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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 be studied

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 like:

  1. 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 isolated region.
  2. Lack of healthcare workers trained in service delivery in scheduled areas.
  3. Dysfunctional primary healthcare centers and community health care centers.
  4. Unfriendly behavior by healthcare staff due to language barriers.
  5. Access to hospital care remains low for serious cases in tribal areas.
  6. Lack of representation or participation from ST people in designing policies at state or national level.
  7. Siphoning or diversion of funds meant for development of healthcare facilities to other areas.


  1. Tribal people are not politically vocal but they should get adequate voice in designing of policies that seek to target them.
  2. Due to the high diversity among tribal groups, we need to encourage area specific and tribal sensitive local planning.
  3. 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 healthcare.

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:

  1. Peer education
  2. Weekly iron and folic acid supplement
  3. Menstrual hygiene scheme
  4. 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 school adolescents.

Adolescent health day is to be organized every quarter to give information about adolescent health problems to parents, children.

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 institutions.

  • 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 encouraged.

  • 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.