India Health System

7/28/2019 India Health System

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Comparative analysis of healthsystem of Nepal and India

Presented by:

Suvash Regmi

Suraksha ShahLipasha Shrestha

Priyankya Aryal

Prepared by Suvash Regmi


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Introduction

India and Nepal are the South Asian

neighboring nations sharing culture, tradition

and political scenario.

Both the countries are dependent on

agriculture in a large scale. Agriculture plays

a vital role in the living style of the people in

these respective countries.



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CONTD..

All the sectors have been under political

influence since their independence from

foreign rule and anarchism respectively.

Both these countries have similarities in thehealth system and health services provided.

Heath system in both countries are to a large

extend privatized as the public sector is notmuch effective regarding the tertiary care.



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CONTD

Lack of human resource, skilled human

resource, logistics, updated equipments,

methods, research in health, awareness level

of the citizens, not following the healthreferral system, poverty, illiteracy etc. are the

reasons behind lagging in availability and

accessibility of health services that results in

poor health status of these two countries.



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CONTD.

The factors affecting health of population are

based on the following trends which are

similar in both the countries and statisticalinfluence only being a difference, not the

problems and services provided in health

sector.



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Factors affecting health inboth countries

Economic trend

Poverty

Demography Food supply and nutritional status

Social Trends

Lifestyle and Risk Factors



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PROBLEMS, CONSTRAINTS,CHALLENGES

Difficult to get trained human resource to

work in remote areas.

Lack of awareness in legalization of safeabortion.

Difficult terrain is a challenge to reaching the

most at-risk populations.

International Non-Government Organisations



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Contd..

Ensuring effective synergy, coordination and

collaboration with key public and private

Sector stakeholders is essential to program

success.



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Health System in India



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Introduction

The political economy context

The organisational structure and delivery

mechanism

Top 5 Diseases

Health financing mechanisms

Coverage patterns Current status of health and health care



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The Political Economy Context

A democratic federal system which is subdivided into

28 States, 7 union territories and 593 districts

In most of the states three local levels of government(Panchayati-raj)

Per capita income US $890. 435 million Indians are estimated to live on less than US $ 1 a

day

36% of the total number of the worlds poor are in India

Tax based health finance system with health insurance

80% health care expenditure born by patients and theirfamilies as out-of -pocket payment (fee for service and drugs)

Expenditure on health care is second major cause ofindebtedness among rural poor



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Characteristics of IndianHealth System

Complex mixed health system

- Publicly financed government

health system

- Fee-levying private health sector



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Different Phases of IndianHealth System Development

Pre-independence phase

Development centred phase

Comprehensive Primary Health Care phase Neoliberal economic and health sector reform

phase

Health systems phase



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Main Systems of Medicine

Western allopathic

Ayurveda

Unani Siddha

Homeopathy



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Government Health System

Three levels of responsibilities-

- First-

- health is primarily a state responsibility

- Second-- the central government is responsible for developing andmonitoring national standards and regulations

- sponsoring various schemes for implementation by stategovernments

- providing health services in union territories

- Third-

- both the centre and the states have a joint responsibility

for programmes listed under the concurrent list.Prepared by Suvash Regmi


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Administrative Structure

1. Central Ministries of Health and FamilyWelfare

- Responsible for all health related

programmes

- Regulatory role for private sector

2. State Ministries of Health and Family

Welfare3. District Health Teams headed by Chief

Medical and Health OfficerPrepared by Suvash Regmi


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Service Delivery Structure

Sub Health Centres- staffed by a trainedfemale health worker and/or a male health workerfor a population of 5000 in the plains and a

population of 3000 in hilly and tribal areas. Primary Health Centres-

staffed by a medical officer and other paramedicalstaff for a population of 30,000 in the plains and a

population of 20,000 in hilly, tribal and backwardareas. A PHC centre supervises six to eight subcentres.



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Service Delivery Structure

Community health centres- with 30-50 beds

and basic specialities covering a population

of 80,000 to 120,000. The CHC acts as a

referral centre for four to six PHCs.

District/General hospitals- at district level with

multi speciality facilities (City dispensaries)

Medical colleges, All India institute of MedicalSciences and quasi government institutes.



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Physical infrastructures

Regarding the hospitals and hospital beds, the scenario presents the

dominance of healthcare facilities in the private sector. Public health

infrastructure in rural areas consists of a three-tier system, a sub centre for

every 5,000 population with a male and female worker; a PHC for every

30,000 population with a medical doctor and other para medical staff, and a

Community Health Centre (CHC) for every 100,000 population with 30 bedsand basic specialists. In urban areas, it is two tier systems with Urban

Health Centre (UHC)/Urban Family Welfare Centre (UFWC) for every

100,000 population followed by general hospital.

In 2001, there were about 1,37,311 Sub Centres (SCs), 28,000dispensaries, 22,842 PHCs, 3,043 CHCs and 3,500 UFWCs and an

additional 12,000 secondary and tertiary hospitals in the public sector,

besides an estimated 68 percent of total hospitals in the private sector.



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Health Care Workforce

Community and traditional health workers density (per 10 000

population)


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Contd

Number of nursing and midwifery personnel

1,372,059 (2004)

Number of other health service providers

695,024 (2003)

Number of Pharmaceutical personnel

559,408 (2003)

Number of Physicians

645,825 (2004)



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Contd..

Nursing and midwifery personnel density (per 10,000

population)

13.00 (2004)

Other health service providers density (per 10,000population)

7.00 (2003)

Pharmaceutical personnel density (per 10,000

population) 5.00 (2003)

Physicians density (per 10,000 population)

6.00 (2004)Prepared by Suvash Regmi


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Contd.

SC/Public Health Center (PHC)/Community

Health Centers (CHC) - 1,63,181

Dispensaries & Hospitals - 43,322

Beds (Pvt & Public) - 8,70.161

Doctors (Allopathy) - 5,03,900

Nursing Personnel) - 7,37,000 *MOHFW



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Top Five Diseases

HIV/AIDS

MALARIA

TUBERCULOSIS DENGUE

PNEUMONIA



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Health Financing Mechanisms..

Revenue generation by tax

Out of pocket payments or direct payments Private insurance

Social insurance

External Aid supported schemes



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Spending on Health

National health Accounts and Health statistics by

2010 show increase in the expenditure by

government as a percentage of GDP from the

the then existing 0.9 percent to 2 percentincrease share of central grant to constitute at

least 25 percent of total spending by 2010,

increase State sector health spending from 5.5

percent to 7 percent of the budget by 2010 andfurther increase it by 8 percent by 2010.



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CONTD..

Out of this only 15 % is publicly financed

4% from social insurance, 1% by private

insurance remaining 80% is out of pocket

spending ( 85% of which goes in privatesector)

Only 15% of the population is in organised

sector and has some sort of social securitythe rest is left to the mercy of the market



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The Aspects of Neoliberal Economic

Reforms Affecting Public Health

Increasing unregulated privatisation of the health caresector with little accountability to patients

Cutting down government Health care expenditure

Systematic deregulation of drug prices resulting in

skyrocketing prices of drugs and rising cost of healthservices

Selective intervention approach instead comprehensiveprimary health care

Measure diseases in terms of cost effectiveness Techno centric approach( emphasis on content instead

processes)



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Contradictions

India has the largest numbers of medical

colleges in the world

It produces the largest numbers of doctors

among developing countries

It gets medical Tourists from developed

countries

This country is fourth largest producer of

drugs by volume in the world



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But... the current situation.

Only 43.5% children are fully immunised. 79.1% of children from 6 months to 5 years of age are

anaemic. 56.1% ever married women aged 15-49 are anemic. Infant Mortality Rate is 58/1000 live births for the country with

a low of 12 for Kerala and a high of 79 for Madhya Pradesh. Maternal Mortality Rate is 301 for the country with a low of

110 for Kerala and a high of 517 for UP and Uttaranchal in the2001-03 period.

Two thirds of the population lack access to essential drugs. 80% health care expenditure born by patients and their

families as out-of -pocket payment (fee for service and drugs) Health inequalities across states, between urban and rural

areas, and across the economic and gender divides havebecome worse

Health, far from being accepted as a basic right of the people,is now being shaped into a saleable commodity



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Contd.

poor are being excluded from health services

Increased indebtedness among poor

(Expenditure on health care is second

major cause of Indebtedness amongrural poor)

Difference across the economic class spectrumand by gender in the untreated illness has

significantly increased Cutbacks by poor on food and other

consumptions resulting increased illnesses andincreasing malnutrition



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Health Inequities

The infant mortality Rate in the poorest 20% of thepopulation is 2.5 times higher than that in the richest20% of the population

A child in the Low standard of living economicgroup is almost four times more likely to die inchildhood than a child in a better of high standardliving group

A person from the poorest quintile of the population,

despite more health problems, is six times less likelyto access hospitlisation than a person from richestquintile.



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Health Inequities

A girl is 1.5 times more likely to die before

reaching her fifth birthday

The ratio of doctors to population in rural

areas is almost six times lower than that for

urban areas.

Per person, government spending on public

health is seven times lower in rural areascompared to government spending urban

areasPrepared by Suvash Regmi


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Diseases such as dengue fever, hepatitis,tuberculosis,

malaria and pneumonia continue to plague India due to

increased resistance to drugs. And in 2011, India finally

developed a totally drug-resistantform of

tuberculosis. India is ranked 3rd among the countries

with the most number of HIV-infected. Diarrheal

diseases are the primary causes of early childhood

mortality. These diseases can be attributed to poor

sanitation and inadequate safe drinking water in India. However in 2012, India was polio free for the first time in

its history.



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Thank You.


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India Health System