PUBLIC HEALTH IN INDIA

* Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its concerned with the total system and not only the eradication of a particular disease. The three main public health functions are:

1. The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities.

2. The formulation of public policies designed to solve identified local and national health problems and priorities.

3. To assure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services.


* Thepublic health system in Indiacomprises a set of state-ownedhealth carefacilities funded and controlled by thegovernment of India. Some of these are controlled by agencies of the central government while some are controlled by the governments of thestates of India.

* Nodal Ministry - Ministry of Health & Family Welfare.

* List of institutions:


AIIMS (central govt.)

Regional Cancer Centre (centre and resp. state govt.)

Govt. medical hospitals

District hospitals

Taluk hospitals

Primary health care centre



* Key words for focus on issue:

* Right to health finds place in the Universal Declaration of Human Rights.

* Directive Principles of State Policy in articles 45 and 47.

* Health care indicators:

* MMR no of women in reproductive age (15-49) dying due to maternal causes per 1,00,000 live births sensitive indicator of quality of healthcare system. Absence of proper abortive centers is one reason

* IMR death of children below age of 1 year per 1000 live births- indicator of nutritional status

* TFR no of children born to women during her entire reproductive age indicates early marriage, lack of gap between births, lack of contraceptive measures and awareness

* Child sex ratio

* Anemia and malnutrition

* Goals set:

* IMR As per MDG it would be 27 by 2015.

* MMR - As per MDG it would be 109 by 2015.

* Total fertility rate (TFR): 2.1 by 2017.

* Policies:

* National health policy

* National population policy

* Why issue needs to be addressed

* When health improves, life improves by every manner.

* Indias burden in terms of maternal, new born, and child mortality is one the highest in the world.

* Health of the child and mother are closely linked; each has the capacity to influence the other.

* India is passing through demographic and environmental transition, which is adding to burden of diseases.

* There is triple burden of diseases of communicable and non-communicable and emerging infectious diseases

* Issues with public health

* Have disease oriented system rather than care oriented system

* The health care system present is quantitatively inadequate to serve the population.

* About 75% of the health infrastructures are concentrated in urban areas where 25% of the population lives.

* Significant inter-state, regional, social, gender disparities

* Sub-optimal health outcomes given level of income growth (GDP per capita)

* Sub-optimal spending by public sector

* Inadequate accountability of both public and private health service delivery

* Affordability of healthcare services is serious issues; especially tertiary services.

* Increasing public awareness for treatments is causing increase in demands.

* Unregulated private supply; unmonitored and unknown quality; concentration in urban areas

* Double Jeopardy increasing burden of non-communicable diseases, while communicable disease burden remains high.

* Chronic shortage of healthcare work force

* Lack of mobility for field staff

* Only 1% of GDP spent on health sector

* Inadequate integration of different health programs

* No referral system is present

* Lack of flexibility in program forestalls effective local level planning and implementation based on local disease priority.

* Delay in recruitment of healthcare workforce

* Postings not being done on work load basis or sanctioned basis

* Lack of HR management policies; no motivation

* Fragmented functional responsibilities

* ICDS, RWS, Food security, rural development, sanitation, etc., have little integration with healthcare.

* No public health cadre present

* Vacancies of specialists

* Lack of considerations of elements of disaster management in policies

* Suggestions/ Improvements

* Preventive and promotive health should be pursued to bring down expenses on curative Care.

* Increase expenditure in public health b govt

* Increase public investment in healthcare infrastructure

* Reduce out-of-pocket expenses by strengthening the government health system and strategic partnership with private sector that confirms to quality standards

* Resource allocation to districts and sub-district hospitals and health centers shall be based on formula that reckons remoteness, absence of private healthcare system, percentage of ST/SC population, prevalence of diseases, etc.

* Integration of primary, secondary, and tertiary health systems in order to provide comprehensive care

* Strengthened referral services.

* Revitalization of the primary health system, which is intricately linked with the first and second referral units with effective emergency transport services

* Energized comprehensive maternal and child health services

* Proactive community participation in promotive and preventive healt

* Few Measures taken as per 12th FYP

* Setting up of 6 AIIMS like institutes and up-gradation of medical colleges under Pradhan Mantri Swasthya Suraksha Yojana

* Promotion of institutional deliveries to reduce MMR through janani suraksha yojna

* Home based neo natal care through ASHA

* National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)started.

by Jyoti Anandani

1. Sources: WHO website, indian journal of public health; 12th FYP.