This document provides an overview of the history and development of the Indian health system. It discusses the evolution of medicine from ancient practices intertwined with religion and magic to the development of modern scientific medicine. It outlines the key systems of traditional Indian medicine including Ayurveda and Siddha. It also summarizes the current structure of healthcare delivery in India, which involves both public and private sectors, as well as traditional medicine. The government aims to improve health indicators through national health programs and policies while still facing issues with public health infrastructure and availability of staff.

1. INDIAN HEALTH SYSTEM- AN OVERVIEW

2. MAN AND MEDICINE :TOWARDS HEALTH FOR ALL

3. I. Medicine in AntiquityHealth and illness were interpreted in a cosmological and anthropological perspective.

4. Medicine was dominated by magical and religious beliefs which were an integral part of ancient cultures and civilizations.

5. Since there is an organic relationship between medicine and human advancement, any account of medicine at a given period should be viewed against the civilization human advancement at that time.A. Primitive MedicineSalient Features: Medicine was conceived in sympathy and born out of necessity

6. Since man’s knowledge was limited, the primitive man attributed disease, all human sufferings and calamities to wrath of gods, invasion of body by evil spirits and malevolent influence of stars and planets

7. The concept of disease is known as “supernatural theory of disease”

8. They used to perform surgeries like circumcision, amputations and trephining of skulls with improvised stone and flint instruments

9. In 5000 BC, the medicine was intermingled with superstition, religion, magic and witchcraft.B. Indian Medicine Siddha and Ayurveda medical systems are truly Indian in origin. Ayurveda is practiced in all parts of India, but Siddha is practiced only in Tamil Nadu

10. Ayurveda by definition implies the “knowledge of life” or the knowledge by which life may be prolonged. Its origin is traced back to the Vedic times, about 5000 B C.

11. Hygiene was given an important place in ancient Indian Medicine. Medical Historians admit that Indian medicine has played in Asia the same role as the Greek Medicine in West for it has spread in Indochina, Indonesia, Tibet, Central Asia, and Japan, exactly as the Greek Medicine has done in Europe and Arab Countries.

12. The other systems of medicine that are not of Indian origin are Unani- Tibb and Homeopathy. All these systems of medicine are very much alive today in India and have become part of Indian culture. They also continue to an important source of medical relief to the rural population.C. Medicine practiced in other countries Chinese Medicine – world’s first organized body of medical knowledge dating back to 2700 B .C

13. Egyptian Medicine – one of the oldest civilizations in about 2000 B. C where art of medicine was mingled with religion.

14. Mesopotamian Medicine – “Cradle of Civilization” 6000 years ago.

15. Greek Medicine – 460 – 136 B. C; the Greeks enjoyed the reputation – the civilizers of the ancient world, taught people to think in terms of why and how

16. Roman Medicine – First Century B.C; While the politics of the world became Roman, medicine remained Greek.

17. Middle Ages – Period between 500 and 1500 A.D – establishment of hospitals, religious institutions, schools of medicine etc.II. Dawn of Scientific Medicine The period following 1500 A.D was marked by political, industrial, religious and medical revolutions.

18. Revival of Medicine – 1453 – 1600 A D – an age of individual scientific endeavor; Paracelsus helped turn medicine towards rational research; Fracastorius, an Italian physician enunciated the “theory of contagion”; Ambriose Pare advanced the art of surgery.

19. 17th and 18th Centuries – Harvey’s discovery of the circulation of blood, Leeuwenhoek’s microscope, Jenner’s vaccination against small pox etc

20. Sanitary Awakening in England in mid nineteenth century

21. Rise of Public Health in England around 1840.

22. Germ Theory of Disease – Louis Pasteur in 1860 demonstrated the presence of bacteria in air. In 1877, Robert Koch showed that Anthrax is caused by bacteria. Gonoccus was discovered in 1847, typhoid bacillus in in 1880, cholera vibrio in 1883 III. Modern Medicine The dichotomy of Medicine divided into preventive and curative medicine was quite evident in 19th Century.

23. After 1900, medicine moved towards specialization. Multi-factorial causation of disease was put forward by Pettenkoefer.

24. Development of anti-viral vaccines like for Polio, Small Pox

25. Discovery of synthetic insecticides such as DDT, HCH, malathion etc

26. Discovery of drugs, chemoprophylaxis

27. Concept of disease eradication

28. Development of screening for the diagnosis of disease in its pre-symptomatic stage in 20th century Development of Family, Social and Community Medicine

29. Healthcare revolution in terms of

30. Health for all by 2000

31. Concept of Primary Healthcare

32. Millennium Development Goals in 2000

33. National Health Policy 2003INTRODUCTION TO INDIAN HEALTHCARE

34. 5,000 year old ancient civilization

35. 325 languages spoken – 1,652 dialects

36. 18 official languages

37. 29 states, 5 union territories

38. 3.28 million sq. kilometers - Area

39. 7,516 kilometers - Coastline

40. 1.1 Billion population.

41. 5600 dailies, 15000 weeklies and 20000 periodicals in 21 languages with a combined circulation of 142 million.

42. GDP $576 Billion. (GDP rate 8%)

43. Parliamentary form of Government

44. World’s largest democracy.

45. World’s 4th largest economy.

46. World-class recognition in IT, bio-technology and space.

47. Largest English speaking nation in the world.

48. 3rd largest standing army force, over 1.5Million strong.

49. 2nd largest pool of scientists and engineers in the World.

50. 5,000 year old ancient civilization

51. 325 languages spoken – 1,652 dialects

52. 18 official languages

53. 29 states, 5 union territories

54. 3.28 million sq. kilometers - Area

55. 7,516 kilometers - Coastline

56. 1.1 Billion population.

57. 5600 dailies, 15000 weeklies and 20000 periodicals in 21 languages with a combined circulation of 142 million.

58. GDP $576 Billion. (GDP rate 8%)

59. Parliamentary form of Government

60. World’s largest democracy.

61. World’s 4th largest economy.

62. World-class recognition in IT, bio-technology and space.

63. Largest English speaking nation in the world.

64. 3rd largest standing army force, over 1.5Million strong.

65. 2nd largest pool of scientists and engineers in the World. Health sector in India is the responsibility of the state, local and also the central government.

66. But in terms of service delivery it is more concerned with the state.

67. The center is responsible for health services in union territories without a legislature and is also responsible for developing and monitoring national standards and regulations, linking the states with funding agencies, and sponsoring numerous schemes for implementation by state governments.

68. Both the center and the state have a joint responsibility for programs listed under the concurrent list.MILESTONES IN INDEPENDENT INDIAPRIMARY HEALTH CENTERS 1952

69. FAMILY PLANNING 1952

70. GREEN REVOLUTION 1967 - 1977

71. NATIONAL HEALTH PROGRAMS – From 1957

72. NATIONAL HEALTH POLICY – 1982 & 2002

73. NRHM 2005

74. PHFI -2008Healthcare has emerged as one of the largest service sectors in India. Rather dynamic, it is constantly developing building further on the areas it is most competent at.

75. Further there are many factors that differentiate it from its foreign counterparts along with making it thriving in itself In 2004, national healthcare spending equaled about 5.2 per cent of nominal GDP, or about US$ 34.9 billion. Healthcare spending in India is expected to rise by 12 per cent per annum through 2005-09 (in rupee terms) and scale up to about 5.5 per cent of GDP, or US$ 60.9 billion, by 2009

76. Total expenditure on health 5.2% of GDP

77. Public health investment 0.9% of GDP

78. Budget allocation for health 1.3% of central budget

79. Govt expenditure 25%

80. Out of pocket expenditure 75% (www.searo.who.int/EN/Section313/Section1519_10852.htm )Central contribution to state 15%

81. State budgetary allocations reduced from 7% to 5.5%

82. India's health budget has gone up by nearly Rs.4000 crore to Rs.21113.33 crore ($4.35 billion) (www.thaindian.com/newsportal/.../public-health-infrastructure )

83. India’s medical infrastructure at a glance5,097 hospitals8,70,161 hospital beds5,03,900 doctors7,37,000 nurses162 medical collegesSource: Review of Health Care in India, 2005

85. Monitorable, time bound goals for the Eleventh Five Year Plan (2007 – 2012) Reducing Maternal Mortality Ration (MMR) to 1 per 1000 live births

86. Reducing Infant Mortality Rate (IMR) to 28 per 1000 live births

87. Reducing total fertility rate (TFR) to 2.1

88. Providing clean drinking water for All by 20009 and ensuring no slip backs

89. Reducing malnutrition among children of age group 0-3 to half its present level

90. Reducing anemia among women and girls by 50%

91. Raising the sex ratio for age group 0-6 to 935 by 2011-2012 and 8950 by 2016 - 17HEALTHCARE DELIVERY IN INDIA

92. Healthcare Delivery in IndiaPUBLIC HEALTH SECTORPrimary Health CarePrimary Health Centres

93. Sub-centresHospitals / Health centresCommunity Health Centres

94. Rural Hospital

95. District Hospitals/health centres

96. Specialist Hospitals

97. Teaching HospitalsHealth Insurance SchemesEmployee State Insurance Scheme

98. Central Govt. Health SchemeOther AgenciesDefence

99. RailwaysHealthcare Delivery in India Contd…..2. PRIVATE SECTORPrivate Hospitals, polyclinics, nursing homes, and dispensariesGeneral Practitioners and clinics3. INDIGENOUS SYSTEMS OF MEDICINEAyurveda and SiddhaUnaniHomeopathUn-registered practitionersVOLUNTARY HEALTH AGENCIES5. NATIONAL HEALTH PROGRAMMES

100. Public and Private sectorsThe majority of healthcare services in India are provided by the private sector.At present, India’s healthcare burden has gone beyond the Government’s budgetary applications.The increased spending power middle class is driving growth opportunities for corporate healthcare providers. Factors like privatization of medical insurance are making the market more attractive for international and national corporate players.The Government has taken an initiative to institutionalize a mechanism of public-private partnerships (PPP) in healthcare, right up from the district level.

101. Public Health Infrastructure1950-2000 rural health facilities up from 725 to 163,000

102. Yet shortfall by 16% in PHCs and 58% in CHCs

103. PHI not satisfying as service delivery hampered by policy and management concerns

104. Non availability of staff

105. Weak referral system

106. Recurring funding shortfalls

107. Lack of accountability for quality of care Problems Very low use of massive PH infrastructure

108. Poor availability and access

109. Unsatisfactory work of the PHI

110. So poor seeking private health care

111. Only 20% of OPD and 45% of inpatient care obtained from govt health infrastructure while the rest is from the private sector

112. ((www.searo.who.int/EN/Section313/Section1519_10852.htm )Encouraging Trends in Public HealthNRHMGOI has resolved to launch the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the basic health care delivery system in 2005.

113. The Mission adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water.

114. It also aims at mainstreaming the Indian systems of medicine to facilitate health care.NRHM PLAN OF ACTIONincreasing public expenditure on health, reducing regional imbalance in health infrastructure

115. pooling resources

116. integration of organizational structures, optimization of health manpower

117. decentralization and district management of health programmes

118. Community participation and ownership of assetsInduction of management and financial personnel into district health system

119. Operationalizing community health centers into functional hospitals

120. Meeting Indian public health standards in each block of the countrySource: http://www.mohfw.nic.in/NRHM.htm

121. PUBLIC Health foundation of indiaThe Public Health Foundation of India (PHFI) is a response to redress the limited institutional capacity in India for strengthening training, research and policy development in the area of Public Health. It is a public private partnership that was collaboratively evolved through consultations with multiple constituencies*Source: www.phfi.org

122. PHFI - Structure and objectivesStructured as an independent foundation, PHFI adopts a broad, integrative approach to public health, tailoring its endeavors to Indian conditions and bearing relevance to countries facing similar challenges and concerns.

123. The PHFI focuses on broad dimensions of public health that encompass promotive, preventive and therapeutic services, many of which are frequently lost sight of in policy planning as well as in popular understanding.*Source: www.phfi.org

124. Private HealthcareMore preference

125. Inpatient care more in govt sector since low cost rather than quality

126. Emphasis on secondary and tertiary care

127. Not mandatory to register so no clear picture

128. Unregulated, with serious complaints of poor quality, over charging, and unethical behavior.

129. Accounts for

130. 1. 67% of total 30,000 hospitals

131. 2. 33% of 1,000,000 beds

132. 3. 60% of 5 million doctorsLarge Demand Supply Gap100 beds per 100,000 population (WHO norms 300 beds)

133. No of doctors per 1000 low as per WHO norms

134. Investment range to bridge gap in next 10 yrs from 100,000 to 140,000 crores

135. Can create huge income and employment growth in next 10 years

136. Govt should encourage private, social and community insurance

137. Existing financing and payment system not suitable for countering market failures AffordabilityLow use of PHI so high out of pocket expenses

138. Health insurance

139. Regional licensing of HI business and HI schemes as Yeshaswini etc

140. Cost benefit analysis of ESI

141. Cost of care can be contained

142. Improvement in public sector service levels

143. Referral systems enforcement

144. Controlling infectious diseases

145. Ensure availability of proper and adequate health services for any insurance scheme to succeed In 2003, fee-charging private companies accounted for 82% of India’s $30.5 billion expenditure on healthcare.

146. Private firms are now thought to provide about 60% of all outpatient care in India and as much as 40% of all in-patient care.

147. It is estimated that nearly 70% of all hospitals and 40% of hospital beds in the country are in the private sector.

148. STATISTICS

149. Achievements Through The Years - 1951-2000Source: National Health Policy 2002

150. Achievements Through The Years - 1951-2000Source: National Health Policy 2002

151. Differentials in Health Status Among StatesSource: National Health Policy 2002

152. National Health policy – 2002Goals to be achieved by 2015 Eradicate polio and Yaws 2005

153. Eliminate Leprosy 2005

154. Eliminate Kala azar 2010

155. Eliminate Lymphatic Filariasis 2015

156. Achieve zero level growth of HIV/AIDS 2007

157. Reduce mortality by 50% on account of TB, Malaria and 2010 other vector and water borne diseases Reduce prevalence of blindness to 0.5% 2010

158. Reduce IMR to 30/100 and MMR to 100/Lakh 2010

159. Increase utilization of public health facilities from 2010 current level of <20% to >75% Establish an integrated system of surveillance, National 2005 Health Accounts and Health Statistics Increase Health expenditure by Government as a %of GDP 2010 from the existing 0.9 to 2.0% Increase share of the central grants to constitute at least 2010 25% of total health sharing Increase state sector health spending from 5.5% to 7% of budget 2005

160. Further Increase to 8% of the budget 2010Source: National Health Policy 2002

161. Differentials in Health status Among Socio-Economic GroupsSource: National Health Policy 2002

162. Indicators

163. Public Health Spending in select Countries

164. India Current Scenario: Health Resurgence of Communicable Diseases

165. Declining Public Investments and Expenditures in Health and Healthcare

166. Breakdown of the Public Health System

167. Access to Basic Healthcare Declining

168. Absence of Regulation and Control, and Quality Standards in Private Healthcare

169. Corporatisation and Rising Costs of Healthcare and Changed Character of the EconomyOPPORTUNITIES WITHIN INDIAN HEALTHCARE SECTOR

170. Growing incomes and literacy bode well for the Indian healthcare services marketMuch of India’s healthcare expenditure comes from private patients’ pockets, primarily the higher-income households.

171. A survey by NCAER, an independent economics research agency, suggests that per-capita expenditures on healthcare rise with higher education levels. Households that have higher education levels tend to spend more per illness than households with lower education levels.

172. Rising literacy in India is improving health awarenessIndia’s low cost of medical care, a strong value propositionIndia offers highly cost-competitive medical treatment and technological advances in many areas.

173. With diagnostic tests in India being inexpensive, India also has the potential to emerge as a hub for preventive health screening.

174. Not only are skilled Indian surgeons available for less, they are also less susceptible to costly litigation. This brings down the overall cost of treatment. India’s value proposition goes far beyond cost; quality second to noneApart from being in step with changing healthcare delivery technology, leading Indian medical care facilities are increasingly complying with stringent quality standards and queuing up for international accreditations( such as from the Chicago-based Joint Commission of Accreditation of Hospital Organizations (JCAHO) )

175. With an increasing number of Indian hospitals offering services at the cutting edge, there is a growing acceptance of India-based medical care among global insurers. The medical devices market in India is highly promising. The market size for medical devices in India is expected to touch US$ 1.7 billion by 2010, against US$ 1.2 billion presently. Presently, nearly 90 per cent of the demand is being met by imports since domestic production comprises primarily of low-tech devices.

176. Pathology Services: The US$ 500 million domestic pathology industry has been growing over the last five years at an estimated Compound Annual Growth Rate (CAGR) of 20 per cent per annum. It currently comprises almost 2.5 per cent of the overall healthcare delivery market. The major players are Dr. Lal’sPathlabs, Metropolis, SRL Ranbaxy, Thyrocare, and Nicholas Piramal.

177. Medical TourismAn important contributor to the GDP from the Indian Healthcare Sector is the Medical Tourism subdivision. Approximately 1,80,000 patients arrived in 2004 from across the globe for medical treatment. India is seeing a surge of patients from developed countries as well as from countries in Africa and South and West Asia that lack adequate healthcare infrastructure.

178. Apart from state of the art facilities, India provides low-cost treatments which is what makes it so attractive to foreign customers.According to a joint study by the Confederation of Indian Industry and McKinsey, Indian medical tourism was estimated at $350 million in 2006 and has the potential to grow into a $2 billion industry by 2012.4. To encourage the growth of medical tourism, the government also is providing a variety of incentives, including lower import duties and higher depreciation rates on medical equipment, as well as expedited visas for overseas patients seeking medical care in India.

179. In addition to receiving traditional medical treatments, a growing number of western tourists are traveling to India to pursue alternate medicines such as ayurveda, which has blossomed in the state of Kerala, in southwestern India. The number of medical tourists visiting Kerala was close to 15,000 in 2006 and is expected to reach 100,000 by 2010.

180. India has the potential to attract one million medical tourists eachyear, which could contribute $5 billion to the economy, according to theConfederation of Indian Industries

181. Health insurance:India offers tremendous opportunity for private medical insurance players. Increasing awareness levels and large-scale group insurance policies have pushed growth in the health insurance segment in recent years.

182. Due to liberalization and a growing middle class with increased spending power, there has been an increase in the number of insurance policies 2001-02, 7.5 million policies were sold. By 2003-4, the number of policies issued had increased by 37%, to 10.3 million policies issued in the country.

183. In the wake of liberalization, health insurance is projected to grow to $5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry

184. In order to spur the private health insurance sector, the Insurance Regulatory & Development Authority (IRDA) has increased the FDI limit from 26 per cent to 51 per cent.

185. Health insurance premium touched US$ 533.3 million by the end of 2005-06 Healthcare BPO:India is capable of offering a wide spectrum of outsourced Healthcare services. Outsourcing of pathology and laboratory tests by foreign hospital chains is becoming is a huge opportunity because of the high cost differential in India.Types of services:

186. Data capture

187. Documentation

188. Commercial

189. Administration

190. Human resources

191. Customer careTelemedicine:Only 25% of India’s specialist physicians reside in semi-urban areas, and a mere 3 % live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities

192. One solution is telemedicine—the remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet. Telemedicine is a fast-emerging trend in India, supported by exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs.Several major private hospitals have adopted telemedicine services, and a number of hospitals have developed public-private partnerships (PPPs), among them Apollo, AIIMS, NarayanaHrudayalaya, Aravind Hospitals and SankaraNethralaya.

193. Growth incentives…Policy initiatives

194. National Accreditation Board of Hospitals and Healthcare Providers (NABH)- committee to make provisions for access, assessment, care of patients and protect patient’s rights.

195. Clinical Establishment Act, 2006: Low cost and Good quality healthcare.

196. Policy decision on easy provision of ‘medical visas’.

197. National Rural Health Mission

198. Increased foreign investments in various Healthcare segments such as Insurance.

199. Development of competent technology.

200. Well trained personnel.Conclusion:The Indian healthcare sector can be viewed as a glass half empty or a glass half full. The challenges the sector faces are substantial, from the need to improve physical infrastructure to the necessity of providing health insurance and ensuring the availability of trained medical personnel. But the opportunities are equally compelling, from developing new infrastructure and providing medical equipment to deliveringtelemedicine solutions and conducting cost-effective clinical trials. For companies that view the Indian healthcare sector as a glass half full, the potential is enormous.The Indian health care sector is predicted to touch $14.2 billion by 2012 due to rising income levels, high populations, and change in the illness pattern in the countryThe value of domestic health care will rise up to four times by 2017.

201. Private and public spending in Indian health sector would touch $14.2 billion in 2013, at an annual growth rate of 5.8 percent from 2009