Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to National health policy 2017.pptx
Similar to National health policy 2017.pptx (20)
More from Dr. Chirag Sonkusare
More from Dr. Chirag Sonkusare (16)
Recently uploaded
Recently uploaded (20)
National health policy 2017.pptx
- 2. Contents Definition Policy Vs Programme and Legislation History Situational Analysis Need for NHP 2017 Goal Key Policy Principles Objectives Policy Thrust National health programmes Other areas Critical analysis NHP-2017 and Covid-19
- 3. DEFINITION • Policy is statement which lays down the stated agreement of a government regarding the strategy and broad course of actions that will be taken to address a problem.
- 4. Policy Vs Programme & Legislation Policy Programme Legislation Vision Interventions Rights Values Resources Do’s & Don’ts Principles Budget Accountability Broad objectives Specific Punishment
- 5. History PHASE I 1946- 1982 PHASE II 1983-2001 PHASE III 2002-2020 NHP- 2017 NHP- 2002 NHP- 1983 1978- Alma ata
- 6. 1946- Bhore committee 1951-1956 Community Development Programme 1956-1962 Mudaliar Committee- 1967- Jungalwalla Committee 1973- Kartar singh Committee 1975- Shrivastava Committee 1977- Rural Health Scheme 1978- Alma ata declaration 1983- NHP 2000- National Population Policy 2002- NHP 2005- NRHM 2007- state- sponsored insurance schemes 2011- Framework for UHC 2012- Last five year plan 2017- NHP
- 8. Situational analysis MDG’s 2015- Achieved reasonably Population stabilizing, except for sex ratio Burden of disease Inequities- Exists Urban- Rural & across states Quality of care (Pregnancy care, abortions practices etc.) Disease control programs- Mixed results
- 9. NRHM- strengthened public health systems well, but Uneven and limited to RCH and National programmes NUHM- Sanctioned in 2013. Catastrophic Health expenditure- Increasing Publicly Financed Health Insurance Private health care industry Ongoing push for AYUSH. Situational Analysis
- 10. Human resource development Health research Regulatory role of Government Investment in health care Major expansion of med/ nursing/ technical education Situational analysis- Health industry
- 11. Health Expenditure in Selected Countries Year Total health expenditure per capita USD-2011 Total health expenditure as % of GDP-2011 Govt. Health expenditure as % of Total health expenditure India $62 3.8% 30.5% Thailand $214 4.1% 77.7% Sri Lanka $93 3.3% 42.1% China $274 5.1% 45.7% UK $3659 9.4% 82.8% Situational Analyses report-2017
- 12. Need for NHP 2017 Changing health care priorities Emergence of a robust health care industry Growing incidences of catastrophic expenditure due to health care costs Enhanced fiscal capacity
- 13. Goal • Attainment of the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence.
- 14. Key Policy Principles Professionalism, Integrity and Ethics A.Equity Affordability Universality Patient Centered & Quality of Care A.Accountability A.Inclusive Partnerships Pluralism A.Decentralization Dynamism and Adaptiveness
- 15. Objectives Progressively achieve Universal Health Coverage Reinforcing trust in Public Health Care System Align the growth of private health care sector with public health goals
- 16. Specific Quantitative Goals and Objectives Health status and programme impact Life Expectancy and healthy life Mortality by Age and/ or cause Reduction of disease prevalence/ incidence Health Systems Performance Coverage of Health Services Cross Sectoral goals related to health Health Systems strengthening Health finance Health Infrastructure and Human Resource Health Management Information
- 17. Health Status and Programme Impact INDICATOR TARGET YEAR Life Expectancy and healthy life Life Expectancy at birth 67.5 to 70 2025 regular tracking of DALY index 2022 Reduction of TFR 2.1 2025 Mortality by Age and/ or cause Under Five Mortality 23 2025 MMR 100 2020 IMR 28 2019 Neonatal mortality 16 2025 Still birth Single digit 2025 Reduction of disease prevalence/ incidence HIV/AIDS 90:90:90 2020
- 18. Health Systems Performance INDICATOR TARGET YEAR Coverage of health services Increase utilization of public health facilities by 50% 2025 skilled attendance at birth Above 90 % 2025 Fully immunized new-borns Above 90 % 2025 Meet need of family planning Above 90 % 2025 80% of known HTN & DM „controlled disease status‟ 2025 Cross sectoral goals related to health prevalence of current tobacco use To be reduced by 30 % 2025 prevalence of stunting of under-five children To be reduced by 40% 2025 Access to safe water and sanitation to all 2020 Reduction of occupational injury 2020
- 19. Health Systems strengthening INDICATOR TARGET YEAR Health finance Increase health expenditure by Government 1.15%-2.5% of GDP 2025 Increase State sector health spending 8% OF THEIR BUDGET 2020 Health Infrastructure and Human Resource Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts 2020 Increase community health volunteers 2025 Establish primary and secondary care facility 2025 Health Management Information district-level electronic database establish registries for diseases of public health importance ******************************
- 20. POLICY THRUST ENSURING ADEQUATE INVESTMENT ORGANIZATIO N OF PUBLIC HEALTH CARE DELIVERY PREVENTIVE AND PROMOTIVE HEALTH
- 21. Ensuring Adequate Investment General taxation Taxes on tobacco, alcohol Raise public health expenditure to 2.5% of the GDP
- 22. Preventive and Promotive Health Swachh Bharat Abhiyan Balanced, healthy diets and regular exercises. Addressing tobacco, alcohol and substance abuse Yatri Suraksha Nirbhaya Nari Reduced stress and improved safety in the work place Reducing air pollution SWASTH NAGRIK ABHIYAN
- 23. Organization of Public Health Care Delivery Primary care Selective care Comprehensive care Secondary and tertiary care Input oriented Output based strategic purchasing Public hospitals User fees & cost recovery Assured free sevices Infrastructure and HR development Normative approach Targeted approach key policy shifts
- 26. National Health Programmes RMNCH+A services Child and Adolescent Health Intervention to address Malnutrition Universal immunization Communica ble diseases Control of tuberculosis Control of HIV/AIDS Leprosy elimination Vector Borne disease control Noncommu nicable diseases Mental health Population stabilization
- 27. • Elicit developmental action of all sectors to support Maternal and Child survival. • Strengthening of general health systems to prevent and manage maternal complications • Ensure continuity of care and emergency services for maternal health. • Address the social determinants through developmental action in all sectors. • Accelerated achievement of neonatal mortality targets and “single digit” stillbirth rates • District hospitals- screening and treatment of children • Pre-emptive care • School health programmes- health and hygiene – part of curriculum • Expansion of scope of Reproductive and Sexual Health RMNCH+A services Child and Adolescent Health
- 28. • Reducing micronutrient malnourishment. • Augmentation of Micro nutrient supplementation, food fortification, screening for anemia and public awareness. • Screening • Intensify the present efforts (IFA,vit-A, ORS,Calcium, Iodized salt etc. • Effective integration of both nutrition- sensitive and nutrition-specific interventions for coordinated optimal results. • Improve immunization coverage with quality and safety, improve vaccine security as per National Vaccine Policy 2011 • Introduction of newer vaccines • Success of Mission Indradhanush Intervention to address Malnutrition Universal immunization
- 29. • For Integrated Disease Surveillance Programme- response of districts to the communicable disease priorities • Active case detection • Greater involvement of private sector supplemented by preventive and promotive action • Access to free drugs Communicable diseases Control of tuberculosis
- 30. • Focused interventions on the high-risk communities (MSM, Transgender, FSW, etc.) and prioritized geographies. • Support care and treatment for people living with HIV/AIDS • Proactive measures targeted towards elimination of leprosy from India by 2018 Control of HIV/AIDS Leprosy elimination
- 31. • Changing treatment regimens of drug resistance in Malaria • National Programme for prevention and control of Japanese Encephalitis (JE)/Acute Encephalitis Syndrome (AES) acceleration with inter-sectoral collaboration. • Set-up a National Institute of Chronic Diseases including Trauma • Integrated approach where screening for the most prevalent NCDs with secondary prevention • Comprehensive primary health care network - specialist consultations + follow up at the primary level. • Research • Developing protocol for mainstreaming AYUSH -Integrated medical care. • Geriatric care (Maintenance and Welfare of Parents and Senior Citizens Act, 2007) • Public awareness to promote voluntary tissue and organ donation Vector Borne disease control Noncommunicable diseases
- 32. • Provisions of the National Mental Health Policy 2014 • Increase creation of specialists to work in public systems • Strengthen mental health services at primary level • Leverage digital technology in a context where access to qualified psychiatrists is difficult • Camp based services Any day of the week / A fixed day • Increase the proportion of male sterilization <5% 30% and if possible much higher. Mental health Population stabilization
- 33. Other areas 1. Women’s health & Gender based violence 2. Supportive Supervision 3. Emergency Care and Disaster Preparedness 4. Mainstreaming the Potential of AYUSH 5. Tertiary care Services
- 34. 6. Human Resources for Health Medical Education Attracting and Retaining Doctors in Remote Areas Specialist Attraction and Retention Mid-Level Service Providers Nursing Education ASHA Paramedical Skills Public Health Management Cadre Human Resource Governance and leadership development Other areas
- 35. Other areas 7. Financing of Health Care (National health account system) Purchasing of Healthcare Services 8. Collaboration with Non-Government Sector/Engagement with private sector Capacity building Skill Development programmes Corporate Social Responsibility (CSR) Mental healthcare programmes Disaster Management Strategic Purchasing as Stewardship Enhancing accessibility in private sector Role in Immunization Disease Surveillance Tissue and organ transplantations Make in India Health Information System Incentivising Private Sector
- 36. Other areas 9. Regulatory Framework Professional Education Regulation Regulation of Clinical Establishments Food Safety Drug Regulation Medical Devices Regulation Clinical Trial Regulation Pricing- Drugs, Medical Devices and Equipment 10. Vaccine safety 11.Medical Technologies 12. Public Procurement 13. Availability of Drugs and Medical Devices 14. Aligning other policies for medical devices and equipment with public health goals 15. Improving Public Sector Capacity for Manufacturing Essential Drugs and Vaccines
- 37. Other areas 16. Anti-microbial resistance 17. Health Technology Assessment 18. Digital Health Technology Eco – System Application of Digital Health Leveraging Digital Tools for AYUSH 18. Health surveys 19. Health Research Strengthening Knowledge for Health: Drug Innovation & Discovery Development of Information Databases Research Collaboration 20. Governance Role of Centre & State Role of Panchayati Raj Institutions Improving Accountability 21. Legal Framework for Health Care and Health Pathway 22. Implementation Framework and Way Forward
- 38. Let’s go Deep into the reality
- 40. Quantitative objectives INDICATOR TARGET By YEAR LATEST DATA Life expectancy at birth 67.5 to 70 2025 69.6 (2019- World bank data) Reduction of TFR 2.1 2025 2 (2019-NFHS 5) Under five mortality 23 2025 42 (2019 NFHS 5) MMR 100 2020 103 (2019 SRS DATA-2019) IMR 28 2019 30 (2019-NFHS 5) Neonatal mortality 16 2025 25(2019-NFHS 5) Still birth Single digit 2025 13.9(2019 WHO report) HIV/AIDS 90:90:90 2020 77:65:55(2021-UNAIDS report) Increase utilization of public health facilities by 50% 2025 Prevalence of current tobacco use To be reduced by 30 % (32.2-2015-world Bank Data) 2025 27.2%(2019) Prevalence of stunting of under-five children To be reduced by 40% (38%-NFHS 4) 2025 35.5%(NFHS 5) Increase health expenditure by government 1.15%-2.5% of GDP 2025 Increase state sector health spending 8% OF THEIR BUDGET 2020
- 41. • Ref: NFHS-5 Report Targets Year 23 2025 28 2019 16 2025
- 42. 1.15 1.13 1.18 1.2 1.35 1.28 1 1.05 1.1 1.15 1.2 1.25 1.3 1.35 1.4 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 Government Health Expenditure as % of GDP GHE as % of GDP Ref: MoHFW/National Health Estimates 2018-19 report launch/12 Sept 2022/4
- 44. Poverty ‘Emerging’ health challenges such as high blood pressure, diabetes and mental illness Chronic anemia and malnutrition among children lack of infrastructure, insufficient spending, lack of trained medical personnel poor outcome Investment is well below the World Health Organisation (WHO) guidelines in both qualitative and quantitative terms Implementation Challenges in ABP Will it be possible to achieve universal health coverage by 2030?
- 45. • Health financing being neglected (GHE is 1.4% of GDP) National health policy 2017: Can it lead to achievement of sustainable development goals?
- 46. Sri Lanka - 3.25% Bangladesh - 3.7% Pakistan - 2.8% India -1.4% South-East Asian region countries Government health expenditure (% of GDP)
- 47. Year Total health expenditure per capita Total health expenditure as % of GDP Govt. Health expenditure as % of Total health expenditure 2015 $62 3.9% 30.5% 2019 $63.75 3.01% 32.79% Health Outcomes and Health expenditures in India World bank data-2019
- 48. • Health financing being neglected (GHE is 1.4% of GDP) • Need to relook our strategies to reduce maternal and child mortality National health policy 2017: Can it lead to achievement of sustainable development goals?
- 49. 254 212 178 167 130 122 113 103 0 50 100 150 200 250 300 2004-06 2007-09 2010-12 2011-13 2014-16 2015-17 2016-18 2017-19 TREND OF MATERNAL MORTALITY RATE IN INDIA MMR Ref: Annual report 2021-22 and Sample Registration System (SRS) special bulletin on maternal mortality in India (2017-19
- 50. Ref: According to the latest Sample Registration System (SRS) special bulletin on maternal mortality in India (2017-19), brought out by the office of the Registrar General of India.
- 52. • Health financing being neglected (GHE is 1.4% of GDP) • Need to relook our strategies to reduce maternal and child mortality • Over reliance on private sector National health policy 2017: Can it lead to achievement of sustainable development goals?
- 53. Household social consumption in India: Health NSS 75th round (July, 2017 – June, 2018) [Internet]. [cited 2022 Oct 8]. Available from: https://pib.gov.in/newsite/PrintRelease.aspx?relid=194918 55% 42% 3% Inpatiant care Private hospitals Public Hospitals Charitable/Trust/NGO run hospitals 69% 30% 1% Outpatient care Private Hospitals Public hospitals Utilization of public and private hospitals in inpatient and outpatient healthcare
- 54. Comparison of per episode treatment cost (INR) in Public and Private Facilities Hospitals Treatment cost Inpatient Treatment cost outpatient Public 4451.9 331.4 Private 31845.4 1062.2 Charitable/Trust/NGO 24452.4 732.4 Household social consumption in India: Health NSS 75th round (July, 2017 – June, 2018) [Internet]. [cited 2022 Oct 8]. Available from: https://pib.gov.in/newsite/PrintRelease.aspx?relid=194918
- 55. • Health financing being neglected (GHE is 1.4% of GDP) • Need to relook our strategies to reduce maternal and child mortality • Over reliance on private sector • Uniform health insurance system for the country is the need of the hour National health policy 2017: Can it lead to achievement of sustainable development goals?
- 56. Out of pocket expenditure 54.78% (2019) 10%
- 57. Facility is only provided for indoor patients The scheme covers all public health institutes, which generally lack infrastructure and human resources Scale up the scheme with Rajiv Arogyasri scheme and Enrollment of many corporate hospitals under it. A large portion of the financial resources is spent on paying the premium and reimbursement money to the insurance providers and the beneficiaries respectively
- 58. • Health financing being neglected (GHE is 1.4% of GDP) • Need to relook our strategies to reduce maternal and child mortality • Over reliance on private sector • Uniform health insurance system for the country is the need of the hour • Inequities & Inter and intra State variations. National health policy 2017: Can it lead to achievement of sustainable development goals?
- 61. 4.682 4.006 3.346 3.002 2.334 2.22 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 1/1/1983 1/1/1985 1/1/1987 1/1/1989 1/1/1991 1/1/1993 1/1/1995 1/1/1997 1/1/1999 1/1/2001 1/1/2003 1/1/2005 1/1/2007 1/1/2009 1/1/2011 1/1/2013 1/1/2015 1/1/2017 1/1/2019 TOTAL FERTILITY RATE TFR 254 212 178 167 130 122 113 103 0 50 100 150 200 250 300 2004-06 2007-09 2010-12 2011-13 2014-16 2015-17 2016-18 2017-19 TREND OF MATERNAL MORTALITY RATE IN INDIA MMR
- 63. Country Life expectancy at Birth India 66 Thailand 75 Sri Lanka 75 Brazil 74 China 75 Russia 69 South Africa 59 USA 79 UK 81 Germany 82 France 82 Norway 82 Denmark 80 Japan 84 Life expectancy at birth in different countries Ref: Situational analysis-2017
- 65. Indicators NHP 2002 target (year) (MoHFW, 2002) NHP 2017 target (year) (MoHFW, 2017) Current status (year) Maternal mortality ratio 100 (2010) 100 (2020) 113 (2016–2018) Leprosy Elimination by 2005 Elimination by 2018 8.38 new cases detected per 100 000 population (2019) Kala-azar Elimination by 2010 Elimination by 2017 Reported cases: 1967, deaths: 6 (2020) Lymphatic filariasis Elimination by 2015 Elimination by 2017 (in endemic pockets) Average microfilaria rate (2014): 0.44% Public spending on health 2% of GDP (2010) 2.5% of GDP (2025) 1.2% GDP (2016– 2017) Increase state sector health spending 8% of budget by 2010 8% of budget by 2020 6.3% of total revenue expenditure (20192020) Srivastava S, Karan AK, Bhan N, Mukhopadhya I, World Health Organization. India: health system review. Health Systems in Transition. 2022;11(1).
- 68. What happened during Covid-19 pandemic? Main target of NHP 2017 Universalization of health care “Health in All approach” Private healthcare system Vs Public health care system
- 69. Private healthcare system’s cooperation was less in support with public health care High admissions in private hospitals Higher numbers of private hospitals have been empaneled on board than public hospitals Private healthcare system during Covid 19 Government funds are being used to subsidize the private health sector Fraudulent practices by the private hospitals due to illiteracy among Indians
- 70. Public healthcare system during covid-19 Lack of healthcare infrastructure Non-availability of skilled human resources Low expenditure on health SDGs healthcare targets like “healthy living and well-being for all; universal health coverage, not covering the entire population Less trust of people in the public hospitals
- 71. 25778 713986 35699 17850 43487 1185242 59262 29631 0 200000 400000 600000 800000 1000000 1200000 1400000 Total hospitals Hospital beds ICU beds Ventilators Healthcare infrastructure of public and private hospitals Public hospitals Private hospitals Ref: Center For Disease Dynamics, Economics & Policy report (20 April 2020) and National Health Profile 2019
- 73. • Where the policy is lagging behind? • What can be done to achieve the targets by 2030? • What should be added in future policies?
- 74. References 1. National health policy -2017 report (MoHFW) 2. National health policy- 2002 (MoHFW) 3. Situational analysis-Backdrop to the nationalhealth policy-2017 4. Kaur H, Rathi SK. National Health Policies in Practice: An Explorative Analysis for India. Journal of Health Management. 2019 Sep;21(3):372-82. 5. Sundararaman T. National Health Policy 2017: a cautious welcome. Indian Journal of Medical Ethics. 2017 Apr 4;2(2):69-71. 6. Sharma S, Singh M, Pal R, Ranjan R, Pal S, Ghosh A. National Health Policy 2017: Can it lead to achievement of sustainable development goals. Al Ameen J Med Sci. 2018;11(1):4-11 7. Gupta RK, Kumari R. National health policy 2017: an overview. JK Science. 2017 Jul 1;19(3):135-6. 8. Grover A, Singh RB. Health policy, programmes and initiatives. InUrban Health and Wellbeing 2020 (pp. 251-266). Springer, Singapore. 9. Gauttam P, Patel N, Singh B, Kaur J, Chattu VK, Jakovljevic M. Public health policy of India and COVID- 19: Diagnosis and prognosis of the combating response. Sustainability. 2021 Mar 19;13(6):3415. 10. Srivastava S, Karan AK, Bhan N, Mukhopadhya I, World Health Organization. India: health system review. Health Systems in Transition. 2022;11(1). 11. Annual report-2021-22 12. NFHS-5 data
Editor's Notes
- Policy is statement which lays down the stated agreement of a government regarding the strategy and broad course of actions that will be taken to address a problem.
- Inactivated Polio Vaccine (IPV) Rotavirus vaccine (RVV Measles Rubella (MR) vaccine Pneumococcal Conjugate Vaccine (PCV) Tetanus and adult diphtheria (Td) vaccine
- National Leprosy Eradication Programme was introduced in 1983
- HIV- prevalence 2019-23.49%
- ninety-five per cent of the population is still in the low-income category who are extremely vulnerable to health shocks and unexpected out-of-pocket expenditures (at sixty per cent, one of the highest in the world) Distant memory but chronic anaemia and malnutrition among children continue to be recurring problems with the latest Global Hunger Index (GHI, 2019) ranking India at 102 out of 117 nations However, eleven per cent of Sub Health Centres, sixteen per cent of Primary Health Centres and sixteen per cent Community Health Centres suffer from poor infrastructure, understaffing, lack of equipment and medicines (Government of India, 2017a, 2017b) India is a country where bed density is low (less than 0.9 per 1,000 persons as compared to WHO guidelines of three) with perennial doctor shortages plaguing the medical system. India was ranked at 154 of 195 countries on health service delivery index in 2017 (Health in India, 2017)
- Considering the budget allocation made by the Government of India for the health sector, the targets mentioned in the NHP seem overambitious. The expenditure for health in India is one of the lowest in the world at 1.4% of the Gross Domestic Product (GDP). The NHP-2017 aims to increase this to about 2.5%, which again is much less than the required 5-6%. The money allocated for health in the Union Budget 2017, is nowhere near to achieving the target of even 2.5%.
- Considering the budget allocation made by the Government of India for the health sector, the targets mentioned in the NHP seem overambitious. The expenditure for health in India is one of the lowest in the world at 1.4% of the Gross Domestic Product (GDP). The NHP-2017 aims to increase this to about 2.5%, which again is much less than the required 5-6%. The money allocated for health in the Union Budget 2017, is nowhere near to achieving the target of even 2.5%.
- the health policy relies on the same strategies of ‘Janani Surakksha Yojana’ and ‘Janani Shishu Suraksha Karyakram’ for the reduction of maternal and neonatal mortality
- delayed identification of high risk conditions leading to maternal death, delay in reaching the correct health facility for timely action and the delay in managing a complication after reaching the appropriate health facility, are responsible for the high proportion of maternal deaths
- Social development indicators are stronger than many states across the country, which is a reflection of the sustainable development model being followed by Kerala wherein more importance is given to the public and social service sectors. Kerala has made substantial investments in setting up high dependency units in every district and in improving 39 delivery points under the Union Health Ministry’s LaQshya initiative. Second, the Confidential Review of Maternal Deaths (an initiative by the Kerala Health Department since 2004-05) laid the foundation for all maternal health improvement initiatives. This initiative was further strengthened by maternal near-miss audits in all districts, to analyze the critical events which nearly resulted in maternal deaths. Third, it developed the Quality Standards in Obstetric Care in 2012-13 to focus on the management of some of the common causes of maternal deaths — postpartum hemorrhage (PPH), pregnancy-induced hypertension (PIH), sepsis and amniotic fluid embolism.
- Another target of reducing under five mortality ahead of time can only be achieved when the infant mortality or more specifically neonatal mortality rate is reduced.. The progress in reduction of neo-natal mortality has been slow in our country. However another important contributor to this mortality is the shortcomings in the health delivery system of the country. Improving India’s health system functioning is vital not just for reducing under-five mortality, but also for addressing other health priorities.
- The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap. This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
- The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap. This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
- Out of pocket expenditure as a percentage of current health expenditure Health insurance in the country is available to only 10% of the people [19]. Insurance is either available to the state or the central government employees or those being covered by the Employees State insurance act. In order to provide insurance to poor families, the government has launched the Rashtriya Suraksha Bima Yojana (RSBY) since 2008 for the below poverty line (BPL) families. The scheme provides cashless treatment for the beneficiary with the help of a smart card up to Rs 30,000/ in one year [
- facility is only provided for indoor patients; hence the outpatient department patients still have to bear the expenses out of their own pocket hence the quality of services is compromised. With the expansion of the scheme country wide, the increasing burden of expenditure is to be tackled only with the single source of income, namely taxes Rajiv Arogyasari scheme also provides a cover of two lakhs to BPL families has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households- mainly for tertiarycare.
- The private sector in the country provides 70% of the health care services, most of which are secondary and tertiary care on one hand the NHP aims to improve the use of public health system in the country by 50% of current levels by the year 2025, at the same time, the government intends to hire services of the private sector in order to bridge the gap. This involvement of the private sector would be for secondary and tertiary care services, besides involving them in providing immunization services, disease surveillance, tissue and organ transplantations and purchase of medical devices from indigenous firms [4]. Such an arrangement raises a question on the quality of services which the private providers would render in the public sector, when their personal interests would lie in their own private concerns. The financial burden on the already starved resources is another matter of concern, as this money can be better utilized in strengthening the public sector infrastructure. Moreover most of the targets enlisted in the policy can be better achieved by strengthening the primary care services of the country. Countries such as Chile, Brazil and Thailand have shifted focus from hospital centric care to primary care in their efforts to achieve universal health care
- The under-five mortality rate is higher in rural areas than in urban areas (46 deaths per 1,000 live births versus 32 deaths per 1,000 live births). The under-five mortality rate is highest in Uttar Pradesh (60 deaths per 1,000 live births) and lowest in Kerala and Puducherry (5 and 4 deaths per 1,000 live births, respectively) The under-five mortality rate for scheduled tribes (50 deaths per 1,000 live births), scheduled castes (49 deaths per 1,000 live births), and other backward classes (41 deaths per 1,000 live births) are considerably higher than for those who are not from scheduled castes, scheduled tribes, or other backward classes (33 deaths per 1,000 live births). The under-five mortality rate also declines with increasing household wealth. The under-five mortality rate declined from 59 deaths per 1,000 live births in the lowest wealth quintile to 20 deaths per 1,000 live births in the highest wealth quintile. 7.2 BIODEMOGRAPHIC RISK FACTORS Researchers have identified multiple risk factors for infant and child mortality based on the characteristics of the mother and child and the circumstances of the birth. Table 7.3 and Figure 7.3 illustrate the relationship between these risk factors and neonatal, infant, and under-five mortality. Boys are slightly more likely to die before their fifth birthday than girls. The gender gap is most pronounced in the neonatal period (within one month after birth). Shorter birth intervals are associated with higher under-five mortality. The under-five mortality rate for children born less than 2 years after the preceding birth is more than twice as high as that for children born 3 years after their preceding sibling. Children reported to be very small at the time of birth are more than four times as likely to die during the first month of life as children reported to be average size or larger (96 deaths per 1,000 live births versus 20 deaths per 1,000 live births). Children of birth order seven or more are more than twice as likely to die in the first five years of life than children of the first birth order (Figure 7.3). 109 95 74 50 42 79 68 57 41 35 49 43 39 30 25 NFHS-1 NFHS-2 NFHS-3 NFHS-4 NFHS-5 Under-five mortality Infant mortality Neonatal mortality Figure 7.1 Trends in Early Childhood Mortality Rates Deaths per 1,000 live births in the five-year period before the survey 243 Any method of measuring childhood mortality that relies on the mothers’ reports (i.e., birth histories) assumes that female adult mortality is not high, or if it is high, that there is little or no correlation between the mortality risks of the mothers and those of their children. Selected indicators of the quality of the mortality data on which the estimates of mortality given in this chapter are presented in Appendix E (Tables E.4-E.6). 7.1 INFANT AND CHILD MORTALITY Neonatal mortality: The probability of dying within the first month of life. Postneonatal mortality: The probability of dying between the first month of life and the first birthday (computed as the difference between infant and neonatal mortality). Infant mortality: The probability of dying between birth and the first birthday. Child mortality: The probability of dying between the first and fifth birthday. Under-five mortality: The probability of dying between birth and the fifth birthday. For the five-year period before the 2019-21 NFHS, the neonatal mortality rate was 25 deaths per 1,000 live births. This means that one in 40 live births died during the neonatal period. The infant mortality rate was 35 deaths per 1,000 live births. The under-five mortality rate was 42 deaths per 1,000 live births (Table 7.1 and Figure 7.1). This indicates that one in 24 children in India die before their fifth birthday. More than fourfifths (83%) of these deaths occur during infancy. Trends: The neonatal mortality rate declined from 49 deaths per 1,000 live births in the five years before the 1992-93 NFHS survey to 25 deaths per 1,000 live births in the five years before the 2019-21 NFHS survey. The neonatal mortality rates in the five years before the 1998-99 survey, 2005-06 survey, and the 2015-16 survey were 43, 39, and 30 deaths per 1,000 live births, respectively. The infant mortality rate declined from 79 deaths per 1,000 live births in the five years before the 1992-93 NFHS survey to 35 deaths per 1,000 live births in the five years before the 2019-21 NFHS survey. During the same period, the under-five mortality rate declined from 109 deaths per 1,000 live births to 42 deaths per 1,000 live births. The infant mortality rate decreased by 56 percent over a period of 28 years. The decline in the under-five mortality rate is slightly higher than the decline in the infant mortality rate during this period (a decrease of 62 percent). Patterns by background characteristics The under-five mortality rate is higher in rural areas than in urban areas (46 deaths per 1,000 live births versus 32 deaths per 1,000 live births). The under-five mortality rate is highest in Uttar Pradesh (60 deaths per 1,000 live births) and lowest in Kerala and Puducherry (5 and 4 deaths per 1,000 live births, respectively) (Figure 7.2). The under-five mortality rate declines with an increase in mother’s schooling (Table 7.2). The under-five mortality rate for scheduled tribes (50 deaths per 1,000 live births), scheduled castes (49 deaths per 1,000 live births), and other backward classes (41 deaths per 1,000 live births) are considerably higher than for those who are not from scheduled castes, scheduled tribes, or other backward classes (33 deaths per 1,000 live births)
- Goals can be ambitious, the objectives to achieve those goals should specific as well as goal oriented.
- The private healthcare system has not been proved reliable during the emergency. Only the public health system is suitable for the country wherein the population’s substantial size is rural and poor
- Under PMJAY, the states that have registered the most hospitalizations are Rajasthan, Gujarat, Jharkhand, Chhattisgarh, and Kerala. However, the irony is that admissions in private hospitals were higher than those in public hospitals. The numbers of hospitals registered/empaneled under the private sector scheme are also higher than in the public sector [65]. The key argument against the PMJAY model is that government funds are being used to subsidize the private health sector, where healthcare expenditures are nearly double or even three times in public hospitals the Ayushman Bharat scheme also has been proving public funds for private benefits because this policy ensures a publicly funded and privately managed health insurance scheme. Though the objective of the scheme is universal health coverage as recommended by NHP-2017.
- 1.Given the privately controlled health infrastructures, India’s health system is not universalistic to deal with the pandemic situation. The adequate availability of public healthcare infrastructures, particularly in hospitals, primary and community health centers, beds, ICUs, ventilators, etc., still has not been congruent to the size of the country’s population 2. healthcare expenditure in India is one of the lowest in the world. The severity of the situation can be best understood by the fact, according to the WHO Expenditure Database 2016, India ranks 170 out of 188 countries in domestic general government spending on health as a percentage of GDP. Now, the question is how the government would achieve these lofty objectives with a mere expenditure of 2.5 percent of GDP? Early diagnosis, effective treatment and preventive measures form the cornerstones in disease containment thereby reducing its rapid spread, high morbidity and economic impact on the health systems Undoubtedly, some of the states in India did very well in containing the spread of COVID-19. However, in the long run, the GOI needs to focus on reshaping the health policy to make India well-prepared for health emergencies like COVID-19.