Health related issues

National Health Profile – 2015

- Every government hospital serves estimated 61000 people in India with one bed for every 1833 people
- Every government allopathic doctor serves population of over 11000 people

High Blood pressure, high blood sugar, household air pollution from solid fuels, unsafe water sources and smoking were the top avoidable health risks associated with health loss and a significant amount of health burden among Indians in both sexes. — The Lancet

Some Progress in last decade:

(1). Safe/institutional delivery improved to about 80% in 2013-14 (JSY, cash incentives for institutional deliveries). But regular antenatal check-ups and use of Iron and folic acid tablets still remain low.

(2). Vaccination : Coverage about 80%. Still India has one of the lowest child vaccination rates in world and lags far behind Bangladesh and Nepal. (ASHAs and ANMs)

Low progress:

(1). Proportion of undernourished child is still around 39%. Significant improvement, but still lots of scope.

(2). Access to safe drinking water stagnated at around 90%

Need efficient managers in health care systems – managers in India seem better at marketing cell phones and tablets rather than setting right an ailing health system.
80% shortfall at CHCs
1 doctor for 1200

A new study says that five billion people globally do not have access to safe, affordable surgery and anaesthesia when they need them. Examine the reasons and suggest what union and state governments can do to address this issue in India. (200 Words)

Most of the poor and underdeveloped nations face the issue of lack of access to safe and affordable surgery and anaesthesia. This is because of various reasons:

1. Lack of adequate number of hospitals and also the emergency transport methods to them. The problem is more severe in rural areas of these countries. Shortage of power is another issue for operation theatres.
2. Lack of adequate number and quality of trained medical staff at these centres. Also there are shortages of medical instruments and properly sterilized kits as was seen in recent Chhattisgarh tubectomy incident.
3. Often the cost of surgery is quite high for poor people who can ill-afford such expensive treatment. Schemes like RSBY is reported to be misused to conduct unnecessary operation and showing inflated bills to receive insurance.
4. Due to such acute problems, may people die of preventable conditions like appendicitis, delivery complications, etc. This amounts to gross violation of their basic rights

To improve the situation, government can initiate measures:

1. Preventive Cure Nutrition ,Sanitation Eliminating Hunger ,Ensuring Food security is comprehensive Approach to be followed by Central and state govt
2. Increase investment in the Healthcare Sector from the present 1.04 % of GDP (11th plan)
3. Universal Health Coverage scheme . Arogya siri of AP provides universal coverage to its population.
4. Cost of the medicine should be lowered, use of generic medicines should be encouraged through more jan aushadhi outlets
5. More number of medical colleges, AIIMS. Training of AYUSH doctors in performing simple surgeries like deliveries etc as envisaged in Medical termination of pregnancy act and is also the followed in US.
6. Increase penetration of health insurance.
7. Amending National Pharmaceutical Pricing Policy to make more drugs affordable.
8. Mobile surgery vans to rural areas to perform surgeries like that of eyes as is happening to be increased.
9. Making rural service compulsory for 2 years for doctors and also provide better facilities to doctors in rural areas
10. Provide tax relief who establish health institutions in rural and marginalised regions.
11. PPPs to tap the material, human and managerial resources of the private sector for public good. Also encourage corporate social responsibility.

The poor health of children and pregnant women in India, even after decades of robust economic growth, is one of the world‘s most perplexing public health issues. Critically discuss the magnitude and causes of this problem and why government interventions have failed to address this issue. (200 Words)

Women and children in India are often found to be malnourished and suffer poor health. The graveness of the situation can be seen in the following:

1. A child raised in India is far more malnourished than most of the sub-Saharan countries like Zimbabwe and Somalia
2. Lower body mass of mothers before conception and less weight gain during pregnancy
3. Shorter and smaller children in India than in sub-Saharan Africa
4. 90% of adolescent Indian girls are anemic
5. 42% Indian mothers are underweight compared to 16.5% in sub-Saharan countries

The causes for this are multifold:

1. Poor status of Indian women in the family
2. High gender disparity in India
3. Poor sanitation
4. Growth of drug resistant infections affecting nutrition
5. Mothers low pre pregnancy weight

Although Govt has launched several schemes for the benefit of the pregnant and lactating mothers, but there are several fronts on which it has yet to achieve

1. India has no national guidelines for healthy weight gain during pregnancy
2. High cultural discrimination against women in India
3. Low number of primary healthcare centres
4. High level of illiteracy among women
5. Poor transportation and connectivity in rural
6. High poverty and economic disparity
7. less availability of doctors in villages

Critically analyse some of the major issues afflicting health sector in India. In your opinion, what solutions are required to address these issues keeping in mind long-term objectives for the sector. (200 Words)

The heath sector of India has mostly been a neglected field since long. In the early years of Independence, industrial growth and development was given much more importance as compared to human resource development.

The trend has been almost constant since then, with the following shortcomings:

1. Rural areas don‘t have health infrastructure on par with the urban areas, leading to higher child and maternal mortality rates there.
2. The brand culture in medicines, where a few companies monopolise the market, by bribing the contractors, while the cheaper versions of the same medicine are not promoted.
3. Lesser medical personnel’s willing to work in rural areas
4. Lesser political will towards reforms in this sector, with more importance given to industrial economy

Such loopholes don‘t allow the majority of population to contribute effectively in the nation‘s economy, leading to a high scale loss in the form of negative externalities.

The govt needs to give this sector an equal priority, as compared to other infrastructural projects:

1. Service in the rural areas should be mandatory for all medical graduates, for a certain amount of period.
2. Primarily it must reorganise the health service delivery with a right mix and distribution of preventive, promotive and rehabilitative services to tackle contingencies with higher availability of quality health services, developing effective referral linkage and ensuring continuity of care, from primary to tertiary care facilities.
3. There is a need for strengthened regulatory mechanism to oversee quality of health service provision, in both public and private sector.

With such steps, govt can achieve a major breakthrough in the health sector which will also help in advancing the MDG of eliminating poverty and hunger and reducing infant and maternal mortality rates.

Many developing, underdeveloped nations have large population and unequal facility distribution. Reasons for unaffordable surgery, unavailable anaesthesia and other failures in medical universalisation.

1. Because of economic inequality among population in geographical regions accessibility, availability and affordability of medical facilities fail.
2. Doctors/Surgeons/Medical practitioners are very short in supply as per WHO report and this makes them to stay in urban or well-paid areas and make surgery high cost affair.
3. Mostly anaesthesia is in short supply. Licenses, Certification to use it makes the process more difficult for Auxiliary trained doctors or nurses to use them.

Suggestions for Union and State Govt to address these issues:

1. Union Govt: Raise the number of medical college maintaining the qualities. Have strict regulations on fees charged by these colleges.
2. State Govt: Introduce universal insurance for medical cheap and affordable, this will lead to private hospitals in rural areas also. Make duty of each doctor in rural area compulsory for 2 years in their district rural areas in every 10 years.
3. State Govt: Make staying facilities for doctors, surgeons in rural areas better so that doctors will go there. Provide ambulance service for each tehsil or nodal agency so that any complicated case can be taken to district hospital.

Health is universal right for every human and failure to provide this is failure of state. Hence, Govt must provide affordable health care at short distance to everyone.

Supply of healthcare in India is among the lowest in the world on a per capita basis and both the government and private healthcare service haven’t reached the masses. Examine why and suggest what government should do to make affordable healthcare facilities available to all. (200 Words)

Healthcare in India suffers from serious handicaps, whether it be in access, equity or quality. Though govt programs like NRHM and JSY have shown considerable success, the overall scenario remains bleak due to the following reasons:

1. Insufficient penetration of PHCs and UHCs: There is an urgent need to expand the primary healthcare services to cover the remotest parts of the country.
2. Insufficient human resource: The doctor to patient ratio is low in India. Also, the network of ASHAs and ANMs is limited to certain regions.
3. Funding and infrastructure: Only 1.3% of GDP is spent on healthcare, while in advanced economies this % is about 4-7%.
4. Lack of trust in public sector: Even though the recruitment standards to govt services is often more stringent than the private sector, people have a perception that they’ll get better delivery in private sector.
5. There is hardly any focus on Non Communicable diseases, which are growing more because of urban lifestyles.
6. PPP models in this sector have failed up till now.
7. Doctors in public hospitals are highly irregular and usually have their private practice.
8. High import duties on imported high-end medical equipment. Also, govt charge higher electricity tariffs on hospitals as they use high end equipment than heavy industries. Yet, hospitals are required to provide affordable treatment. This paradox should be corrected.
9. The private sector is often non-accessible, costly and is the only provider of secondary and tertiary services. It accounts for nearly 70% of out of pocket spending.

The 12th plan document lays down a comprehensive roadmap to achieve UHC, which includes cashless delivery of services to all and leveraging the capabilities of the private sector to achieve this target. Progress first needs to be made in public infra, the opening of more medical colleges and super specialty hospitals-and intertwining this with the placement of right human resource (doctors, nurses, ANMs etc.) and putting in mechanisms for accountability of delivery. Use of tele-medicine can help reach remote populations. Generic medicines can make it more affordable to people.

Promotion to AYUSH doctors in PHCs is a welcome step. Insurance penetration should also be focussed.

Health related issues

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