Country's health infrastructure of India has improved in last two decades but it is still in poor condition needing radical reforms to deal with emerging challenges of MDR Tuberculosis, HIV/AIDS and non communicable diseases . Infant mortality rate and maternal mortality rates are still high in some states needing corrective action. Accessibility and affordability with equity is still a cause for concern particularly in rural and urban slums. Cost of healthcare needs to brought down considerably so that poor and low middle income class can afford quality care.
During last two decades there has been paradigm shift in infrastructure and quality of healthcare in private sector in India .The role of private healthcare providers has been continuously increasing in healthcare sector. The out of pocket expenses for healthcare is increasing day by day which needs remedial measures. The government hospitals are facing the problem of lack of adequate beds, resources, infrastructure, medical supplies, manpower and finances.
In any country health care reform typically attempts to:-
Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies.
Expand the array of health care providers consumers may choose among.
Improve the access to health care specialists.
Improve the quality of health care.
Give more care to citizens.
To address the problems of healthcare in rural areas and even in urban areas, Ministry of Health & Family Welfare, Government of India on 12 April 2005 took a major welfare initiative by launching National Rural Health Mission (NRHM) in 18 states with weak public health indicators and infrastructure and extended it across the entire country.
The mission has a special focus on 18 states Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttarkhand and Uttar Pradesh.
Under the mission, health funding had increased from 27,700 crores in 2004-05 to 39,000 crores in 2005-06 (from 0.95% of GDP to 1.05%).
In 2004 the Central Government launched National Common Minimum Programme (NCMP) to ensure, through social security, health insurance and other schemes the welfare and well –being of all workers . However major healthcare reforms are needed to put the healthcare system on right track:-
- Road Traffic Accidents
There was an accident in every minute in 2011 in the country that claimed the lives of 1.42 lakh people, according to a government study. The number of accidents in the previous year was 4.97 lakh injuring 5.11 lakh people, according to a report released by Ministry of Road Transport and Highways. The 2011 numbers are, however, marginally lower than the 5.27 lakh accidents and 1.42 lakh deaths in 2010.
Many of the accident victims do not have any insurance cover and are subjected to financial burden to get the treatment. There is a need to evolve a mechanism or create a central fund to cater for such needy poor patients for their treatment and sustenance. .
- High infant mortality rate
Approximately 1.72 million children die each year before turning one.
42% of India's children below the age of three are malnourished, which is greater than the statistics of sub-Saharan African region of 28%.
- Disease Load
such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs. And in 2011, India developed a Totally drug-resistant form of tuberculosis. India is ranked 3rd among the countries with the most HIV-infected. Diarrheal diseases are the primary causes of early childhood mortality.
- Poor sanitation
As more than 122 million households have no toilets, and 33% lack access to latrines; over 50% of the population (638 million) defecates in the open. This is relatively higher than Bangladesh and Brazil (7%) and China (4%).
- Inadequate safe drinking water
only 26% of the slum population has access to safe drinking water]and 25% of the total population has drinking water on their premises.
- Cost of Healthcare
Out of pocket expending continues to be high and increasing persistently. Government can address this problem by PPP model. Private healthcare providers can be allotted land at 50% lower of market rate, reducing commercial rate of property tax, rates of electricity , water and levying all duties on essential drugs and equipments to minimum or granting full exemption.
- Infrastructure gaps remain high
Total bed density had increased to 1.3 per 1,000 by 2010 but remains significantly lower as per WHO guide line of 3.5 beds per 1000.
- Deficiency of Doctors & Nurses
The number of Medical Colleges and Nursing Colleges & Nursing Schools are inadequate for capacity building of Hospitals & Nursing Homes, District Hospitals, CHCs and PHCs . Though few measures have been initiated by Central Government by easing norms for establishing Medical Colleges, but it is considered to be inadequate. Rules need to be much more liberal so that it becomes easier to open Medical Colleges, Nursing Colleges & Paramedical Training Institutes and also cost of courses comes down.
Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare Government of India.