Unit III

Health Sector in India

Healthcare has become more focused on innovation and technology over the past
two years and 80% of healthcare systems are aiming to increase their investment in
digital healthcare tools in the coming five years.
Healthcare has become one of India’s largest sectors, both in terms of revenue and
employment.
Healthcare comprises hospitals, medical devices, clinical trials, outsourcing,
telemedicine, medical tourism, health insurance and medical equipment.
The Indian healthcare sector is growing at a rapid pace due to its strengthening
coverage, services, and increasing expenditure by public as well as private players.
India’s healthcare delivery system is categorised into two major components - public
and private.
The government, i.e., the public healthcare system, comprises limited secondary and
tertiary care institutions in key cities and focuses on providing basic healthcare
facilities in the form of Primary Healthcare Centres (PHCs) in rural areas.
The private sector provides the majority of secondary, tertiary, and quaternary care
institutions with a major concentration in metros, tier-I, and tier-II cities.
India's competitive advantage lies in its large pool of well-trained medical
professionals. India is also cost-competitive compared to its peers in Asia and
Western countries.
The cost of surgery in India is about one-tenth of that in the US or Western Europe.
The low cost of medical services has resulted in a rise in the country’s medical
tourism, attracting patients from across the world.
Moreover, India has emerged as a hub for R&D activities for international players
due to its relatively low cost of clinical research.
Health outcomes in India
India has made significant progress in improving health outcomes in recent years, but still
faces several challenges:
Life Expectancy and Mortality Rates
Life expectancy at birth in India has increased from 63 years in 2000 to 68 years in
2015.
 Infant mortality rate fell from 66 to 38 per 1,000 live births from 2000 to 2015.
Maternal mortality ratio decreased from 374 to 174 per 100,000 live births between
2000 and 2015.
Non-Communicable Diseases
Non-communicable diseases (NCDs) like cardiovascular disease, diabetes, chronic
obstructive pulmonary disease, and cancer contributed to 6.8 million deaths in India
in 2019, about 67.6% of overall deaths.
Indians are at high risk for atherosclerosis and coronary artery disease, likely due to
genetic predisposition to metabolic syndrome
Challenges
India faces persistent challenges like child undernutrition, high neonatal and
maternal mortality, growth in NCDs, high rates of road traffic accidents, and
urban-rural disparities in healthcare access.
Health insurance coverage remains limited, with Indians spending about 55% of
total health expenditure out-of-pocket in 2019, down from 74% in 2001.
Healthcare management practices in India fall short compared to developed
countries, with only 4% of Indian hospitals better managed than the average US
hospital.
Government Initiatives
The Indian government has launched several programs to improve healthcare:
National Health Mission to improve medical equipment, supplies, and community
engagement
Ayushman Bharat health insurance scheme providing up to ₹5 lakhs coverage per
family annually for secondary and tertiary care
Allocation of ₹860 billion to the Ministry of Health in the 2022 Union Budget,
forecast to reach over 2.5% of GDP by 2025
Despite challenges, India's continued investment in healthcare and innovations like low-cost
medical devices provide reasons for optimism about the future of healthcare in the country.

Health system in India

Health systems and polices have a critical role in determining the manner in
which health services are delivered, utilized and affect health outcomes.
Due to the India’s federalized system of government, the areas of governance
 and operations of health system in India have been divided between the union
and the state governments.
The Union Ministry of Health & Family Welfare is responsible for
implementation of various programs on a national scale (National AIDS Control
Program, Revised National Tuberculosis Program, to name a few) in the areas of
health and family welfare, prevention and control of major communicable
diseases, and promotion of traditional and indigenous systems of medicines and
setting standards and guidelines, which state governments can adapt.
In addition, Through technical assistance, the Ministry helps states prevent and
control outbreaks and pandemic of seasonal diseases.
On the other hand, Health is a state subject since the state oversees public health,
hospitals, sanitation, and other related sectors. However, the union and the state
governments work together to oversee matters with more national significance, such
as medical education, food adulteration prevention, quality control in medicine
manufacturing, family welfare, and population management.
PUBLIC HEALTH-CARE INFRASTRUCTURE IN INDIA
India has a mixed health-care system, which includes of public and private
health-care service providers.
However, most of the private healthcare providers are concentrated in urban India,
providing secondary and tertiary care health-care services.
Sub-centres
A sub-center (SC) is established in a plain area with a population of 5000 people and
in hilly/difficult to reach/tribal areas with a population of 3000, and it is the most
peripheral and first contact point between the primary health-care system and the
community.
A minimum of one alternative nurse midwife (ANM) or female health worker and one
male health worker are needed to staff each SC .
Under National Rural Health Mission (NRHM), there is a provision for one
additional ANM on a contract basis.
The Ministry of Health & Family Welfare is providing 100% central assistance to all
the SCs in the country since April 2002 in the form of salaries, rent and
contingencies in addition to drugs and equipment.
Indian Public Health System. Reprinted with permission from National Rural Health
Mission, Ministry of Health and Family Welfare, Government of India

Primary health centres

A primary health centre (PHC) is established in a plain area with a population of 30
000 people and in hilly/difficult to reach/tribal areas with a population of 20 000,
and is the first contact point between the village community and the medical officer.
PHCs were designed to offer comprehensive diagnostic and preventative healthcare to
the rural populace, with a focus on the health care's preventive and promotional
components.
The PHCs are established and maintained by the State Governments under the
Minimum Needs Program (MNP)/Basic Minimum Services (BMS) Program.
It serves as a referral facility for five to six SCs and contains four to six inpatient
beds. PHCs engage in both medical and health-care promotion plans.
Community health centres
Community health centres (CHCs) are established and maintained by the State
Government under the MNP/BMS program in an area with a population of 120 000
people and in hilly/difficult to reach/ tribal areas with a population of 80 000.
As per minimum norms, a CHC is required to be staffed by four medical specialists,
that is, surgeon, physician, gynaecologist/obstetrician and paediatrician supported by
21 paramedical and other staff.
It has 30 beds with an operating theatre, X-ray, labour room and laboratory facilities.
It serves as a referral centre for PHCs within the block and also provides facilities
for obstetric care and specialist consultations.
First referral units
An existing facility (district hospital, sub-divisional hospital, CHC) can be declared
a fully operational first referral unit (FRU) only if it is equipped to provide
round-the-clock services for emergency obstetric and newborn care, in addition to
all emergencies that any hospital is required to provide.
It should be noted that there are three critical determinants of a facility being
declared as a FRU: (i) emergency obstetric care including surgical interventions
such as caesarean sections; (ii) care for small and sick newborns; and (iii) blood
storage facility on a 24-h basis.
NATIONAL RURAL HEALTH MISSION: STRENGTHENING OF
RURAL PUBLIC HEALTH SYSTEM
NRHM, launched in 2005, was a watershed for the health sector in India. With its
core focus to reduce maternal and child mortality, it aimed at increased public
expenditure on health care, decreased inequity, decentralization and community
participation in operationalization of health-care facilities based on IPHS norms.
It was also an articulation of the commitment of the government to raise public
spending on health from 0.9% to 2-3% of GDP.
Seeking to improve access of rural people, especially poor women and children, to
equitable, affordable, accountable and effective primary health care, NRHM
(2005-2012) aimed to provide effective health care to the rural population
throughout the country with special focus on 18 states having weak public health
indicators and/or weak infrastructure.
Within the mission there are high-focused and low-focused states and districts based
on the status of infant and maternal mortality rates, and these states are provided
additional support, both financially and technically.
Gradually it has emerged as a major financing and health sector reform strategy to
strengthen the state health systems.
Major initiatives have been undertaken under NRHM for architectural correction of
the rural health system—in terms of availability of human resources, program
management, physical infrastructure, community participation, financing health care
and use of information technology.
NATIONAL PROGRAMS AND INITIATIVES FOR NEWBORN
HEALTH
In India, major policies and national programs are planned and implemented during
the 5-year planning phase.
The launch of the CSSM program in 1992, for the first time included an essential
newborn care component, and specifically integrated newborn care in the maternal
and child health program. Thereafter, newborn care started receiving more attention
and resources in the subsequent programs and initiatives.
Under NRHM, newborn health received unprecedented attention and resources with
the launch of several new initiatives aimed at reducing the burden of maternal and
newborn mortality and morbidity.
In February 2013, the government launched the strategic approach, reproductive,
maternal, newborn, child and adolescent health (RMNCH+A),20 to accelerate
actions for equity, harmonization and improved coverage of services.
Although the RMNCH+A approach recognized that newborn health and survival is
inextricably linked to women’s health, across all life stages, it also clearly
emphasized interlinkages between each of the five life stages with adolescent health
as a distinct life stage, and connected community, outreach- and facility-based
services.
On the basis of this approach, the central government has taken vital policy
decisions to combat major causes of newborn death, providing special attention to
sick newborns, babies born too soon (premature) and too small (small for gestational
age).