India's population in 2021 as per World Bank is 1.39 billion. Being the world's most populous country and one of its fastest-growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues.
The Urban Health Resource Centre (UHRC) is a non-government organization in India that works towards improved the health, nutrition, well-being and social organization among poor urban communities. Established in 2005 in New Delhi, UHRC works in Indore, Agra and Delhi.
India has a robust social security legislative framework governing social security, encompassing multiple labour laws and regulations. These laws govern various aspects of social security, particularly focusing on the welfare of the workforce. The primary objective of these measures is to foster sound industrial relations, cultivate a high-quality work environment, ensure legislative compliance, and mitigate risks such as accidents and health concerns. Moreover, social security initiatives aim to safeguard against social risks such as retirement, maternity, healthcare and unemployment while tax-funded social assistance aims to reduce inequalities and poverty. The Directive Principles of State Policy, enshrined in Part IV of the Indian Constitution reflects that India is a welfare state. Food security to all Indians are guaranteed under the National Food Security Act, 2013 where the government provides highly subsidised food grains or a food security allowance to economically vulnerable people. The system has since been universalised with the passing of The Code on Social Security, 2020. These cover most of the Indian population with social protection in various situations in their lives.
Community-based monitoring (CBM) is a form of public oversight, ideally driven by local information needs and community values, to increase the accountability and quality of social services such as health, development aid, or to contribute to the management of natural resources. Within the CBM framework, members of a community affected by a social program or environmental change track this change and its local impacts, and generate demands, suggestions, critiques and data that they then act on, including by feeding back to the organization implementing the program or managing the environmental change. For a Toolkit on Community-Based Monitoring methodology with a focus on community oversight of infrastructure projects, see www.communitymonitoring.org. For a library of resources relating to community-based monitoring of tropical forests, see forestcompass.org/how/resources.
An Accredited Social Health Activist (ASHA) is a community health worker employed by the Ministry of Health and Family Welfare (MoHFW) as a part of India's National Rural Health Mission (NRHM). The mission began in 2005; full implementation was targeted for 2012. The idea behind the Accredited Social Health Activist (ASHA) was to connect marginalized communities to the health care system. The target was to have an "ASHA in every village" in India. In July 2013, the number of ASHAs was reported to be 870,089. In 2018, this number became 939,978. The ideal number of ASHAs envisaged was 1,022,265.
The Government of India has initiated several National Missions in order to achieve individual goals that together ensure the wellbeing of its citizens.
Achieving Universal Health Care has been a key goal of the Indian Government since the Constitution was drafted. The Government has since launched several programs and policies to realize ‘Health for All’ in the nation. These measures are in line with the sustainable development goals set by the United Nations. Health disparities generated through the Hindu caste system have been a major roadblock in realizing these goals. The Dalit (untouchables) community occupies the lowest stratum of the Hindu caste system. Historically, they have performed menial jobs like - manual scavenging, skinning animal hide, and sanitation. The Indian constitution officially recognizes the Dalit community as ‘Scheduled Castes’ and bans caste-based discrimination of any form. However, caste and its far-reaching effects are still prominent in several domains including healthcare. Dalits and Adivasis have the lowest healthcare utilization and outcome percentage. Their living conditions and occupations put them at high risk for disease exposure. This, clubbed with discrimination from healthcare workers and lack of awareness makes them the most disadvantaged groups in society.
The Department of Health and Family Welfare is one of the departments of Government of Tamil Nadu and is responsible for ensuring access to basic public health services in the state.
Direct Benefit Transfer or DBT is an attempt to change the mechanism of transferring subsidies launched by Government of India on 1 January 2013. This scheme or program aims to establish a Giro system to transfer subsidies directly to the people through their linked bank accounts. It is hoped that crediting subsidies into bank accounts will reduce leakages, duplicity and delay and the new processes will increase transparency and accountability.
Pradhan Mantri Matru Vandana Yojana (PMMVY), previously known as the Indira Gandhi Matritva Sahyog Yojana, is a maternity benefit program run by the government of India. It was originally launched in 2010 and renamed in 2017. The scheme is implemented by the Ministry of Women and Child Development. It is a conditional cash transfer scheme for pregnant and lactating women of 19 years of age or above for the first live birth.
India has a multi-payer universal health care model that is paid for by a combination of public and government regulated private health insurances along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. Economic Survey 2022-23 highlighted that the Central and State Governments’ budgeted expenditure on the health sector reached 2.1% of GDP in FY23 and 2.2% in FY22, against 1.6% in FY21. India ranks 78th and has one of the lowest healthcare spending as a percent of GDP. It also ranks 77th on the list of countries by total health expenditure per capita.
Women's health in India can be examined in terms of multiple indicators, which vary by geography, socioeconomic standing and culture. To adequately improve the health of women in India multiple dimensions of wellbeing must be analysed in relation to global health averages and also in comparison to men in India. Health is an important factor that contributes to human wellbeing and economic growth.
Under Article 15(3), the Constitution of India allows for positive discrimination in favor of women. The article, under right to equality, states that: "Nothing in this article shall prevent the State from making any special provision for women and children." In addition, the Directive Principles of State Policy 39(A) states that: "The State shall, in particular, direct its policy towards securing that the citizens, men and women equally, have the right to an adequate means of livelihood."
Auxiliary nurse midwife or nurse hybrids commonly known as ANM, is a village-level female health worker in India who is known as the first contact person between the community and the health services. ANMs are regarded as the grass-roots workers in the health organisation pyramid. Their services are considered important to provide safe and effective care to village communities. The role may help communities achieve the targets of national health programmes.
The 102 Free Ambulance Service is an emergency medical transport service in India. It is also called National Ambulance Service (NAS). Under this service, all the ambulances are fitted with GPS system and other necessary medical equipment. This emergency transport service facilitates 24x7 free of cost service to pregnant women, newborn babies and their mothers as well under the Janani SurakshaYojana and Janani Shishu Suraksha Karyakram. The ambulance service provides first aid to the patient and transport them to the nearest Community Health Centre or Government hospitals. There are 10017 ambulances operating as 102 patient transport. In some states, 5484 empanelled vehicles are also used as 102 ambulances to transport pregnant women and children to nearest healthcare facility.
The Abiye Programme is a home-grown comprehensive health initiative formulated to tackle the challenges of maternal mortality and morbidity in Ondo State, Nigeria. It was initiated in 2009 by the Mimiko administration in response to the 2008 Nigeria Demographic Health Survey (NDHS) which put Ondo State as having the worst maternal and child health indices in the southwest of Nigeria. The Abiye programme was also intended to achieve the Millennium Development Goals 4 and 5 by 2015. It is a free health program for pregnant women, and young children up to age 5. The Abiye initiative aims at ensuring that maternal health care service delivery in Ondo state is accessible and efficient enough to effect a reduction in the rate of maternal and infant mortality The Abiye model has been recognized by the World Bank as a viable template for achieving the targets of the Millennium Development Goals on maternal health within the African continent Ondo State is the only state in Nigeria that met the MDG indicators of reducing maternal death in the country, surpassing the goal with a 75 percent reduction. By 2016, the Ondo State Government had reduced MMR by 84.9 per cent; from 745 per 100,000 live births in 2009 to 112 per 100,000 live births in 2016 through the Abiye Initiative. The programme is funded by the Ondo State government.
Biju Swasthya Kalyan Yojana is a universal health coverage scheme launched by Chief Minister of Odisha, Naveen Patnaik. The program extends coverage to approximately 70 lakh families, with the state government allocating a budget of 250 crore rupees. Services:
- Free health services are available in all state government health care facilities, starting from the subcenter level up to the district headquarter hospital level, with Swasthya Mitras deployed at help desk.
- Annual health coverage of Rs 5 lakhs per family and 7 lakhs per female members of the family.
The Twelfth Five Year plan for health services in India covering 2012-2017 was formulated based on the recommendation of a High Level Experts Group (HLEG) and other stakeholder consultations. The long-term objective of this strategy is to establish a system of Universal Health Coverage (UHC) in the country. Key points include:
- Substantial expansion and strengthening of public sector health care system, freeing the vulnerable population from dependence on high cost and often unreachable private sector health care system.
- Health sector expenditure by central government and state government, both plan and non-plan, will have to be substantially increased by the twelfth five-year plan. It was increased from 0.94 per cent of GDP in tenth plan to 1.04 per cent in eleventh plan. The provision of clean drinking water and sanitation as one of the principal factors in control of diseases is well established from the history of industrialized countries and it should have high priority in health related resource allocation. The expenditure on health should increased to 2.5 per cent of GDP by the end of Twelfth Five Year Plan.
- Financial and managerial system will be redesigned to ensure efficient utilization of available resources and achieve better health outcome. Coordinated delivery of services within and across sectors, delegation matched with accountability, fostering a spirit of innovation are some of the measures proposed.
- Increasing the cooperation between private and public sector health care providers to achieve health goals. This will include contracting in of services for gap filling, and various forms of effectively regulated and managed Public-Private Partnership, while also ensuring that there is no compromise in terms of standards of delivery and that the incentive structure does not undermine health care objectives.
- The present Rashtriya Swasthya Bima Yojana (RSBY) which provides cash less in-patient treatment through an insurance based system should be reformed to enable access to a continuum of comprehensive primary, secondary and tertiary care. In twelfth plan period entire Below Poverty Line (BPL) population will be covered through RSBY scheme. In planning health care structure for the future, it is desirable to move from a 'fee-for-service' mechanism, to address the issue of fragmentation of services that works to the detriment of preventive and primary care and also to reduce the scope of fraud and induced demand.
- In order to increase the availability of skilled human resources, a large expansion of medical schools, nursing colleges, and so on, is therefore necessary and public sector medical schools must play a major role in the process. Special effort will be made to expand medical education in states which are under-served. In addition, a massive effort will be made to recruit and train paramedical and community level health workers.
- The multiplicity of Central sector or Centrally Sponsored Schemes has constrained the flexibility of states to make need based plans or deploy their resources in the most efficient manner. The way forward is to focus on strengthening the pillars of the health system, so that it can prevent, detect and manage each of the unique challenges that different parts of the country face.
- A series of prescription drugs reforms, promotion of essential, generic medicine and making these universally available free of cost to all patients in public facilities as a part of the Essential Health Package will be a priority.
- Effective regulation in medical practice, public health, food and drugs is essential to safeguard people against risks and unethical practices. This is especially so given the information gaps in the health sector which make it difficult for individual to make reasoned choices.
- The health system in the Twelfth Plan will continue to have a mix of public and private service providers. The public sector health services need to be strengthened to deliver both public health related and clinical services. The public and private sectors also need to coordinate for the delivery of a continuum of care. A strong regulatory system would supervise the quality of services delivered. Standard treatment guidelines should form the basis of clinical care across public and private sectors, with the adequate monitoring by the regulatory bodies to improve the quality and control the cost of care,
Maternal mortality in India is the maternal death of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods. Different countries and cultures have different rates and causes for maternal death. Within India, there is a marked variation in healthcare access between regions and in socioeconomic factors, accordingly, there is also variation in maternal deaths for various states, regions, and demographics of women.
