India & Its Health System
An Introduction
Radhika Arora
MPH2013-14
03/10/2015
1
A snapshot
1. 2 Billion People
940 women : 1000 men
41% less than 18 years
100million over the age
of 60 years
©Telegraph
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2
A snapshot
28 states- 7 union territories
7 major religions
22 official languages
Multiple ethnicities
A terrain for every mood
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3
A country of contradictions
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4
Health in India
• An introduction
• Films
• Discussion
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5
A grand tribute
to
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maternal
mortality
6
Some facts
Maternal mortality:
women dying at
childbirth for every
100,000 live births
Infant mortality:
probability that a
newborn baby will die
before reaching age 5
(per 1,000)
Complete antenatal care
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India
Belgium
Sri Lanka
200
8
43
61
4
21
37%
98%
98%
7
Nutrition
• 20% of children under 5 undernourished
• 43% underweight
• Approximately 25% are breastfed in the first
hour
– Less than 50% exclusively breastfed for the first
six months
• Anaemia:
– 90% adolescent girls
– 50% women
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8
In addition
• 41 million people with
diabetes
• 52% deaths due to CVD
• 12% injuries and other
Non Communicable
Diseases are the leading
cause of death in India
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Health system: India
Rich traditional systems of medicine
Western [modern
medicine]
Public & private health
care
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Delivering
services
Vertical health
programs
• Tuberculosis
• Malaria
And others…
Public
services
Medical colleges & Tertiary level care
District health centres
Community health centres
Community health workers
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Primary health centres
Anganwadi centres/ sub-centres
11
What the health system feels like
Private hospitals
Qualified & unqualified health
providers
Private pharmacies/diagnostic
services
53% exclusive use
Public
2% exclusive use/40% both
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12
Financing
• 70% OOP  people pay for
services
• 75% of their money 
medicines
• Low insurance coverage
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13
Financing
• Tax-based
• Some Social health insurance
– ESIS
• Community health insurance
– SEWA
• Large private sector
– 5 to10% in 1947 to 80% outpatient care (2005)
• Health spending
– 3.9% GDP
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Human Resources
• 20 per 10,000 vs.
recommended 25
– 8 per 10,000 if
reduced for
qualifications
• Unqualified 37%
(rural) & 63%
(Urban)
• Inequitable
distribution
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Human Resources
So many, yet few: Human resources for health in India
Krishna D Rao1*, Aarushi Bhatnagar2 and Peter Berman3
http://www.human-resources-health.com/content/10/1/19
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All is not bleak:
Changes: 2005 to 2012
• Need to strengthen public health system
• 2005: National Rural Health Mission
– Health for rural populations
– Improve health indicators
• 2012: National Health Mission
– Improve basic health indicators
– Health system strengthening
– National programs
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Changes: 2005 to 2012
• Financing: Insurance schemes
– Rashtriya Swasthya Bima Yojana (RSBY)
• Below poverty line (BPL) families  hospitalization
– Janani Suraksha Yojana (JSY)
• Maternal health (BPL)  increase institutional
deliveries/financial incentives
– Rajiv Aarogyasri Scheme (RAS)
• State specific BPL insurance scheme (inpatient)
• Other:
– Tamil Nadu Medical Services Corporation Ltd.,
(TNMSC)  FILM
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Challenges & comments
• Public system
– Historically low resources allocated
– Poor governance issues
• If it was more efficient it could do better with limited efforts
• Prioritization
– Focus on vertical programs
– Human resources for health constraints
– Infrastructure, medicines
• Efforts to revive the public health system
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19
Challenges & comments
• Booming private sector
– In remote locations
– Accessible
– Challenges:
• Low/minimum regulation
• Quality/Accountability
• Money talks
– Do we want to regulate?
• Medical tourism
• Income generation (?)
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20
Social change
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21
Challenges & comments
• Public and private
– How can the public sector be improved
– Private:
• Belgium has private providers: GPs, specialists
• People have the freedom to choose
• BUT regulation ensures quality
– Social health insurance: financial protection for
people
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22
Challenges & comments
• Quality of care
– Patient-doctor relationship
• Investment in social factors that
impact health
•
•
•
•
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Education
Water & sanitation
Social barriers and empowerment
Gender equality
23
Moving forward…
• Health indicators are improving
• Investments in education, water & sanitation
and other aspects of development
• Public health as a field of study/practice has
emerged
• But a lot more needs to be done…
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Discussion
• Can developing countries like India do without
the private sector?
• Should health be a public service (good)?
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Sources
• Indian Government
– censusindia.gov.in
– mohfw.nic.in
– planningcommission.nic.in/reports/peoreport/peo/peo_ch
c.pdf
– http://planningcommission.nic.in/reports/genrep/rep_uhc
0812.pdf
– National Rural Health Mission nrhm.gov.in
• WHO Building Blocks
– Monitoring the building blocks of health systems: A
handbook of indicators and their measurement strategies
http://www.who.int/healthinfo/systems/WHO_MBHSS_20
10_full_web.pdf
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26
Leaping
forward!
Thank you
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27
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