to make effective recommendations to improve the health sector. The recommendation of these committees need to translated into reality.
by Name- chitralekha tiwari

References-
yojana
Indianjournals.com
Kurukshetra
Asian journal of research in social science & humanities
The hindu