Health is not only the absence illness but is also the yardstick of well being. Health is related to the overall growth and economic development of a nation. It is not possible to study the health facilities of a country using just one or two indicators. Economists use various indicators like life expectancy, infant mortality, maternity mortality etc to assess the health of the people of a country.
Investments into the health sector ensure a healthy man power. In modern times, scholars argue that people have a basic right to health care services. The government has to ensure that basic health facilities are available to its citizens. Health infrastructure includes hospitals, beds, doctors, nurses, a good pharmaceutical industry etc. Presence of health infrastructure is not enough, it should be accessible by everyone.
State of Health Infrastructure
The government has a constitutional obligation to guide and regulate the health services available to our people. The Union Government initiates policies and plans periodically through the Central Council of Health and Family Welfare. It also collects and distributes money for the development of health care in the states, union territories and other bodies for the implementation of these policies.
Over these years, India's health care sector has expanded in all levels. At the village level, many government hospitals have been set up and many voluntary organizations run private hospitals too. Trained and medical and para-medical professionals take care of these hospitals. In the period 1953-2000, the number of hospitals and dispensaries has grown from 9,300 to 43,300 and the number of beds has increased from 1.2 million to 7.2 million. Nursing personnel have increased from .18lakh to .87 lakhs. Doctors have increased to 5 lakh from .62 lakh. This expansion has resulted in the eradication of small pox and near eradication of leprosy and polio.
Private Sector Health Infrastructure
The private sector has grown massively in providing health care facilities. More than 70% of the hospitals in India are run by the private sector. They are responsible for more than 40% of the available beds. They provide healthcare for 80% of outpatients at 46% of in patients. They account for 60% of the dispensaries that are run.
The private sector has played a very dominant role in our health care industry. They have a major hand in medical training and education, medical technology, diagnostics, hospital construction, drug manufacturing and sales and provision of medial services. N 2001-02, there were more than 13 lakh medical firms which employed more than 22 lakh people. Many of them were single person owned and operated. Scholars have pointed out the fact that the private sector has grown unregulated and some of the practitioners are not even registered and are known as quacks.
After the reforms, many NRIs and foreign national have set up mutli specialty state of art hospitals which cater to the need of the rich Indians and foreign tourists. These establishments are very costly and hence the poor depend on the government hospitals for their health care.
Indian Systems of Medicine (ISM)
ISM includes six systems namely, Ayurveda, Siddha, Yoga, Unani, Naturopathy and Homeopathy(Ayush). At present, there are 3004 ISM hospitals, 23,028 dispensaries and 6,11,431 practioners of ISM who are registered. Very little has been done to standardize education or promote research in ISMs. ISMs can solve a lot of our health problems because they are cheap, effective and have no side effects.
Indicator of Health Care and Health Infrastructure
The indicators of health status as pointed out earlier are life expectancy, infant mortality, maternity mortality and nutritional level. Scholars feel that the government should get more involved in the health care sector. The expenditure on the health care sector is just 5% of the GDP which is totally inadequate when compared to other developed and developing nations.
A study has pointed out that India has about 17% of the world's population and an alarming 20% of global burden diseases (GDB). GDB is a measure sued by experts to find the number of premature deaths that occur due to a disease and also the number of years of disability because of it.
In India, more than 50% of GDB is due to communicable diseases like malaria, cholera, diarrhea and tuberculosis. Every year more than 5 lakh children die due to water borne diseases. Malnutrition and inadequate vaccination accounts for 2.2 million dead children every year.
Now, only 20% of the population uses public health services. A study has revealed that only 38% of PHCs have the required number of doctors and only 30% have adequate supply of medicine.
Divide between Urban-Rural and Poor-Rich
Though the concentration of population is about 70% in the rural sector, the concentration of hospitals in the rural sector is just 20%. Rural India has just 50% of the total dispensaries and only around 11% of the total beds available. Rural people do not have enough medical facilities. This has lead to a difference in the status of health of people in the urban and rural sectors. There are just .36 hospitals for every 1 lakh people in the rural sector while there are 3.6 hospitals for every 1 lakh people in the urban sector. The PHCs in the rural sector do not offer X rays or blood testing. Rajastan, Bihar, Madhya Pradesh and Uttar Pradesh are lagging behind in health care services. The rural percentage of people having no access to health care has increased from 15% in 1986 to 24% in 2003.
Specialized medical care like anesthesia, gynecology and obstetrics are inaccessible to people living in villages. Though the number of medical doctors passing out annually is around 12,000, there is a perennial shortage of doctors in the rural sector. 20% of the medical graduates leave the country for future studies and never return back.
The poorest Indians spend 20% of their income on healthcare while the rich spend just 2%. When the poor fall sick they are driven to borrow and since the government hospitals are not good, they are forced to go to private hospitals for treatment and their expenses mount. Sometimes lack of cash causes their death.
The female population is almost half our total population. Women are always at a disadvantage as they are given lesser education, wages and health care when compared to men. The child sex ratio has declined from 945 in 1991 to 927 in 2001. This indicated the growing of female foeticide. More than 50% of married women between the age group of 15-50 suffer from anaemia. Iron deficiency and abortions are a major cause of maternity deaths.
Health is a very important basic right and every citizen has the right to be healthy. The need of the hour is better efficiency of the public health services and the provision of health care facilities for the poor and the rural people. The main aim is to better the standards of living of our people and move towards a better quality of life. Private-public partnership should be forged in health care so that there is reliability, quality, equality and affordability of medicines and drugs. We cannot afford to neglect this deepening divide as it will have a negative impact on our economic growth.