Health

Health is not merely the absence of disease but the ability to realise one's potential — a yardstick of a person's well-being and a holistic process tied to the overall growth and development of a nation. Although the twentieth century saw an unmatched global transformation in human health, the health status of a nation cannot easily be captured by a single measure. Scholars generally assess it through indicators such as infant and maternal mortality rates, life expectancy, nutrition levels, and the incidence of communicable and non-communicable diseases.

A developed health infrastructure ensures a country of healthy manpower to produce goods and services, and many scholars now argue that people are entitled to health care, making it the government's responsibility to ensure the right to healthy living. Health infrastructure includes hospitals, doctors, nurses and other para-medical professionals, beds, hospital equipment and a well-developed pharmaceutical industry. But the mere presence of such infrastructure is not enough — it must be accessible to all. From the earliest stages of planned development, policy-makers held that no one should fail to secure medical care, curative or preventive, for lack of the ability to pay. Whether India has achieved this vision is the question this section examines.

State of Health Infrastructure

The government has a constitutional obligation to guide and regulate all health-related matters — from medical education and the medical profession to the adulteration of food, drugs and poisons, vital statistics, and mental health. The Union Government frames broad policies and plans through the Central Council of Health and Family Welfare, and it collects information and gives financial and technical assistance to the states, union territories and other bodies to run important health programmes.

Over the years India has built a vast health infrastructure. At the village level the government has set up Primary Health Centres (PHCs), and there are also many hospitals run by voluntary agencies and the private sector, staffed by professionals trained in medical, pharmacy and nursing colleges. Since independence the physical provision of health services has expanded significantly — during 1951-2013, the number of government hospitals and dispensaries rose from 9,300 to 44,000 and hospital beds from 1.2 to 6.3 lakh, nursing personnel grew from 0.18 to 23.44 lakh and allopathic doctors from 0.62 to 9.2 lakh. This expansion helped eradicate smallpox and guinea worms and bring polio and leprosy close to eradication. Table 8.3 traces this growth.

Table 8.3 — Public Health Infrastructure in India, 1951-2010

Sources: National Commission on Macroeconomics and Health, Ministry of Health and Family Welfare (2005); National Health Profile 2010.

Private Sector Health Infrastructure

While the public health sector has not been very successful in delivering results, the private sector has grown by leaps and bounds. More than 70 per cent of hospitals in India are run privately; they control nearly two-fifths of hospital beds and run nearly 60 per cent of dispensaries, providing health care for about 80 per cent of out-patients and 46 per cent of in-patients. The private sector now dominates medical education and training, medical technology and diagnostics, the manufacture and sale of pharmaceuticals, hospital construction and the provision of medical services. In 2001-02 there were more than 13 lakh medical enterprises employing 22 lakh people, over 80 per cent of them owned and run by a single person. Because the private sector has grown with little regulation, some practitioners are not even registered doctors and are known as quacks. Since the liberalisation measures of the 1990s, many non-resident Indians and pharmaceutical companies have set up state-of-the-art super-specialty hospitals to attract India's rich and medical tourists — raising the question of whether ordinary people can ever reach such care.

Box 8.5 — Health System in India

India's health care is organised as a three-tier system — primary, secondary and tertiary. Primary health care covers education about common health problems, food supply and nutrition, safe water and basic sanitation, maternal and child health care, immunisation, mental-health promotion and essential drugs; the Auxiliary Nursing Midwife (ANM) is the first provider of primary health care in rural areas, through Primary Health Centres (PHCs), Community Health Centres (CHCs) and sub-centres. Secondary institutions (with facilities for surgery, X-ray and ECG) are mostly in district headquarters, and cases they cannot handle are referred to the tertiary sector, which has advanced equipment and premier institutes such as the All India Institute of Medical Sciences, New Delhi.

Box 8.6 — Medical Tourism: A Great Opportunity

Foreigners increasingly come to India for surgeries, transplants, dental and cosmetic care, because Indian health services combine the latest medical technologies with qualified professionals at a lower cost than in their home countries. In 2004-05 about 1,50,000 foreigners visited India for treatment, a figure expected to grow by around 15 per cent a year — a real opportunity if health infrastructure is upgraded to attract more of them.

Box 8.7 — Community and Non-Profit Organisations in Healthcare

A good health-care system depends on community participation: people can be trained and involved in primary health care. NGOs such as SEWA (Ahmedabad) and ACCORD (Nilgiris) work along these lines; trade unions have built alternative low-cost health services (the pioneering Shahid Hospital, built in 1983 by the workers of the Chhattisgarh Mines Shramik Sangh, is one example); and rural organisations such as the Kashtakari Sangathan in Thane train village women to treat simple illnesses at minimal cost.

Indian Systems of Medicine (ISM)

India also has its own Indian Systems of Medicine, made up of six systems — Ayurveda, Yoga, Unani, Siddha, Naturopathy and Homeopathy (together AYUSH). There are about 3,167 ISM hospitals, 26,000 dispensaries and as many as 7 lakh registered practitioners. Little has yet been done to standardise ISM education or promote research, but the systems have huge potential and could solve a large part of India's health-care problems because they are effective, safe and inexpensive.

Indicators of Health and Health Infrastructure — A Critical Appraisal

The health status of a country can be assessed through indicators such as infant and maternal mortality rates, life expectancy, nutrition levels and the incidence of diseases. Table 8.4 gives some of these indicators and India's position.

Table 8.4 — Indicators of Health in India in Comparison with other Countries, 2012

Sources: World Health Statistics 2013 and World Bank.

The table shows that government spending on health is only 8.2 per cent of total government spending (and health expenditure only 3.9 per cent of GDP) — abysmally low compared with other countries, developed and developing alike. One study notes that India has about 17 per cent of the world's population but bears a frightening 20 per cent of the global burden of diseases (GBD) — an indicator that gauges the number of people dying prematurely from a disease and the number of years they spend in a state of 'disability' because of it. In India, more than half of the GBD is accounted for by communicable diseases such as diarrhoea, malaria and tuberculosis; around five lakh children die of water-borne diseases each year, the danger of AIDS looms large, and malnutrition and inadequate vaccine supply lead to the death of 2.2 million children every year. At present, less than 20 per cent of the population uses public health facilities; only 38 per cent of PHCs have the required number of doctors, and only 30 per cent have a sufficient stock of medicines.

Urban-Rural and Poor-Rich Divide …