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Health Care System in India- A focus on Rural Women and Children

Dr.K.Ravinder Reddy1

Abstract

This paper attempts to examine the health care system in India and expenditure on medical and

public health as well as family welfare. It has been observed that coverage of health insurance,

medical education as swell as impact on Janani Suraksha Yojana and pulse polio immunization

programme particularly on women and children as the part health care system in rural India.

1. IntroductionGood health is universal acknowledged to be of intrinsic value and, therefore, constitutes and

integral element of development, one can be rich sick enough to not enjoy any opportunities that

wealth opens up, and poor health may translate in to worsening economic opportunities as well

health is a multidimensional subject. The WHO highlights three specific dimension of health the

Physical, Mental and Social. Health is multifactorial as well. There are numerous factors that

influence health like hereditary factors, environment factors, life style, adequate housing, basic

sanitation and socio- economic conditions including income, education, availability and quality

of health infrastructure and per capita health expenditure, (Park K, 1994)

The role of health care in economic development has received increasing in recent years. There

is a general agreement that economic growth is not merely a function of incremental capital-

output ratio. Investment enhanced allocation of education, imparting skills and health care plays

a significant role in fostering economic growing. The pubic health care system in many states is

in not reached to target of government due to critical shortage of health personnel, particularly

doctors and nurses, poor working conditions and inadequate incentives and low utilization of the

merge facilities in government hospitals. Government hospitals at all levels present a picture of

neglect and decline.

In rural India medical facilities were rudimentary. The Community Development Block patternof rural development launched in the 1950s was harbinger of modern health care in rural areas.

Every block was to have a Primary Health Centers (PHCs) with 10 beds at the block

headquarters and three sub-centers at village level. The sanctioned staff for a PHC consisted of

1Assistant Professor and Head, Department of Applied Economics, Telangana University, Nizamabad,503 322, He

can be reached ravinderreddy_konda @ yahoo.co.in


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two doctors, one lady health visitors and two sanitary inspectors. A doctor was required to visit

each sub-center twice in a week. The Eleventh Plan presents a well through out and

comprehensive important features of the set-up are

1. To establish 1.75 lakh sub-centers.

2. 30,000 PHCs at one for a group of five subs centers with one lady visitor and three staff

nurses.

3. 6,500 CHCs each with 30-50 beds and seven specialists and nine staff nurses.

4.1800 taluk or sub divisional hospitals and 600 district hospitals will be fully equipped to

provide quality health services.

When, the government provides the infrastructure facilities, we can expect a significant

improvement in the quality of medical care in rural India.

2. Medical EducationHealth is a state of mental, social and physical well-being and not merely an absence of

disease or infirmity. To achieve this noble objective India requires health case professionals who

are trained in institutional with standeredised infrastructure and availability of accessib le and

equitable health care for both rural and urban populace. The growth of medical colleges has been

exponential from 88 colleges in 1965 to 335 in 2011 several more are in the pipeline. The non-

availability of qualified faculty, sub-standard infrastructure and clustering of medical colleges

contribute to poor training and limited exposure to clinical material. The net result is that the outgoing basic doctor is not fully equipped to face the challenges in medical practice.

2.1 Practice in Rural Areas

Recently, the number of seats available in private and public medical colleges has been

doubled and efforts are on to concepualize a rural doctor scheme with 3 years of training to

improve the doctor-patient ratio in rural areas, over the years, various committees including

National Knowledge Commission (NKC) have made recommendations to improve medical

education system. The NKC for training existing health care professionals and workeres as

multipurpose workers and creation of health workers like specialist nurses and ASHH workers,will provide a solution to needs in rural of rural peaple. The doctor population ratio is 1:1722 in

2005. The present estimation ratio, logically, should be around 1:1450. However, the MCI vision

document estimated it at 1:1700 in 2010. Over the few decades, the medical field has seen never

innovation prevented illness and death and increased life span in rural areas.


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3. Medical InsuranceIn India, particularly rural areas lack of progress towards provision of universal, equitable

health care. According to Bhore Committee in 1946, public funded allopathic health system for

the entire popultion indicates the low priority given to public health policy. The consequences of

this disastrous neglect is that Indians have among the highest out of pocket expenditure onhealth. The government is now considering universal health insurance scheme in public sector

and private sector with proper subsidy. But some classes of citizens, such as children, the elderly

and women are not registered due to lack of awareness as well as living in poverty. However,

health insurance has became the fastest growing segment of general insurance, it registered on

94th

annual growth 35 per cent over the 1987 decade with less than 10 per cent of the eligible

population covered withdrawel of the most popular features of health insurance is also one of the

main reason to not interesting in to the join of the health insurance. The public insurance

compnies are trying to provide some of the benefits of the cashless policies. On the other side,

the leading corporate hospitals also offer the health insurance policies with subsidary cost.

Finally, public, private insurance companies and hospitals to give better with transperancy is in

introduced in health insurance.

4. Expenditure on HealthHealth care expenditure is a very necessary social expenditure for any country. Whether

it is developing country or developed one, states role in developing is good health infrastructure

and assuring good health to everybody becomes very critical and important. The condition of

expenditure on health services in India is no less dismal. As a ratio of GDP, public expenditure

on health is among the lowest in the world about, 1.2 per cent. In fact the health system is almost

totally pivaitsed. It must be raised to at least 2.5 per cent by end of the 12 five year plan, and 3per cent in the subsequent five years. This, the expert group estimates, can bring about a

dramatic reduction in out of pocket spending from 67 per cent of total health expenditure in 2011

to 47 per cent by 2017 and 33 per cent by 2022. By contrast, the ratio of public expenditure to

total health expenditure is 40 per cent in East-Asia, 50 per cent in Latin America, 75 per cent in

Erope and as high as 85 per cent in Britain. In large parts of India, there are no public health

facilities worth the name for female starlisation and polio immunization(Dreze Jean, 2004).

The pattern of revenes and capital expenditure of centre and states shows that spending

on medical public health increased almost four fold from 1986-87 to 2011-12, but as per cent of

total expenditure as per cent of GDP, it is on decline. During 1986-87 combined capitalexpenditure and public health 4.41 per cent of total expenditure and 1.5 per cent of GDP. The

total in 2011-12 only 1.2 per cent to GDP. The same for public expenditure on family welfare the

total expenditure on family7 werlfare incrased from Rs.570 crore during 1986-87, to Rs.2924

crore in 2002-03, but share of capital in total expenditure decreased from 0.61 to 0.43 per cent

and as percentage of GDP it decreased from 0.22 per cent to 0.12 per cent for the same period.


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The pattern of investment on health and family welfare during different plan periods in

public sector investment on health has increased 65.20 crore during the first plan to Rs.9253

crore during Tenth plan. Hower, its ratio to total plan investment is on a declining trend.

Investment on health during First Plan was 3.33 per cent and 1.03 per cent in Tenth plan. On the

othere hand. Total spending on medical and public health, may have increased by nearly 8 times

between 1986-87 to 2010-2011. However, percapital expenditure on medical health services

could increase nearly 5 times and family welfare 6 times during the same period. Indias

percapita health care expenditure is low due to large population and low per capita income. This

scenario is not likely to improve in the near future due to the rising health care costs and Indias

growing population.

5. JSY (Janani Suraksha Yojana)

Janani Suraksha Yojana Scheme is a conditional cash transfer scheme incentive the use

of health services. It is an intervention for safe motherhood and aims at reducing maternal andneo-natal mortality among poor women by encouraging institutional delivery system. This

scheme also provides for the identification of pregnant women ,antenatal care, assistance with

transformations, blood transfusions, consumables and diet.In some states, the scheme is

complemented by the provision of public funds to private services providers in rural areas.

This scheme also given the awareness to rural women.the success of the scheme is

currently being measured by the number of institutional deliveries ,benificiaries and financial

assistance provided.the scheme have confirmed its beneficial impact on antenatal deliveries

,benificiaries and financial assistance provided . The scheme have confirmed its beneficial

impact on antenatal care , health fecility births and neonatal deaths . However, the assessmentalso noted wide interstate and inter-district variations in the scheme.

6. Pulse Polio Immunization Programme.Polio is a highly infection viral disease ,which mainly effects young children. The virus is

transmitted through contaminated food and water and multiples in the intensitive,from where it

can invade the nervous system. Many infected people have no symptom but excrete the virous

in their feces, hence transmitting infection to other.

Pulse polio immunization programme was started in the late 1970s .in 1985, it became a

part of the universal immunization programme launched throughout the country .a significant

milestone in the journey was the launch of National Pulse Polio Intiative (PPI) in 1995-96

.forgeting coverage of every child under five in the country with the oral polio vaccine(OPV) to

be given on two National Immunisation Days one each December and January, followed by

more focused state-level immunization compaings throughout the year.the PPIset for the nation a

new target eradication of polio by 2005.


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