By Dinesh C Sharma
New Delhi: The Indian health care scenario currently is a picture of contradictions. On the one hand, private health care industry is booming with prospects of India becoming a destination for medical tourism. And on the other, access to health care remains a distant dream for the poor in rural areas and medical expenses remain a major cause of rural indebtedness.
Rural health care in most Indian states is suffering due to absence of doctors and paramedical staff, low levels of skills among health workers, shortage of medicines and inadequate monitoring, points out a review released by the Planning Commission in December 2006. There is neither reward for service providers nor punishment for defaulters. The result is poor health outcomes. Infant mortality per 1000 live births in India is 60, compared to 19 in Vietnam and 12 in Sri Lanka. The Tenth Plan targets for maternal mortality and infant mortality have been missed due to slow progress in the past five years, the review notes. Access, affordability, efficiency, quality and effectiveness remain the bane of the public health system, despite progress made with new initiatives like the seven-year National Rural Health Mission.
The long-term solution is to enhance public investment in health and improve efficiencies, which the theme of this year's World Health Day. At present, government expenditure on health in India is less than 1 percent of the gross domestic product. The health policy announced in 2002 and subsequent policy prescriptions have all suggested increasing this to 2 to 3 percent of the gross domestic product. Besides increasing public investment in health, efficiency and quality of delivery need to be improved. For this, it has been suggested to link performance with incentives. The approach paper to the Eleventh Plan makes a radical suggestion in this regard - providers should be paid only if they actually perform a service or satisfy the patient or the village health committee, as the case may be.
Another suggestion is to involve private sector in healthcare delivery. For instance, there could be an entitlement system for pregnant women to have professionally supervised deliveries, and specific tasks such as immunization could be contracted out. The Eleventh Plan would also emphasis formulation of integrated health plans at district and block levels, with active participation of all health related sectors (such as drinking water, sanitation ) and voluntary bodies.
While dealing with the existing burden of communicable diseases, efforts need to be directed towards tackling emerging infections such as HIV and the threat of bird flu. The number of people with living with HIV/AIDS in India is estimated to be 5.206 million, the second largest in the world. Over the years, the virus has moved from urban to rural areas; from high risk groups to general population; and in all the states and union territories. The Working Group on Communicable and Non-communicable Diseases for the 11 th five year plan has mooted an outlay of Rupees 11,585 crore for the National AIDS Control Programme III. Nearly 67 percent of this is proposed to be spent on prevention. The overall objective would be to "halt and reverse the epidemic in India over the next five years by integrating programmes for prevention, care, support and treatment." The plan would recognise the feminine face of HIV and accord it the highest priority.
Dinesh Sharma writes on environment and health issues for international publications.