This report provides a broad direction for India’s health sector in the coming years. In doing so, it describes India’s achievements with regard to the three key goals of health policy—improved health status, financial risk protection, and equity. It does so by identifying some of the factors and the state of policy instruments that have facilitated these achievements in the areas of access, quality and efficiency. Hence, it looks at public health interventions, regulations, financing, and the organisation of healthcare. The role of both public and private institutions in the pro- vision of such services is studied in this overall context. The focus, therefore, is to analyse the status of health in India, and this is done by bringing together data and analyses from government documents, health economics and policy literature and a host of other sources. Organised in nine chapters, the report begins by making a case for investing in health as a sound economic decision. Ajay Mahal and Victoria Fan (Chapter 1) make the point that investing in health should be a priority, even when resources are otherwise limited, owing to the high returns from such investment. As such, they highlight the need to enhance protection against the financial risk inherent in an unhealthy population. They argue their case at four levels: (a) health is a major factor in influencing aggregate economic outcomes; (b) instances of ill health can expose entire households to financial risk and, in many cases, im poverishment; (c) health status itself is an indicator of human well-being; and (d) in a society undergoing great economic and social transition, such as India, improvements in health carry an added importance (and correspondingly constitute a greater challenge). As the mere provision of health infrastructure does not necessarily ensure universal accessibility, in Chapter 2, Laveesh Bhandari and Aali Sinha examine the multiple facets governing the access to, and utilisation of, health- care services: awareness levels; locational or financial constraints; efficiency of public and private healthcare providers; issues of quality and reliability of service and treatment; analysis of hospitalisation and out-of-pocket expenditure, etc. They conclude that despite heavy public intervention, the health burden carried by Indians con- tinues to be significant. They underline the importance of effectively addressing the constraining issues through effective systemic changes. In Chapter 3, Sumita Kale studies the new issues in disease management in India today, many of which are linked to growing prosperity in the country. One set of issues she examines is the rising incidence of diseases like ischemic heart, diabetes, cancer, HIV/AIDs, where health education and regular screening can play a significant preventive role. She also highlights the need to match society’s rising affluence with an environment where mental and physical disorders and disabilities are included in the mainstream discussion on health management. In Chapter 4, Laveesh Bhandari and Ankur Gupta discuss the status of the four major inputs fundamental to a good health profile in India: well-trained, adequate and well-motivated healthcare providers; a well spread and acces sible healthcare infrastructure; a good water supply and sanitation system which also facilitates hygienic prac- tices; and a population that is well supplied nutritionally and practices a hygienic lifestyle. Bhandari and Gupta highlight a single key problem underlying all these inputs: the lack of a public health focus. Seeing the multiplicity of government units involved in the various aspects of health administration, they recommend a centralised authority that is able to synchronise and coordinate various policy measures in line with the received evidence on improving health outcomes. Medical ethics encompasses a vast range of issues, and in

1. CII-INDICUS RELEASE OF INDIA HEALTH REPORT THURSDAY, 2ND SEPTEMBER 2010 Venue: Hotel The Lalit, Barakhamba Avenue, Connaught Place, New Delhi – 011

19. State-wise Distribution of Private Hospitals and Beds (% to total; 2002) India Health Report 2010 by Indicus Analytics