Categorization of states performance wise-

The decline in the overall Health Index score for five EAG States (Bihar, Uttar Pradesh, Uttarakhand, Madhya Pradesh, and Odisha) between the Base Year and Reference Year is attributed to the deterioration of performance in several indicators.

Kerala, despite the decrease in overall Health Index score, maintained its ranking as the top performing among the Larger States. However, Tamil Nadu dropped from third position to ninth position, while Punjab dropped from second position to the fifth. The decline in the overall Health Index score in Tamil Nadu and Punjab is largely attributed to the decline in several health outcome indicators.

Among the Smaller States, Mizoram ranked first in overall performance; while Tripura and Manipur were top two States in terms of incremental performance

• Among the UTs, Chandigarh ranked first in overall performance, while Dadra and Nagar Haveli improved the most
• Three UTs registered decline in their overall Health Index scores: Lakshadweep, Andaman and Nicobar Islands, and Delhi

There was a general positive correlation between the Health Index scores and the economic development levels of States and UTs as measured by per capita Net State Domestic Product (NSDP)

• The Health Index is a useful tool to measure and compare the overall performance and incremental performance across States and UTs over time.
• The Health Index is an important instrument in understanding the variations and complexity of the nation’s performance in health.
• The first round of Health Index had triggered many useful discussions, including how best to measure health performance, how to strengthen the data collection system, how to identify barriers and motivate actions using data, and how to promote positive competition and learning among the States and UTs.

Indian Health Sector Problems – Can the National Health Policy 2017 make a change?

The health sector in India faces numerous problems. With the new national health policy, the government aims to achieve better and inclusive health standards for all. But can the National Health Policy 2017 really make a change? This article is an analysis of the problems of health sector, solutions and new initiatives.

Indian Health Sector Data: Budget spending and Insurance Levels-

• The public expenditure on health sector remains a dismal show of only around 1.4% of the GDP.
• The investment in health research has been low with a modest rate of 1% of the total public health expenditure.
• Insurance coverage remains low as per the latest NSSO reports over 80% of India’s population remains uncovered by any health insurance scheme.
• Under the center run Rashtriya Swyasthya Bima Abhiyaan, only 13% of the rural and 12% of the urban population had access to insurance cover.
• There has been a stark rise in the out-of-pocket expenditure (6.9% in rural areas and 5.5% in urban areas – OOP in proportion to monthly expenditure). This led to an increasing number of households facing catastrophic expenditures due to health costs.

Indian Health Sector Data: IMR, MMR, Hunger, Non-Communicable diseases, and Mental Diseases-

• India missed by close margins in achieving the millennium development goals of maternal mortality (India – 167, MDG – 139) and under 5 child mortality rate (India 49, MDG – 42). The rate of decrements in stillbirths and neonatal death cases has been slow.
• Nutrition status has been dismal and is one of the causes of child mortality and morbidity. As per the global hunger index (by IFPRI), India ranks 78th among 118 developing countries (with 15% of our population being undernourished; about 15% under-5 children who are ‘wasted’ while the share of children who are `stunted’ is a staggering 39% and the under-5 mortality rate is 4.8% in India.)
• While communicable diseases contribute 28% of the entire disease burden, non-communicable diseases (60%) show ample rise and injuries at (12%) now constitute the bulk of the country’s disease burden.
• India ironically has to cater two extreme healthcare situations. They are (1) one arising out of exclusions (out of poverty or lack of proper healthcare facilities) (2) while the other as lifestyle diseases like diabetes and cardiac related problems.
• There has been a steady rise in mental illnesses in the country. According to a recent publication, one in every four women and 10% men suffer from depression in India.
• At the same time progress has been marked in the field of communicable diseases as such. Polio has been eradicated, leprosy has been curtailed and HIV – AIDS cases have met the MDG target of being reduced by half in number.

Indian Health Sector Data-

• Health workforce density in India remains low.
• India’s ratio of 7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the WHO average of 2.5 doctors and nurses per 1,000 people.
• The majority of the health workforce is concentrated in urban areas.
• Furthermore, there is an acute shortage of paramedical and administrative professionals too.

The National Health Policy 2017

The main objectives of the National Health Policy 2017 are as following-

• To achieve Universal Health Coverage by assuring the availability of free, comprehensive primary health care services, ensuring improved access and affordability, of quality secondary and tertiary care, achieving a significant reduction in out of pocket expenditure due to health care costs.
• To make a predictable, efficient, patient-centric, affordable and effective health care system.
• Bringing in healthy and vital private sector contribution

Bring a policy thrust by –

1. By increasing public investment (raise it to 5% of the GDP).
2. To coordinate various non-health departments to improve the environment for health (by linking areas like – Swatch Bharath, balanced diet, reduced stress at workplace, Yatri Suraksha etc).
3. Incorporating health education as part of the curriculum, promoting hygiene and safe health practices within the school environs and by acting as a site of primary health care and also promoting healthy practices via AYUSH and Yoga at workplaces and schools
4. Organizing public health care delivery

To enhance National health programs-

• Utilizing the potential of AYUSH and mainstreaming it.
• Improving women health and addressing gender violence. Initiatives like Janani Suraksha Yojana, new norms of addressing domestic violence; family planning program etc. can go a long way.
• Enhancing tertiary care services – via specialized consultative and intensive care facilities, tertiary services via advanced medical colleges and health institutes.

Improving the healthcare personals by-

• Providing better health education
• Incentivizing doctors for rural services
• Enhancing nursing and other paramedical services
• Developing and encouraging ASHA volunteers.

Collaborating with non-governmental organizations and private sector to –

• Train, encourage skill development programs
• Utilize and direct corporate social responsibility into health investments
• Encourage the personnel training in mental health care and disaster management etc.
• Establishing a strong regulatory framework to include regulation of clinical establishments, professional and technical education, food safety, medical technologies, medical products, clinical trials, research and implementation of other health-related laws
• Involving and providing more role to local self-governments, bringing in decentralization and enhancing accountability of government institutions to ensure effective efficient delivery of services

Improve health system performance-

• Increase utilization of public health facilities by 50% from current levels by 2025.
• More than 90% of the newborn are fully immunized by one year of age by 2025
• The relative reduction in the prevalence of current tobacco use by 15% by 2020 and 30% by 2025
• Reduction of 40% in the prevalence of stunting of under-five children by 2025
• Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission)
• Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020

Enhance health status and program impact-

• Increase health expenditure by Government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025
• Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020.
• Establish primary and secondary care facility as per norms in high priority districts (population as well as time to reach norms) by 2025.
• Ensure district-level electronic database of information on health system components by 2020.
• Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020

Major national programs in this sector-

National Health Mission

    This mission is targeting universal health care, to achieve IMR, MMR, TFR targets, family welfare and infrastructure maintenance etc.

The major components of the program are-

• RMNCH+A services – which stands for reproductive, maternal, newborn, child and adolescent health care. Programs like Janani Suraksha Yojana, the program for adolescents like addressing the problem of anaemia among adolescent girls and boys etc.
• Communicable Diseases: The National Health Policy 2017 recognizes the interrelationship between communicable disease control programs and public health system strengthening. Different programs like National Aids Control Program, National Leprosy Eradication Program, Revised Tuberculosis Control Program, National Vector Borne Disease Control Program.
• Non-Communicable Diseases: The National Health Policy 2017 recognizes the need to halt and reverse the growing incidence of chronic diseases. Different programs through the involvement of AYUSH are taking forth to address these situations, for instance, Mission Madhumeha through Ayurveda is an example of efforts to address the issue of diabetes among people.
• Health system improvement at rural and urban level
• Universal Immunization Programme– to provide life-saving vaccines to all children across the country free of cost to protect them against Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis, Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhea. via Mission Indra Dhanush
• Mental Health: via new mental health policy

Other global initiatives in health involving India-

International Vaccine Institute (IVI)-

• India has taken full membership of International Vaccine Institute.
• Initially a UNDP initiative, IVI began formal operations as an independent international organization, in Seoul, South Korea.
• It is devoted to developing and introducing new and improved vaccines to protect people, especially children, against deadly infectious diseases.
• The Institute has a unique mandate to work exclusively on vaccine development and introduction specifically for people in developing countries, with a focus on neglected diseases affecting these regions
• India has to contribute $50,000 annually to the institute.

The Global Promotion of the Traditional System of Medicines-

• Ministry of AYUSH, Government of India and the World Health Organization (WHO) have signed a historic Project Collaboration Agreement (PCA) for the same.
• PCA is titled as ‘Co-operation on promoting the quality, safety, and effectiveness of service provision in traditional and complementary medicine between WHO and AYUSH, India, 2016-2020’.
• It will help building and strengthening national capacities.

The Network to Improve quality of Care for Mothers, Newborns, and Children-

• India is among nine countries that will be part of a global health network focused on improving the quality of care for new mothers and babies and strengthen national efforts to end preventable deaths of pregnant women and newborns by 2030.
• The nine countries are India, Bangladesh, A Cote d’Ivoire, Ethiopia, Ghana, Malawi, Nigeria, Tanzania, and Uganda.
• The new ‘Network for Improving Quality of Care for Maternal, Newborn and Child Health’ is supported by World Health Organization (WHO), UN International Children’s Fund (UNICEF) and other partners.

India and SDG goal 3 commitment -

• India’s National Health Mission is making striding efforts in ensuring the goal of good health and well-being of the sustainable development goal.
• We have strengthened the implementation of WHO framework convention on tobacco control
• To enhance the research and development of medicines for communicable and non-communicable diseases, provide access to essential medicines and vaccines in accordance with the Doha Declaration on TRIPS agreement and public health regarding flexibility to protect public health.
• We are aiming to increase our spending in this field and also strengthen institutions to target the achievement of the goal.

Conclusion-

• Health plays a vital role in ensuring the rights of people and in facilitating social justice. A healthy and strong India can reap the best from the future world.
• Developments in health sector enhance the human resource and also open avenues for revenue and employment generation.