YOJANA FEBRUARY 2016
Access to Healthcare in India
Angus Deaton, Nobel prize in economist in 2016 in
his book "Great Escape" shows that to increase
life expectancy in advanced economies one should have a four
fold increase in public expenditure. But in developing
countries where vast numbers of death occur due to epidemics
this is different. To improve public healthcare in India
either the public healthcare delivery system needs
improvement or private healthcare systems needs to be
regulated better to ensure better access. Though private
healthcare systems contribute to 79% of outpatient care and
68% of inpatient care they are ignored as stakeholders by
the government. Government though may improve its own
primary health care services but now a hybrid model of
service delivery in partnership with private sector needs to
India's National Health policy wants expenditure on
healthcare to be 2.5% of GDP. The schemes such as Janani
suraksha yojana, Indira gandhi matritva sahayok yojana,
ASHA, Dial 104 - 108 ambulance service, Janani shishu
suraksha yojana have made significant impact on decline of
maternal and infant deaths.
Challenges are safe sterilization techniques, abortion
centers and quality of post natal care. However
institutional deliveries have improved. Non communicable
diseases like cancer, diabetes, heart diseases and
respiratory diseases are however on the rise. Health policy
had so far excluded these from its purview. Universalizing
access to healthcare for this is distant dream. The private
sector has filled this gap but market forces have focused on
curative and tertiary care but neglected primary and
secondary prevention which the government should take up.
Methods to allow allow public health units to generate
additional funds autonomously and manage these funds need to
be seen. Additionally to motivate the less than optimally
motivated workers in healthcare sector, a scheme to link
payments to outcomes must be developed.
Attention also should be given to healthcare of
marginalized sections like ST's which constitute 8.6% of the
population and number 10 crore. It is revealed from
statistics that the healthcare indicator of this community
have improved but still lag behind the general population.
The public health service to ST's suffers from handicaps
- It doesn't take into account the different health care
needs, disease burdens, belief systems and difficulties in
delivering healthcare to a population in geographically
- Lack of healthcare workers trained in service delivery
in scheduled areas.
- Dysfunctional primary healthcare centers and community
health care centers.
- Unfriendly behavior by healthcare staff due to language
- Access to hospital care remains low for serious cases in
- Lack of representation or participation from ST people
in designing policies at state or national level.
- Siphoning or diversion of funds meant for development of
healthcare facilities to other areas.
- Tribal people are not politically vocal but they should
get adequate voice in designing of policies that seek to
- Due to the high diversity among tribal groups, we need
to encourage area specific and tribal sensitive local
- Health outcomes depend on factors like sanitation
facilities, food, income, transport and connectivity. Thus
inter-agency cooperation is needed to achieve this.
Evolution of National Health Policy in India
The first National Health Policy framed in 1983 envisioned
a "Health for All by 2000" but remained short of defining
implementation strategies for the same as a result by 2000
the country was nowhere close to achieving Health for All.
then the second National Health Policy 2002 was drafted and
it adopted a more practical approach for improving health
standards for people. It emphasized on increasing health
care spending from 1-2% of GDP and focused on primary
National health policy draft released in 2014 was put into
public domain for feedback by experts and general public.
This policy aimed to focus on maternal and child healthcare
and also for first time on non communicable
diseases and injuries. It recognized for
the first time the importance of rising cost of catastrophic
healthcare cost on households. The policy however lacks
clear cut time frame for implementation, identification of
resource base both technical and financial. Though the draft
policy wants a increase in healthcare spending to
2.5% of GDP it has laid no time frame for this.
To make the healthcare policy effective an improved
government framework and legislative mechanisms that create
an enabling environment for providing accessibility to
healthcare services is a must. States should also be held
accountable for ensuring a minimum standards of
healthcare for its people.
Decentralization should be allowed and not
just a devolution of resources but grass root service
delivery units should be given freedom to implement policy
by tailoring it to regional needs but at the same time held
accountable for results. Lastly the draft policy for the
first time wants health to be made a fundamental
right and this bold step shall may it obligatory
for government to provide service to the people.
Rashtriya Kishore Swasthya Karyakram
Ministry of Health and family welfare launched this scheme
to reach out to adolescent health of all sections of society
both male and female but with special focus on marginalized
and under-served groups.
Programs under this scheme:
- Peer education
- Weekly iron and folic acid supplement
- Menstrual hygiene scheme
- Adolescent health day
Peer education would involve selecting 4 educators: 2 males
and 2 females for every 1000 population. One pair would
focus on school going adolescents and another pair on out of
Adolescent health day is to be organized every quarter to
give information about adolescent health problems to
Weekly iron and folic acid supplement to combat growing
prevelance of anaemia in adolescents which reduces oxygen
carrying capacity of blood and reduces physical capacity.
Target groups are adolescents in government schools from 6th
to 12th. Out of school adolescent girls.
Mentrual hygiene program too was started to generate
awareness of menstrual hygiene, provide access to sanitary
products and safe disposal of sanitary products.
- Global health observatory, World
health report - WHO
- Health is a state subject but
central government is also concurrently
responsible for implementation of a number of
disease control and eradication programs and
population stabilisation programs.
- KAYAKALP - Award by Min of Family
welfare to assuring quality at public healthcare
- Kerela has achieved parity with
developed countries in terms of health and education due
to its sustained focus on social sector.
- Stand up India: Encouraged by
department of financial services to provide loans to SC /
ST and women entrepreneurs. SIDBI is the refinance agency
under this scheme. Two projects per branch shall be
- Sikkim - First organic state of India.
- Mid-day Meal Scheme being
implemented under the Ministry of Human
Resource Development is the world’s
largest school feeding program.
- Mission Indradhanush - Immunization
program for children to cover 7 communicable diseases.
- South Asian games: Eight member
countries namely Afghanistan, Bangladesh, Bhutan, India,
Maldives, Nepal, Pakistan & Sri Lanka. Its
held every two years. The first South
Asian Games was hosted by Kathmandu, Nepal in 1984. The
12th South Asian Games will be held in Guwahati,
Assam and Shillong, Meghalaya, India from 6th
February to 16 February 2016.