release of india health report
DESCRIPTION
This report provides a broad direction for India’s health sector in the coming years. In doing so, it describes India’s achievements with regard to the three key goals of health policy—improved health status, financial risk protection, and equity. It does so by identifying some of the factors and the state of policy instruments that have facilitated these achievements in the areas of access, quality and efficiency. Hence, it looks at public health interventions, regulations, financing, and the organisation of healthcare. The role of both public and private institutions in the pro- vision of such services is studied in this overall context. The focus, therefore, is to analyse the status of health in India, and this is done by bringing together data and analyses from government documents, health economics and policy literature and a host of other sources. Organised in nine chapters, the report begins by making a case for investing in health as a sound economic decision. Ajay Mahal and Victoria Fan (Chapter 1) make the point that investing in health should be a priority, even when resources are otherwise limited, owing to the high returns from such investment. As such, they highlight the need to enhance protection against the financial risk inherent in an unhealthy population. They argue their case at four levels: (a) health is a major factor in influencing aggregate economic outcomes; (b) instances of ill health can expose entire households to financial risk and, in many cases, im poverishment; (c) health status itself is an indicator of human well-being; and (d) in a society undergoing great economic and social transition, such as India, improvements in health carry an added importance (and correspondingly constitute a greater challenge). As the mere provision of health infrastructure does not necessarily ensure universal accessibility, in Chapter 2, Laveesh Bhandari and Aali Sinha examine the multiple facets governing the access to, and utilisation of, health- care services: awareness levels; locational or financial constraints; efficiency of public and private healthcare providers; issues of quality and reliability of service and treatment; analysis of hospitalisation and out-of-pocket expenditure, etc. They conclude that despite heavy public intervention, the health burden carried by Indians con- tinues to be significant. They underline the importance of effectively addressing the constraining issues through effective systemic changes. In Chapter 3, Sumita Kale studies the new issues in disease management in India today, many of which are linked to growing prosperity in the country. One set of issues she examines is the rising incidence of diseases like ischemic heart, diabetes, cancer, HIV/AIDs, where health education and regular screening can play a significant preventive role. She also highlights the need to match society’s rising affluence with an environment where mental and physical disorders and disabilities are included in the mainstream discussion on health management. In Chapter 4, Laveesh Bhandari and Ankur Gupta discuss the status of the four major inputs fundamental to a good health profile in India: well-trained, adequate and well-motivated healthcare providers; a well spread and acces sible healthcare infrastructure; a good water supply and sanitation system which also facilitates hygienic prac- tices; and a population that is well supplied nutritionally and practices a hygienic lifestyle. Bhandari and Gupta highlight a single key problem underlying all these inputs: the lack of a public health focus. Seeing the multiplicity of government units involved in the various aspects of health administration, they recommend a centralised authority that is able to synchronise and coordinate various policy measures in line with the received evidence on improving health outcomes. Medical ethics encompasses a vast range of issues, and inTRANSCRIPT
CII-INDICUS RELEASE OF
INDIA HEALTH REPORT
THURSDAY, 2ND SEPTEMBER 2010
Venue: Hotel The Lalit, Barakhamba Avenue, Connaught Place, New Delhi – 011
India Health Report-2010: A Perspective
Health as India’s ‘Double Burden’
→ Public Health / Curative Health
→ Poverty / Affluence
→ Newborn / Elderly
→ Rural / Urban
India Health Report 2010 by Indicus Analytics
Research Methodology
• Bringing together the data on current health issues from government and other highly respected sources
• Reviewing literature from medicine, health policy and health economic journals
India Health Report 2010 by Indicus Analytics
What lies inside?
The Case for Improving Health in India Access to Healthcare Emerging Issues in Health Inputs for Health Ethics and Side Payments Access to Medicines in India: Issues, Challenges and Policy
Options The Evolving Role of the Government: Regulations and
Programmes Health Financing in India Health Reform: A Historical Perspective and the Future
India Health Report 2010 by Indicus Analytics
The Case for Improving Health in India
Health status is an indicator of human well-beingHealth is a major factor influencing aggregate economic outcomesPoor health exposes households to financial risk, many case impoverishment.Improvements in health have significant impacts on the socio-economic welfare of the economy.
India Health Report 2010 by Indicus Analytics
Millennium Development Goals for India-2015
• Reduce Child Mortality by two-thirds • Improve Maternal Health – Reduce
maternal mortality ratio by three quarters• Combat HIV/ AIDS, Malaria, and other
diseases• Halve the proportion of the population
without sustainable access to safe drinking water and basic sanitation.
India Health Report 2010 by Indicus Analytics
Emerging Issues in Health
India has witnessed a significant rise in Non-Communicable Diseases in last two decades.
Ischematic Heart Diseases, Diabetes, Cancer, HIV/AIDS Mental and Physical Disability – Diseases and conditions need to be addressed with immediacy
India Health Report 2010 by Indicus Analytics
Access to Healthcare
Right combination of quality and price needs to be available for a service to be truly accessible and desirable.
Marginalized groups
reveal a much lower utilization of health services.
Poorest people are worst affected from lack of access of healthcare
0
5
10
15
1995-96 2004
Percentage of People Reporting Ailments
Richest 20 % (Urban) Poorest 20 % (Urban)
Richest 20 % (Rural) Poorest 20 % (Rural)
ST SC
India Health Report 2010 by Indicus Analytics
Access to Healthcare ..continued
Average Indian remains underserved by the present Healthcare system.
Physical proximity to facilities and the cost of the treatment are the important determinants of access.
Bulk of ailments occurring in the poorest quintiles are treated in private facilities.
‘Unqualified’ practitioners form the bulk of private practitioners in India, and are most prevalent in rural areas.
Public Health services are not always free. Often they are poorly equipped.
India Health Report 2010 by Indicus Analytics
Inputs for Health
• India suffers from serious shortages in Health manpower. Physician to Population ratio is 0.6 per 1000 persons in India vis-à-vis WHO bench mark of 1:1000
• Hospital bed density in India (0.7) lags miserably behind current world average of 26 (Beds per 1000 population)
• Only 28 percent of Indians have access to improved sanitation
• Nutrition has a direct impact on health. 36 and 39 percent of Children under 3 are underweight in Urban and Rural India
India Health Report 2010 by Indicus Analytics
Shortfall in Manpower in health sector
Vacancies in sanctioned posts for specialists
India Health Report 2010 by Indicus Analytics
Focus Areas for the Main Inputs for Health
• Creation, Training, Allocation, Motivation and Monitoring are five key focus areas for human Resources in Health
• Capacity building and improving the quality of existing healthcare services.
• Creation of sufficient infrastructure is must so that households in India have adequate access to water supply and sanitation
• Overall improvements in nutrition can be achieved if focus is on improving Poverty, Awareness campaigns.
• Overall a centralized entity is required to synchronize and coordinate various policies measures to improve overall health in India.
India Health Report 2010 by Indicus Analytics
State-wise Distribution of Private Hospitals and Beds (% to total; 2002)
India Health Report 2010 by Indicus Analytics
Access to Medicines in India
Drug spending: Inadequate and inefficient
Drug Price Control: Ineffective and Inadequate- Price controls must ensure all sections of society can afford medicines.
Barriers to expanding access to Medicines
India Health Report 2010 by Indicus Analytics
Accessing Medicines
Medicine Supply systems are unreliable Procurements and logistics presents a serious problem for the supply chain management of Medicines.Pharmaceuticals markets in IndiaRequires competition to ensure price controls happen in the case of essential drugs and medicines.Drug Product Patents The Indian Patent Regime must encourage Indian manufacturers to develop indigenous drugs to battle the growing burden of diseases.Drug spendingInadequate and inefficientDrug Price ControlIneffective and Inadequate- Price controls must ensure all sections of society can afford medicines
India Health Report 2010 by Indicus Analytics
Evolving Role of Government
• India needs a good regulatory structure governing healthcare provision so as to address the many gaps in regulatory oversight and implementation.
• The Health Ministry website lists 42 centrally-sponsored programmes and schemes for which expenditure was allocated.
• Mid-term appraisal of NRHM has found significant improvement in health indicators even in the short period that the Mission has been in operation.
India Health Report 2010 by Indicus Analytics
Government Programmes
NRHM is an integrated bottom-up approach towards the achievement of this objective
Removed the system of parallel schemes, missions and programmes.
Aims at generating systemic improvements with checks and balances, community involvement, and monitoring and planning.
The proposed NUHM is a significant step in the evolution of the government’s role in direct healthcare provision
As suggested by initial documents, it seeks to expand NRHM into urban areas.
Recognises the existence of the ‘diversity of the available facilities in the cities’ and therefore rightly points towards ‘flexible city specific models led by the urban local bodies’.
India Health Report 2010 by Indicus Analytics
Summarizing
India lags behind other countries in health indices Health outcomes considerably poor for those at lower strata Indians extremely vulnerable to financial risks India’s slow progress towards MDGs Public health care delivery mechanisms
insufficient in capacity and poor in quality and delivery
Private sector facing its own set of problems Key issues - Inadequate access, mixed quality of
health services and a generally inefficient use of resources
NRHM and NUHM – key government programmes Indian health care needs more focus and attention
of the policymakers India Health Report 2010 by Indicus Analytics
Authors of India Health Report
• Dr. Ajay Mahal is Associate Professor, Harvard School of Public Health
• Professor Bibek Debroy, Research Professor, Centre for Policy Research
• Dr. Laveesh Bhandari, Director, Indicus Analytics
• Dr. Veena Nabar, Ex-Chief Coordinator for the Government of India High Power Committee on Cooperatives
• Dr. Sumita Kale, Chief Economist, Indicus Analytics
• Dr. Devendra B Gupta, Senior Consultant, National Council of Applied Economic Research
• Dr. Sakthivel Selvaraj is a Health Economist and faculty member at the Public Health Foundation of India
India Health Report 2010 by Indicus Analytics
About Indicus
• Indicus Analytics is a specialized economics research firm
• Indicus among India's highly credible economic research organizations
• We assist business enterprises, industry associations, government and institutions in the development of policy scape serving strategic needs. Indicus Analytics specialises
in Econometric Modeling Monitoring & Evaluation Macro-economics Microeconomic Evaluations Policy Analysis
Thank you
Contact details
Indicus AnalyticsNehru House
2nd Floor, 4, Bahadur Shah Zafar Marg
New Delhi 110002www.indicus.net
India Health Report 2010 by Indicus Analytics