- National Health Profile 2018 provides guiding information to accomplish Universal Health Coverage and Sustainable Development Goals in India. - It presents demographic indicators such as population growth, density and distribution. Health status indicators show communicable diseases account for majority of morbidity and mortality. Maternal and child health indicators point to gaps in service coverage and outcomes. - Health financing is low at 1.1% of GDP with two-thirds of expenditure being incurred by states. Out-of-pocket expenditure remains high indicating lack of financial risk protection.

1. NATIONAL HEALTH PROFILE 2018;
Guiding information to accomplish Universal Health Coverage and
those envisioned in Sustainable Development Goals
Name of the Speaker: Dr.Rama Shankar
Assistant Professor
Department of Community Medicine
Date: 31st August 2018
!1

2. !2

3. Outline of the Presentation
• National Health Profile
• Demographic
• Socio-Economic
• Health Status
• Health finance
• Human resource in Health Sector
• Health Infrastructure
• UHC
• Current status of Health related to SDG targets- Indian Scenario!3

4. Demographic Indicators
• Population Statistics
• Vital Statistics
!4

5. Population Statistics
920
935
950
965
980
0
3250
6500
9750
3000
1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011
Pop ( Lakh)
Sex Ratio
943
933
926
934
930
941
946945
950
955
964
972 12,108.5
10,287.4
8,464.2
6,833.3
5,481.6
4,392.3
3,610.9
3,186.6
2,789.82,513.22,520.92,3842,384 2,520.9 2,513.2 2,789.8
3,186.6
3,610.9
4,392.3
5,481.6
6,833.3
8,464.2
10,287.4
12,108.5
!5
Doubling Time:60 years Doubling Time :30 years

6. 0
100
200
300
400
1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011
382
325
267
216
177
142
117
103
90818277
Population Density
Population density
!6

7. !7
-7.5
0
7.5
15
22.5
30 1901-1911
1911-1921
1921-1931
1931-1941
1941-1951
1951-1961
1961-1971
1971-1981
1981-1991
1991-2001
2001-2011
Decadal Growth Rate ( %)
5.75
-0.31
11
14.22
13.31
21.64
24.8 24.66 23.87
21.54
17.7
Decadal Growth Rate
Decline by 3.90

8. 0
10
20
30
40
1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011
% of Urban Population to Total Population
10.85 10.29 11.18 11.99
13.86
17.29 17.97
19.91
23.33
25.7
27.81
31.14
Urban Population
!8

9. !9
Distribution of Estimated population-2016
Urban
Rural
Total

10. !10
Adolescent
20.7
17.6
19.7
Total
Urban
Rural
Reproductive age
( 15-49 yrs)
55.8
58.9
56.8
Total
Urban
Rural
Distribution of estimated population-2016

11. Vital
Statistics
1991
19.7
9.8
29.5
Vital
Statistics
2016
14.0
6.4
20.4
Birth Rate
Death Rate
Natural Growth Rate
!11
Vital Statistics ( Birth, death and Growth rate)

12. 1973
1993
2013
0 20 40 60 80
71.9
65.9
58.9
67.1
58.9
48
68.3
60.3
49.7 Total
Rural
Urban
Life Expectancy at Birth over the years
!12

13. Maternal Mortality Ratio
!13

14. 0
20
40
60
80
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
80 80
77 77 77 75 74 72
69
66 64 64 62 61
58
55
51
48 46 44 43 41
3852
48 46 45 45 44 44 42 40 38 40 40 39 37 36 34
31 29 28 27 26 25 23
74 74 72 71 72 70 68 66
63
60 58 58 57 55 53
50
47
44 42 40 39 37
34
Total
Urban
Rural
Infant Mortality Rate 1994-2016
!14
Infant
Mortality Rate
2016
IMR
34.0
PNMR
11.0
NMR
24.0
Under 5
Mortality Rate
RURAL
43.0
URBAN
25.0
TOTAL
39.0

15. 2015
2016
Total Fertility Rate 2016
!15

16. Socio-Demographic Indicators
•Education
•Social Indicators
•Economic Indicators
•Employment
•Housing & Amenities
!16

17. TOTAL
RURAL
URBAN
Literacy Rate of India per census 2011
!17

18. 0
27.5
55
82.5
110
Primary Upper
Primary
Secondary Higher
Secondary
56.1
80
92.8
99.2
56.4
80.9
97.5
100.6
55.9
79.1
88.7
97.8 Boys
Girls
Total
Gross enrolment ratio 2015-16
!18

19. 0
6.5
13
19.5
26
Rural Urban Total
21.9
13.7
25.7
%age of population below poverty line (2011-12)
!19
Employment
in organised
sector ( in
lakhs) in India
(2011-12)
295.8
119.7
176.1
Public Sector
Private Sector
Total
Employment

20. !20
India ( 246740228 households (excluding institutional households)

21. India(Distributionofhouseholdshavingsafedrinkingwater facilitiesinIndiaasperCensus2011)
Tap water
Well
Handpump
Tubewell
Spring
River, Canal
Tank, Pond Lake
Any other source
From untreated source
11.5
From treated source 32
Covered well 1.6 Un Covered well 9.4
!21

22. India(Distributionofhouseholdshavingsafedrinkingwater facilitiesinIndiaasperCensus2011)
Availability of drinking
water source
Away
17.6%
Near the premises
35.8%
Within the premises
46.6%
!22

23. Availability of Toilet Connectivity within the House In India as per Census 2011
India
Total no. of households ( excluding institutional households) 246740228
Latrine facility available within premises 46.9
Type of
latrine
facility
within the
premises
Flush/pour flush
latrine connected
to
Piped Sewer system 11.9
Septic tank 22.2
Other system 2.3
Pit latrine
Pit latrine with slab/Ventilated Improved Pit 7.6
Pit latrine without slab/Ventilated Improved Pit 1.8
Service Latrine
Night soil deposited into open drain 0.5
Night soil removed by human 0.3
Night soil service serviced by animal 0.2
Latrine facility Not Available within premises 53.1
No latrine within premises
Alternative Source
Public Latrine 3.2
Open 49.8!23

24. Percentage Distribution of Households by Availability of Type of Drainage As per Census
2011
India
Total No. of Households (Excluding institutional households) 246740228
No. of households
having bathing facility
within premises
Bathroom available 42
Bathroom in enclosure without roof 16.4
No bathroom 41.6
Type of Drainage
Closed drainage 18.1
Open Drainage 33
No drainage 48.9
Kitchen
Kitchen available 55.8
Cooking inside house, does not have kitchen 31.5
Cooking in open 6.8
No cooking 0.3
!24

25. Health Status Indicators
!25

26. %age distribution of morbidity
reported in Communicable
disease-2017
Other diseases
1%
Typhoid
4%
Diarrhoes
22%
Pneumonia
1%
TB
1%
Malaria
1%
ARI
69.7%
!26

27. !27
%age distribution of mortality
reported in Communicable
disease-2017
Encephalitis
4%
Viral Hepatitis
4%
Other diseases
9%
Typhoid
4%
Diarrhoea
10%
AES
7%
H1N1
16%
Pneumonia
23%
ARI
23%

28. !28
CFR (%)
Diseases with high Case Fatality Rate
(2% and above) excluding Rabies - 2017

29. India
TB Burden (rate/ lakh population) 2016
Adult HIV Prevalence
!29

30. Adult
Children
New HIV Infection (2015)
88%
12%
Prevalence (2015) among ANC client and risk population
!30

31. !31
0
7.5
15
22.5
30
Diabetes HTN CVDs Common Cancers
0.4
1.2
27.1
21.8
0.1
0.9
14.9
10.7
0.10.6
7.2
5.6
2014-15( n=59 lakh)
2015-16( n=129 lakh)
2016-17( n=224 lakh)
9.7%
12.1%
0.5% 0.2%
No. of attendees of NCD Clinics diagnosed with NCDs in the period 2014-15 till 2016-17

32. !32
0
2000000
4000000
6000000
8000000
Target Achievement
65,135
50,000
7,57,906
9,00,000
64,81,43566,00,000
Cataract operations
Free Spectacles distribution in school
Collection of Donated eyes
98.2%
84.2%
130.3%
Eye Disease Burden & achievement

33. !33
0
125000
250000
375000
500000
Total (413457)
66,896
3,36,051
10,510
No of accidental deaths attributable to nature
No of accidental deaths attributable to un-natural cause
No of accidental deaths attributable to other cause
16.2%
81.3%
2.5%
Accidental deaths in India

34. !34
0
35000
70000
105000
140000
Total (133623)
7
42,088
91,528
No. of suicides ( Male)
No. of suicides ( Female)
No. of suicides ( Transgender)
0.0001%
31.5%
68.5%
Suicidal deaths in India

35. Maternal and Child Health
Maternity
Care
% received PNC
within 2 days of delivery
62
% full ANC
21
% mothers who
consumed IFA for 100 days
30
% last birth
protected against NT
89
% min 4 ANC
51
% ANC in
1st Trimester
59
!35

36. Delivery Care
Birth in public
health facility by CS
12
Birth in private
health facility by CS
41
CS
17
Birth assisted by
doctors/Nurse/LHV/ANM
81
% of home delivery
conducted by SBA
4
Institutional Birth
in public facility (%)
52
Institutional Birth (%)
79
!36

37. Current
use of family
planning methods
( Currently married
women age 15-49
years)
Condom (%)
5.6
Pill (%)
4.1
IUD/PPIUD (%)
1.5
Male Sterilization (%)
0.3
Female Sterilization (%)
36.0
Any Modern method (%)
47.8
Any method(%)
53.5
!37

38. !38
Unmet Need for
Family Planning
Unmet need for spacing
5.7
Total Unmet Need
12.9

39. !39
Anaemia
among children &
women
All women age 15-49y
who are anaemic
53
PW age 15-49y
who are anaemic (<11g/dl)
50
NPW age 15-49 y
who are anaemic (<12g/dl)
53.1
Children age 6-59 m
who are anaemic (<11.0 g/d
58.4

40. !40
0
15
30
45
60
Childrenunderage
3years
breastfedwithin
onehourofbirth
Childrenunder
age6months
exclusively
breastfed
Childrenage6-8
monthsreceiving
solidorsemi-solid
foodandbreastmilk
Totalchildrenage
6-23monthsreceiving
anadequatediet
9.6
42.7
54.9
41.6
Child Feeding Practices

41. 0
25
50
75
100 Childrenage12-23months
fullyimmunized(BCG,
measles,and3doses
eachofpolioandDPT)
Childrenage
12-23months
whohavereceivedBCG
Childrenage12-23
monthswhohavereceived
3dosesofpoliovaccine
Childrenage12-23months
whohavereceived3
dosesofDPTvaccine
Childrenage
12-23monthswhohave
receivedmeaslesvaccine
Childrenage
12-23monthswho
havereceived3doses
ofHepatitisBvaccine
Childrenage9-59months
whoreceivedavitamin
Adoseinlast6months
60.262.8
81.178.4
72.8
91.9
62
!41
Child Immunization & Vitamin A Supplementation

42. Health Finance Indicators
!42

43. !43
SERVICES: Which services
are covered ( include other services)
FINANCIAL PROTECTION: what do people
have to pay out of pocket ( reduce cost
sharing and fees)
POPULATION: who is covered ( extend to non
covered
COVERAGE
MECHANISM
UHC ACHIEVED
UHC means that all people have access to promotive, preventive, curative, and rehabilitative health services, of
sufficient quality to be effective, without facing financial hardship.
UNIVERSAL HEALTH COVERAGE: ITS DIMENSION

44. 0
0.325
0.65
0.975
1.3
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
2015-16
2016-17(RE)
2017-18(BE)
1.28
1.17
1.02
0.981
1.091.11.07
1.12
!44
Trends in Public Expenditure on Health as %age of GDP

45. 0
25
50
75
100
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
2015-16
2016-17(RE)
2017-18(BE)
372931333433353536
63
7169676667656564
Centre
State
!45
Trends in centre-state (%) in total public expenditure on Health

46. 0
1.5
3
4.5
6
High
Income
Countries
UpperMiddle
Income
Countries
LowerMiddle
Income
Countries
Low
Income
Countries
India
11.4
2.5
3.8
5.2
!46
% of
total public
expenditure on
health 2015-16
Others
9%
Family Welfare
13%
Medical & Public Health
79%
Public Expenditure on Health as % of GDP across World Bank Income Groups 2015

47. Maldives
Thailand
Bhutan
Timor-leste
Srilanka
Indonesia
Myanmer
Nepal
India
Bangladesh
0 2.5 5 7.5 10
0.4
1
1.1
1.1
1.1
1.6
1.9
2.5
2.9
9.4
Public Expenditure on Health as % of GDP across SEAR Countries 2015
!47

48. Health Coverage & Insurance
• 43 crore individuals were covered under any health insurance in year
16-17.
• 34% of total population covered
• 79% of them were covered by public insurance companies.Overall, 80% of
all persons covered with insurance fall under Government sponsored
schemes
!48

49. !49
Health Human Resource

50. 0
12500
25000
37500
50000
2011
2012
2013
2014
2015
2016
2017
(Prov.)
Registered Allopathic doctors
( upto 2010=827006) &
Total Up to 2017 = 1041395)
17,982
25,282
20,422
33,536
45,106
37,017
35,044
!50
Registered Allopathic doctors over the years

51. 0
75000
150000
225000
300000 2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Registered Dental surgeon
!51
Registered Dental Surgeon over the years
2,51,207
197734
156391
154436
147159
93332
104603
114047
118370
120897
73057
72033
71421
55344
47318
47165
47204

52. 0
45000
90000
35000
80000
Doctors/Dental Surgeons and average population catered
1,76,004
7,239
11,082
1,14,969
No. of Govt. Allopathic Doctors
Averege Population Served/Govt. Allopathic Doctors
No. of Govt. Dental Surgeons
Averege Population Served/Govt. dental surgeons
Govt. Doctors/Dental Surgeons with average population catered
52

53. !53
%age of registered AYUSH
Doctors in India
Unani
6.4%
Homeopathy
36.8%
Siddha
1.1%
Ayurveda
55.4%
Naturopathy

54. !54
Health Infrastructure

55. 0
15000
30000
45000
60000
0
125
250
375
500
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
2015-16
2016-17
2017-18
Medical colleges
Admission
52,646
56,748
48,855
46,456
48,567
43,576
38,210
29,263
34,084
32,815
30,290
25,058 476462
412398381381
356
314300289
266262
25,058
30,290
32,815
34,084
29,263
38,210
43,576
48,567
46,456
48,855
56,748
52,646
Number of Medical Colleges & Admission in India
!55

56. 0
100
200
300
400
2006-07
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
2015-16
2016-17
2017-18
24924224022420519616814814012210487
313309308305301297291288290282
267
238
BDS MDS
!56
Number of Dental colleges in India

57. !57
India ( HSC)
156231/179240= (20%) Shortfall
India ( PHC)
25650/29337=6409 ( 22%)
9920 PHCs are operational as 24X7
facilities
India CHCs
5624/7322=2168 (30%)
Shortfall
We have 1108 SDH and 779 DH
First Referral Units (FRU): 940
(2005) to 3118 per latest
Information
57 Rural Health Statistics (RHS) 2017
Total Govt. Hospital
23582
Rural Govt. Hospital
19810
Urban Govt. Hospital
3772
710761
431173
279588
55591
1844
Service Infrastructure

58. !58

59. !59

60. Code Health-related SDG Indicators SDG Target India
3.1.1 Maternal Mortality Ratio (per 100,000 live births) 70 per 100,000 live births 130
3.2.1 Under five mortality rate (per 1000 live births) 25 per 1000 live births 39
3.2.2 Neo natal mortality rate (per 1000 live births) 12 per 1000 live births 24
3.3.1
New HIV Infections among adults 15-49 years old (per 1000
uninfected population)
0 per 1000 uninfected
population
0.11
3.3.2 TB Incidence (per 100,000 population)
80% reduction in TB
incidence compared with
2015 baseline
211
!60

61. !61
Code Health-related SDG Indicators SDG Target India
3.4.1 Probability of dying from any of CVD, cancer, diabetes (%)
1/3 reduction from 2012
baseline
23.3
3.6 Road traffic mortality rate (per 100,000) population) 50% reduction 16.6
3.7.1
Proportion of married or in-union women of reproductive age who
have their need for family planning satisfied with modern methods
(%)
100% 63.9
3.8.1 Coverage of essential health services 100% 57
3.a.1 Prevalence of tobacco use among persons 15 years and older (%)
30% reduction in current
tobacco use
35
3.c
Skilled health professionals density (physicians/nurses/midwives
per 10000 population)
44.5 per 10000 population 30.2

62. !62
•TFR to 2.1 nationally & sub- nationally by 2025
•MMR to 100 by 2020
•U5MR to 23 by 2025
•NMR to 16
•Elimination Leprosy, KA & Lymphatic filariasis
•>85% cure rate in new TB cases & reduce incidence
rate to elimination status by 2025
•Blindness prevalence to 0.25/1000 by 2025
•Utilization of public health facilities by 50% by 2025
•ANC (90%) & SBA above 90%
•Full Immunization >90
•Meet need of FP above 90%
•80% of known HTN & diabetic individuals at household
level maintain “controlled disease status‟ by 2025.

63. !63
•Increase State sector health spending to >
8% of their budget by 2020.
•Decrease in proportion of households facing
catastrophic health expenditure from the current
levels by 25%, by 2025.
•Access to safe water and sanitation to all by 2020
•Occupational injury by half from current levels of
334 per lakh agricultural workers by 2020.
•Reduction prevalence of current tobacco use
by 15% by 2020 and 30% by 2025
•Reduction 40% in prevalence of stunting of under-
five children by 2025.

64. 64
National
Program/
Schemes/
Polices in
Health sector
in India
NPCB
1976
NPCCF
2008
NMHP
1982
NLEP 1983
NIDDCP 1992
RNTCP 1997
NACP 1992
NVBDCP 2003
IDSP 2004
JSY 2005
PMSSY 2003
NTCP 2007
NPPCD 2007
RSBY 2008
NPHCE
NPCDCS
2010
JSSK 2011
RKSK 2014 NMHP
NPPMBI
NUHM2013
NRHM 2005
NHM
PMSMA
2016
AB-NHPM
2018

65. !65
Ayushman Bharat
For New India @ 2022
https://www.abnhpm.gov.in/

66. !66
National Health Agencies for AB
•NHA constituted on 11th may to provide vision and stewardship on AB-
NHPM in alliance with state governments
•62.58% of our population has to pay for their own health and
hospitalization and this pushes 4.6% of the population below the poverty
line

67. !67
Ayushman Bharat ( Healthy India)
Referral
Secondary
Tertiary
Primary
NHPS
Existing services
RMNCHA
Unmet need:
NCDs/other
chronic diseases
Untrained providers,
faith healers
Ensures Continuum of care
•AB adopts a continuum
of care approach of
two inter-related
components
•CPHC
( Comprehensive
Primary Health
Care)
•NHPM ( National
Health Protection
Mission)
Primary care &
Financial
Protection -
pillar of UHC

68. !68
Organisation of CPHC
Family/Household &
community Level
Health & Wellness Centres
First referral Level
CPHC: Preventive, Promotive Curative,
Palliative, & Rehabilitative & delivered close
HSC, PHC/UPHC strengthened as HWC
General Medical Consultation ( at PHC/
UPHC); Specialist consultation & First
Referral of hospitalisation at CHC/SDH/DH

69. !69
Launch of AYUSHMAN BHARAT
• 14th April 2018-Honorable Prime Minister launched the first Health and Wellness
Centre at Jangla, Bijapur, Chattissgarh

70. !70
National Health Protection Mission (NHPM)
Health Assurance for New India @ 2022

71. !71
Well Off
Non-Poor
Poor & economically Weak
Its time to include the Non- poor
6-7 crore persons fall into poverty
each year due to medical
expenses
A Health Protection Scheme focused only on the poor is not
good enough for New India

72. !72
• Targeted to cover over 10 crore poor and vulnerable families
• Provide a cover of 5 lakh per family
• Service through both public and private hospitals
• Cashless benefits available across India
National Health Protection Scheme (NHPS)

73. !73
Benefits of AB-NHPM
• Beneficiary Level
• All families listed in the SECC database will be covered.
• 1,350 medical packages covering surgery, medical and day care treatments, cost of medicines
and diagnostics.
• All pre-existing diseases covered.
• Cashless and paperless access to quality health care services.
• Hospitals will not be allowed to charge any additional money from beneficiaries for the treatment.
• Eligible beneficiaries can avail services across India, offering benefit of national portability. 24X7
helpline number - 14555

74. !74
Benefits of AB-NHPM
• Health System Level
• Help India achieve UHC and SDG.
• Ensure quality secondary and tertiary care services.
• Mitigate financial risk
• Enhanced used of evidence based health care.
• Strengthen public health care systems through infusion of insurance revenues.
• Increase health expenditure by Government as a percentage of GDP.

75. !75
Summary
•Universal access to health care.
•National Health Policy, 2017 envisions the goal of highest level of health &
well-being
•SDG no. 3 an effort to eradicate disease, strengthen treatment and address
new and emerging health issues.
•Ayushman Bharat Mission, is the latest initiative for expanding the health
insurance net.

76. !76
Thank You for your patience !