An overview of health care reforms in India

With over one-sixth of the world population , two per cent of the global GDP, 26 per cent of the global mortality among the population and one  of the lowest spending on health care by the gvernment (< 5 per cent  of GDP),one of highest levels of infant mortality, influx of all diseases both old and new , India presents a bleak picture on the healthcare side notwithstanding the tremendous economic progress achieved during the last half a century.

In terms of morbidity even now 60 per cent  is due to infectious diseases, 25 per cent due to lifestyle related diseases. However in the case of infectious diseases conditions are normally acute and resolve through available treatments and in the case of most viral disorders even without treatment.

Even though morbidity related to chronic diseases are only 25 per cent life style related diseases  like metabolic disorders such as diabetes, cardiovascular diseases , immune deficient disorders, cancer etc are life long chronic conditions requiring long- term treatment at enremous costs to the patients.

What is frightening is the fact while,  India like all developing countries  has been a storehouse of infectious diseases, during the last few decades morbidity and mortality  from life style related communicable diseases have considerably escalated , in some cases at rates higher than even those in the more affluent developed countries.

Even though there is a long way to in terms of providing nutrition, public health and sanitation facilities and potable water to the masses particularly in the rural areas,  through limited efforts small pox has been eradicated , so too guinea worm infection. During the last two years there has been no case of polio mostly due to the polio vaccination programmes.

Both due to public health measures and due to availability of cheap braoad spectrum anti parasitics, intestinal helminthic infections have considerably reduced. Filariasis is on the decline and under control while malaria and tuberculosis are still major issues in most parts of the country. The growth of HIV/AIDS has also been higher than even in some of the endemic areas other than parts of Africa.

While in all these areas the government has active programmes, two major concerns have been the emergence of newer diseases or newer variances of existing diseases as well as the impact  of resistant strains of tuberculosis for example. Diseases such as leptospirosis, new strains of  dengue, Japanese encephalitis, chike gunea, avian flu, swine flu even though have not turned out to epidemics still are major threats  for which no integrated plan of control has been evolved.

Components of  healthcare
Maintenance of health is an essential prerequisite for development and growth of any nation. Strategies to achieve optimal levels of healthcare for the population is based on a multiplicity of factors and is ultimately the responsibility  of the governmemt . In India , according our planning structre, health is in the concurrent list of responsibilities between the central government and the state governments. Preventable diseases are handled by the Government of India’s programme on vaccination under two major heads the Universal Programme of Immunisation (UPI) and the  Extended Programme of Inmmunisation (EPI). Apart from polio it covers through the introduction of the pentavalent vaccine including Hep B and overall the vaccination programme supported by some global charitable foundations and WHO has been a success story.

Other govt initiatives
The total spending on healthcare  as a  per cent  of GDP in India is one of the lowest of  most countries of the world at 4.1 per cent  compared to the U.S which has reached an astonishing 17.9 per cent. The doctor to patient ratio is a mere 6.47 per 10,000 lower than even Pakistan.

Added to that is the fact that most of them practice on urban India with rural areas being neglected and orphaned. Annual per capita spending on health in India is a mere $ 132 ( adjusting for PPP) compared to $ 8362 in the U.S.  The case of qualified nurses servicing the patients is only slightly better than in the case of doctors.While building up infrastructure to ensure adequate public health, sanitation and potable water are clear objectives for improvements in healthcare,  by the very nature of the activities involved apart from investments and reach, the impact of these measures are bound to be long term.