To make India capable of drafting and
implementing the right to free and mandatory
• India spends a considerable share of its
GDP(4.2%) on the health sector, but the
share per capita is very low at PPP $132.
• The share of the public spending on the
health sector is low at 1.2%.
• High private spending leads to problems of
inequality, inadequacy and often poverty as
the economically weak end up in debts to
pay for the medical expenses.
• Around 75 percent spending is on outdoor
patient services and medicines.
• The expenditure on health varies widely
through diff states with typically low
income states having a lesser emphasis on
• Though India has many world class
hospitals more than 25% of population is
left out of the loop.
Indicators India China Brazil Sri- lanka
IMR 52 17 17 13
Fully Immunized% 66 95 99 99
Birth by skilled
47 96 98 97
Health expenditure %
4.2 4.3 8.4 4.1
Per capita spending $ 122 265 875 187
India and the World
Right to education cant complete its purpose until supporting to it we have a Right to free and mandatory
Primary health. Health being the major reason for poverty leads to a increased drop out rate for earning
purpose and AN UNHEALTHY COMMUNITY CAN NEVER PROVIDE A GOOD EDUCATION.
•Government hospitals are present in every settlement in India. They range from
the district hospitals and government medical colleges of the cities to the rural
hospitals and sub district hospitals in small towns to the primary health care
centres in villages.
•India had a total of 11993 allopathic government hospitals in 2011.
•Existence of a distribution system for UHC in the form of Government Hospitals
Government Hospitals as a
distribution system for UHC
•Despite presence of the UHC system through the country we never succeeded
1)The government assigns a very small portion of its spending to the health
sector, the capital available for providing wages to the medical professionals
and subsidized medicines is quite small. There is thus a scarcity of both
medicines and qualified doctors.
2) Vey few doctors choose to work in the government hospitals. The problem
is especially serious in the rural areas.
3) Due to a consequent lack of proper medical care at these hospitals, many
patients prefer the private hospitals
Shortcomings of the current
• 62% of PHCs are conducting less than 10 deliveries in a month.
• 10% of CHCs do not provide 24x7 normal delivery services.
• 34% of CHCs do not have operation theatre facilities.
• Only 19% of CHCs offer caesarean section deliveries .
• Only 9% of CHCs have blood storage facilities and of the
4,535 CHCs, only 754 are functional as per IPHS norms.
•We can now analyze ways to rid the government hospitals of their
drawbacks so that they could work as focal points of UHC in the
•Government should increase public expenditure on health from 1.2%
to at least 2.5% by the end of the 12th plan.
Increase spending on UHC
•Number of doctors in the government hospitals needs to increased.
The doctors should be given incentives to work at government
hospitals over private hospitals. Starting salary for an MD doctor at a
government hospital is Rs. 2625(basic pay). Though this salary seems
sufficient, it is actually quite low considering the number of years()
required to get an MD and the comparative earnings of private
•Many government doctors thus have their own private clinics to
supplement the government salary.
•Private doctors have another incentive to provide quality medical
care to a higher number of patients- the amount of money that they
earn is directly proportional to the number of patients as well as the
quality of their service.
Government doctors Vs Private
doctors- a case of skewed incentives
•Government doctors could be provided with similar incentives. A
good measure would be to fix their basic salaries and provide higher
floating salaries in proportion to the number of patients that they
•This will bring the government doctors in direct competition with the
private medical professionals and will thus compel them to improve
the quality of services that they provide in order to increase the
number of patients they treat . Improved quality at the subsidized
rates coupled with the subsidized medicines will attract a higher
number of patients to the government hospitals and will facilitate a
better distribution of the UHC schemes.
Better incentives for doctors =
Better service in government
hospitals due to competition with
the private sector and thus a better
outreach of UHC
Changes needed to be undertaken:
Proposed measures to be under taken:
Government should increase
public expenditure on health
from 1.2% to at least 2.5% by
the end of the 12th plan.
The money required for this
should be raised through
general taxation on the entire
population and not through
Reduce the disparity in
expenditure on health in various
states by assisting the states . Also
allow states higher flexibility in
allocating the provided recourses
Integrate all government
funded insurance schemes like
Rashtriya Swasthya Bima Yojna
with the national UHC
Areas of Emphasis
70 percent expenditure
should be targeted on the
primary and preventive
should be made available
India being large
exporter of generic
drugs is incapable
Essential Drugs to
In 1984 33%
comparison to 9%
now was provided
for free and the
same for out
patients from 18%
25% people in
just because they
cant afford it after
loosing all what
10% drugs as
compared to 90%
Drug prices varies
100%to 5000% of
the original cost of
Widespread use of
and no strict
All schemes focus LOW FREQUENCY
HIGH COST TREATMENT and none
of them focus on HIGH FREQUENCY
LOW COST TREATMENT which is
common to all. BIHAR
for Tamil Nadu
17%, with an
duration of 50
OUTCOMES OF THE PREVAILING SYSTEM: An
unreliable and inefficient procurement and
Best and the worst figures in terms
of the medicine availability.
1.Enforce price regulation and
apply price control on all
formulations in the Essential Drug
2.Schemes to be introduced which
focus specially on high frequency
low cost treatment.
1.Reduction in irrational medicine
use and strictly weeding out
unwanted medicines from market.
2.Laying out judicially enforceable
1.Strengthening the public sector
and opening PSU for EDL
productions and ensure a
compulsion of essential drug
production on private companies
at regulated cost.
1.At least one warehouse be built
in each district to ensure ease of
availability of drugs and vaccines to
2.Fee EDL and monitored price of
Spending on Drug
Procurement to 0.5%
of the GDP from
2011 2017 2022
All-Indian Health Services
is one of the biggest need
administration in health
Right to free and
health, as a fundamental
right in analogy to
education!! Should be the
aim of any government.
according to our
Transfer the DEPARTMENT OF
PHARMACEUTICALS to the MINISTRY OF
HEALTH for better regulation of the EDL
and their production accordingly.
In urban areas, the decline in food insecurity between
2000 and 2006 has been by a margin of only 0.4%, out
ofstep with the 6% growth rate in the same period
A 2002 Planning Commission report expressed alarm over the
‘rather extensive presence’ of fluoride and arsenic in Indian
drinking water, which is associated with a number of cancers
A study of backward districts in 12 Indian states is found
that 88% of adolescent girls were undernourished while
almost 64.6% reported some form of sexual abuse.
The odds of reporting poor health are 88% higher among
ST/ SC and 73% higher among OBC women as compared
to forward castes
Civil conflict is also associated with poor health: political
combatants and refugees in Chattisgarh face syndemics
of malnutrition, malaria, and other communicable
Nutrition and Food
Water and Sanitation
Work (In)Security, Occupational
Health and Disasters
Provide not only the necessary means of curing disease when it occurs, but also for preventing it by bringing about an
environment and conditions of living which would prevent the germs of disease taking hold…[through] an organised public
service – SOKHEY REPORT
Multiple studies have found that tribal children face the
greatest incidence of malnutrition in India, particularly in
the states of Jharkhand, Bihar, Madhya Pradesh,
Chhattisgarh, Odisha, and West Bengal
Social Determinants of Health-Problems
Ability of locals to make decisions regarding water planning an management with
adequate technical support from the Government.
Example- Andhra Pradesh Farmer Managed Groundwater Systems project
Ability of locals to invite private players into water managements through
guidelines established by government through which they could gain a substantial
knowledge and would be closer to self sustainability.
Introduction of management devolution Index thereby decentralization can be
scaled and appropriate measures can be taken as necessary.
Behavioural change in the community through awareness programmes which
should be an integral part of Health workers job and also with collaborating with
various NGO’s present in this field.
Method adopted in a village in Karnataka shows how community support makes a
difference-People in the community blow a whistle when they see a person openly
defecating, thus making him embarrassed and awkward.
Awareness has to be brought into the people through active volunteers and health
Convergence of water shed programme with flagship government like Mahatma
Gandhi National Rural Employment Guarantee Act.
Primacy for conjunctive use of water has to be given because of the growing needs
of the population and depletion of ground water resources.
Maintenance of the toilets built has to be given priority with regular cleaning of
Feeling Socially awkward and embarrassed plays an important role in governing our behaviour-Milgram
Infant mortality rate in India is 52 per 1000 live births(higher than many sub-Saharan countries).
Maternal mortality rate 212 per 1,00,000 child births(Higher than global average).
Skewed production of Human resources for health:
South states accounting for 31% population have 58% share of MBBS seats in contrary to empowered action group
states which comprise 46% of India’s population but only 21% of share of MBBS seats.
26% of doctors reside in rural areas serving 72% of India’s population.
Urban density of nurses is 3 times that of rural and urban India has 4 times more health workers per 10,000
population than rural.
Education for health professionals is more clinically and technologically driven towards a treatment-oriented curative
paradigm rather than population-focused primary and preventive health care.
Private sector accounts for 93% of hospitals and 85% of doctors in India.
National commission on population projects India’s population to reach 1353 million by 2022.
A joint learning initiative by WHO has established a threshold of 25 health workers(doctors , nurses and
midwives)for a 10,000 population and India has 19.
Requirements of human resources(education and training)to achieve Universal health coverage will cost a
Country Doctors per
India 0.5 2.19
China 1.6 3.4
Thailand 0.3 5.07
USA 5.5 19.6
Source: WHO,UHC report, World bank data and other reports.
Current Human Resources For Health
Nobody can go back and start a new beginning but anyone can start today and make a new ending.
M -Maria Robinson
Measures to enhance primary health care
Provide one additional village level health worker to the existing
one and also one to low-income urban populations.
Provide incentives based on their performance and also offer
performance-based admission to Nursing schools, ANM schools.
Trained in maternal and
child health care, family
planning, HBNC etc.
Involved in health
education of non-
( hypertension, diabetes,
Basic health promotion
and prevention around
malaria, leprosy , HIV and
other infectious and
Importance of usage of
safe drinking water and
India has the largest number of medical colleges in the world
this could be leveraged with little effort to increase the
annual output without compromising on quality front.
• Potential to generate nearly 2 million jobs.
• The estimated availability of roughly 19 lakh
village level health workers by 2022 will
pave the way for health care accessibility
and thereby shift the focus of health care
delivery from secondary and tertiary sectors
to the primary sector over the next decades.
•Bachelor of rural health care (BRHC)a three year
course focused on primary and preventive health
care can be provided and faculty could be drawn
from India’s pool of retired teachers.
•Additional educational institutions(medical
colleges , nursing colleges, ANM schools)with a
partnership ratio 80:20 between government
and private sector in districts whose population
exceeds 10 lakhs and further effectiveness could
be attained by attaching these to existing district
hospitals with reservation in the order 50:30:20
for local candidates in the district, other district
candidates of the state and to other states
Path for progress
• WHO reports.
• High Level Expert Group Report on Universal health coverage for India(Instituted by the
Planning Commission of India)
• “Closing the gap in a generation”-WHO Report.
On-going programmes for betterment of health care-major bottlenecks in them:
• Movement towards Ensuring People’s Drinking Water Security in Rural India- Ministry of
rural Development Report.
• National Urban Sanitation Policy- Ministry of Urban Development report.
• “Ensuring Drinking Water Security In Rural India” –Department of Drinking Water and
• Ministry of Health & Family Welfare-Government of India