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Health Care in India
The government of India and international organizations, like WHO, are attempting to improve healthcare in India to make it accessible for every section of its society. However, healthcare in India is far from reaching its goal of universal healthcare. The following are some of the hurdles that India faces.

Limited Healthcare Workforce

India’s population is around 1.3 billion, but it has a low number of medical and paramedical professionals. In fact, the density of doctors was 80 doctors per 100,000 of the population in 2001 and the number of nurses was 61 per 100,000. According to WHO recommendations, a physician to population ratio should be at least 1 to 1,000, whereas India’s physician population ratio is 1 to 1,674. India needs around 2.07 million more doctors to reach the goal of 1 to 1,000.

Despite the lack of medical professionals, the urban-rural disparity is also a major hurdle in healthcare in India. According to a WHO report, there were 1,225,381 health workers in urban areas in 2001 and 844,159 in rural areas. While 70 percent of India’s population resides in rural areas, access to healthcare is inefficient compared to urban areas. For example,84 percent of the 23,582 hospitals only hold 39 percent of the total of government beds.

To combat the limited number of healthcare professionals in India, the Indian Government has made a strategic investment in its healthcare. In 2005, it launched the National Rural Health Mission (NHM), which people know as the National Health Mission. The main purpose of this organization is to ensure quality and affordable healthcare for all. In addition to this, Nation Health Policy (NHP) 2017 focuses on the requirement of healthcare management in the country. This policy has implemented a new public health management cadre in all states.

Education and Medical Qualifications

A WHO report stated that India has to work on improving the education of its doctors. In fact, around 31.4 percent of allopathic doctors receive an education up to the secondary school level and even 57.3 percent did not have any medical qualifications. Meanwhile, only 67.1 percent of nurses and midwives had education up to the secondary level.

Lack of Awareness

Despite India’s fast economic development, people in the country often have low health awareness, low education status and poor functional literacy within the healthcare system. According to a report in the Indian Journal of Community Medicine, only one-third of the antenatal mothers in India have adequate knowledge of breastfeeding. It also stated that around 1 million newborn infants die every year because of umbilical cord infection which an optimal breastfeeding practice could avoid.

The Indian Government’s National Rural Health Mission intends to provide aid for neonatal and childhood illness through its existing healthcare delivery system. It has also created the Pradhan Mantri Matru Vandana Yojana and applied amendments to the Maternity Benefit Act, 1961. The amendment protects women’s employment as well as women’s and children’s well being during maternity. In 2016, the Indian Government started the Mothers Absolute Affection program, which is to promote, protect and support optimal breastfeeding across regions of the country.

Public and Private Healthcare

India’s interim budget only allocates 2.2 percent for healthcare. Despite several health reforms, the government is still not able to increase public health spending to 2.5 percent of its GDP. Right now, the current health expenditure in India is only 1.15-1.5 percent of its GDP.

The Indian healthcare system has two main branches. These branches are public and private. The federal and state government regulates the public healthcare systems, whereas medical professionals run private sectors independently. Public healthcare systems receive financing through taxes, while patient’s pay for private healthcare centers. Private healthcare facilities are generally available to people in urban areas. Public healthcare can offer people low cost or no-cost health services, but unfortunately, because of poor quality of services, public healthcare is not the first choice of India’s major population, even though most people from the lower socio-economic status uses this healthcare system. The private healthcare system has the latest technology, qualified doctors and other facilities, but private hospitals are out of reach of the general population who are below the poverty line.

The government is trying to fill the gap between public and private healthcare and has implemented the Rashtriya Swasthya Bima Yojna (RSBY) insurance plan to do this. The main purpose of this insurance plan is to provide low-cost insurance. According to the Indian Government’s data, around 44 percent of people from below the poverty line enrolled in RSBY from 2014 to 2015. Now the fund for this insurance scheme has increased from $4,000 to $14,000 per family. RSBY insurance could help impoverished people receive quality healthcare at a low cost. This subsidized healthcare policy would provide people a choice between public and private hospitals so they can receive quality treatment.

Fraudulence and Corruption

Fraudulence and corruption are big hurdles in healthcare in India. Corruption is common at both the higher and service delivery levels, undermining the accessibility, affordability and quality of healthcare. Some of the common problems at the service delivery level include absenteeism, informal payments from patients, embezzlement and theft, service provision, favoritism and manipulation of outcome data.

The nationwide average absentee rate for doctors and healthcare providers is around 40 percent. Meanwhile, in 2013, Oxfam reported that medical professionals performed many unnecessary hysterectomies on women. Additionally, there was a large conspiracy in healthcare construction in Orissa, India, where 54 of the 55 hospitals built in Orissa had construction problems. Moreover, according to The Guardian, “The Indian healthcare system is one of the most privatized and largely unregulated healthcare systems.” A report by Dr. Gadre found that large numbers of doctors give irrational drug prescriptions while hospital patients often receive pressure to pay for an unnecessary operation or procedure.

A limited workforce, lack of awareness, education and medical qualification of healthcare professionals, corruption and healthcare expenses are inhibiting the improvement of healthcare in India. However, the Indian Government has projected many programs and schemes to improve the healthcare condition of Indians. Organizations like WHO, UNICEF, the Bill and Melinda Gates Foundation are also providing aid. Through public contribution and the Indian Government’s efforts, India should eventually reach its goal of universal health coverage.

– Anuja Kumari


Photo: Flickr

Maternal Mortality in India
USAID and its partner organizations implemented the development impact Utkrisht bond in February 2018. Many believe this is an innovative and cost-effective solution to end preventable maternal and child deaths in India.

The Utkrisht bond is targeted to assist the State of Rajasthan, where 80,000 babies die annually from inadequate medical care. But proponents hope the model can be used throughout India, which accounts for 20 percent of maternal and child deaths globally.

The development impact bond was announced in November of 2017 by USAID Administrator Mark Green at the Global Entrepreneurship Summit in India. It is expected to provide 600,000 women with improved healthcare access and potentially save 10,000 moms and newborns.

The bond works as a public-private partnership. Investors grant providers of maternal care with upfront capital. Then, outcome funders pay back the investors their principal plus a return if pre-agreed metrics are achieved. The investor, in this case, is the UBS Optimus Foundation, which has committed about $3 million. The organization works with philanthropists to bring sustainable benefits to vulnerable children.

Up to 440 private health facilities will then be operated with assistance from Population Services International (PSI) and the Hindustan Latex Family Planning Promotion Trust (HLFPPT), which also are co-investors providing 20 percent of the required capital. PSI is a global health nonprofit and the HLFPPT is an Indian nonprofit that works with maternal care.

In order to maximize success, private facilities are the focus of the Utkrisht bond. They host more than 25 percent of institutional deliveries in Rajasthan and are used by women of all socioeconomic backgrounds, yet little has been done to improve their quality of care.

USAID and Merck for Mothers, a nonprofit with the goal to end maternal mortality, have each committed up to $4.5 million that will be paid if the heath facilities meet accreditation standards. This is a highly cost-effective method to save lives according to World Health Organization standards, which is particularly exciting to USAID.

“The pay for success approach ensures appropriate stewardship of U.S. taxpayer dollars, while unlocking both private capital and government resources for health,” USAID states.

While this is the first development impact bond targeted toward health, the future of the Utkrisht bond looks promising. If it is successful, more initiatives can be implemented that involve private-public cooperation and effective use of taxpayer money to save the lives of many women and children around the world.

– Sean Newhouse

Photo: Flickr

US-Backed Health Programs in India Reduce Risk of Disease
India has a population of approximately 1.3 billion, making it the second-highest populated country in the world. With the exception of the Himalayan foothills and deserts in the northwest, a majority of the country sustains a very high population density that straddles the country’s river valleys. Due to its population density and sanitation conditions, Indian citizens face a high risk of infectious disease with the most common being bacterial diarrhea, hepatitis A & E and typhoid fever.

Public Health Programs

Because of the risk and occurrence of infectious diseases, public health programs in India continue to work with the United States Agency for International Development (USAID) as well as many other U.S backed organizations to decrease the risk of a disease pandemic.

Historically, U.S. public health programs in India foster positive health outcomes. For instance, because of World Health Organization (WHO) and Center for Disease Control (CDC) treatments in the 1990s and early 2000s, India is now polio-free.

In the early and mid-2000s, CDC and USAID programs identified the monsoon seasonality of influenza and shifted their recommendations to vaccinate before India’s monsoons occur, greatly benefiting civilian populations. Between 2009-2015, U.S. backed public health programs in India even developed 65 HIV reference laboratories certified under the CDC training programs, therefore increasing the access to effective testing and treatment programs.

Emerging Pandemic Threats Program

More recently, the United States developed USAID’s Emerging Pandemic Threats Program (EPT), a global health initiative that works in countries that are most vulnerable to the outbreaks of pandemics. This branch of USAID launched in February 2014 and maintains a growing partnership with over 50 nations, international organizations and non-governmental stakeholders to ensure that the country reduces the risk of infectious disease threats.

EPT in India

The Emerging Pandemic Threats Program in India strengthens the subcontinent’s capacity to detect threats of infectious disease through an early intervention approach. USAID works alongside WHO to fight antimicrobial resistance (AMR), which is defined as virus and bacteria’s ability to become resistant to already known and utilized antibiotic treatments.

Antimicrobial Resistance

Antimicrobial resistance occurs due to natural genetic changes viruses and bacteria undergo when they are initially exposed to an antibiotic. AMR is complicating the fight against the spread of tuberculosis, HIV and malaria, by making some current treatments ineffective.

EPT programs in India combat AMR by conducting targeted surveillance of key wildlife and livestock species, as well as those who handle the animals to identify harmful bacterias and viruses and develop new treatments against them.

Also, EPT programs in India collaborate with WHO to identify unknown harmful viruses in nature and better understand its biological characteristics. Through early monitoring of viruses and bacterias, public health professionals can more quickly develop working vaccines as well as preventative community health preparations to lower risk factors in India’s vulnerable populations.

Public Health Programs in India

EPT programs in India also work closely with the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE), encouraging a multi-sectoral response system to food safety hazards and educating farmers and food preparers of sanitary food and livestock keeping practices.

While India’s population density makes public health efforts difficult to perfect, U.S. efforts, as well as United Nations efforts, are working hard to decrease the risk of infectious disease and limit pandemic potential within the country.

– Danny Levy

Photo: Flickr