“Sarvé bhavantu sukhinaḥ, sarvé santu nirāmayāḥ, Sarvé bhadrāṇi pashyantu, mā kashchid_duḥkha-bhāg-bhavét”. The meaning of this Sanskrit Sloka is “All should/must be happy, be healthy, see good; may no one have sorrow. Mahatma Gandhi also says, “It is health which is real wealth, and not pieces of gold and silver”. Without robust health nobody can do anything. WHO emphasized on “Health for all” in this 21st Century in Geneva Conference in 1998. Government of India also committed to the goal of ‘Health for All’. WHO defined “health” as "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity". There are strong linkages between population, health and development. India’s health challenges are not only huge in magnitude due to its large population but they are complex due to its diversity and the chronic poverty and inequality. There are extreme inter-state variations, caused by not only the cultural diversity but because -the states are at different stages of demographic transition, epidemiological transition and socio economic development. Along with the old problems like persistence of communicable diseases and high maternal mortality in some parts, there is an urgent need to address the emerging issues like the threat of non-communicable diseases, HIV (AIDS) and health problems of the growing aged population. Accelerating demographic transition is not only necessary for the population stabilization but it is closely related to health goals. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavorably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of health care. The obligation of the Government of India is to ensure the highest possible health status to its population and access to quality health care has been recognized by a number of its key policy documents. This paper attempts to study the over view of health care in India. Key words: Health Care, National Health Policy, Access, Affordability, Equity, Urban Vs Rural-------------

1. Bharat Jyoti Awardee & Ex - Member of
Board of Studies, Kakatiya University,
Warangal
Kakatiya Government (UG&PG) College
(NAAC “A” Grade), Kakatiya University,
Warangal (Telangana State). – 506 009

2.  “Sarvé bhavantu sukhinaḥ, sarvé santu nirāmayāḥ, Sarvé bhadrāṇi pashyantu, mā
kashchid_duḥkha-bhāg-bhavét”. The meaning of this Sanskrit Sloka is “All
should/must be happy, be healthy, see good; may no one have sorrow. Mahatma
Gandhi also says, “It is health which is real wealth, and not pieces of gold and silver”.
Without robust health nobody can do anything. WHO emphasized on “Health for all”
in this 21st Century in Geneva Conference in 1998. Government of India also
committed to the goal of ‘Health for All’. WHO defined “health” as "State of complete
physical, mental, and social well being, and not merely the absence of disease or
infirmity“.
 India today, is the world’s third largest economy in terms of its Gross National
Income (in PPP terms) , and emerging as one of the developed nations of the world.
Yet, there are wide gaps between demand and Supply i.e. more demand for health
care services from public side and less supply of the same from government side.
 The Constitution of India makes health as the responsibility of state governments,
rather than that of central government. The health situation in India has improved
significantly in the last few decades. The policy and programmatic interventions have
succeeded in reducing the burden of communicable diseases and achieved big
successes like elimination of polio from India.
 Most importantly, assuring universal health coverage will require the explicit
acknowledgment, by government and civil society, of health care as a public good on
par with education. Only a radical restructuring of the health-care system that
promotes health equity and eliminates impoverishment due to out-of-pocket
expenditures will assure health for all Indians.

3.  Continuing burden of infectious diseases
in health.
 Reproductive, child health and nutrition.
 Chronic diseases and injuries.
 Universal access to care and health
equity.
 Healthcare human resources.
 Health care finance.

4. Country Rank
France 1
Italy 2
San Marino 3
UK 18
Switzerland 20
Canada 30
USA 37
Sri Lanka 76
Bangladesh 88
India 112
Pakistan 122
China 144
Myanmar 190

5.  The draft National Health Policy, 2015 has proposed a target of
raising public health expenditure to 2.5 % from the present 1.2% of
GDP. It also notes that 40% of this would need to come from central
expenditure.
 The draft policy suggests making health a fundamental right similar
to education and denial of the same could be punishable.
 As per the draft document, government plans to rely mostly
on general taxation for financing health care expenditure.
 While there is intent to increase spend on health care, the draft
policy also stresses on the role of private sector. While the public
sector is to focus on preventive and secondary care services, the
document recommends contracting out services like ambulatory
care, imaging and diagnostics, tertiary care down to non-medical
services such as catering and laundry to the private sector.

6.  With focus on improving maternal
mortality rate.
 Controlling infectious diseases.
 Tackling the growing burden of
non-communicable diseases.
 Bringing down medical expenses
among other things.

7.  Maternal mortality currently accounts for 0.55% of all deaths and
4% of all female deaths in the 15 – 49 years age group.
 The policy statement also assures universal access to free drugs and
diagnostics in government-run hospitals. However, it proposes to
pose public health system as pre-paid services instead of social
service.
 The policy is a first step in achieving universal health coverage by
advocating health as a fundamental right.
 The current government spending on health care is a dismal 1.04%
of GDP one of the lowest in the world; this translates to Rs.957 per
capita in absolute terms. The draft policy has addressed this critical
issue by championing an increase in government spending to 2.5% of
GDP (Rs. 3, 800/-) per capita in the next five years.

8.  According to latest information, India will take at least 17 more
years before it can reach the World Health Organization’s (WHO)
recommended norm of one doctor per 1,000 people. As per the latest
data, India stands at 67th rank amongst around 133 developing
countries with regard to the number of doctors while in respect of
number of nurses, India is at 75th rank. According to the latest
Central Bureau of Health Intelligence’s survey, the number of beds
in the country is 540330 in 11614 Government hospitals.
 World Physicians Density: 14 per 10,000 population
 Number of Physicians in the world: 8,747,790
 India would need about four lakh more doctors by 2020 to maintain
the required ratio of one doctor per 1,000 people.
 Presently the nurse physician ratio in India is 1.5:1 as against
international norm of 3:1. Current annual training capacity for
nurses is 1.75 lakh. Number of registered nurses in the country is
1.70 lakh out of which around 4 lakh are active.

9.  In India 50% of all villagers have no access to healthcare providers.
 In India 38% are chronically starved
 In India 10% of all babies die before their first birthday.
 In India 50% of all babies are likely to be permanently stunted due to lack of proper
nutrition.
 In India 33% people have no access to toilets, while 50% defecate in the open.
 India spends 4.1 of GDP for health care while, US spend 17.9% of its gross domestic
product (GDP), or $8,362 per person.
 Cuba has some of the highest government health spending in the world – 91.5% of all
health spending. It has 67.23 doctors per 10,000 population, the highest of any major
country
 UK on nurses – it has 101 per 10,000 people, only behind countries like Norway and
Germany.
 Qatar has the lowest health spending in the world, 1.8% of GDP, followed by Burma
(Myanmar) and Pakistan at 2.2%.
 The WHO says Myanmar (Burma) government spends only $4 per person on
healthcare. Indian government spends (% of GDP) are lower than that of Nigeria.

10. Affordability to Health facilities in India:
 The utilization of public health facilities is only about 20% for outpatient
services and 45% for inpatient care.
 Poor people are forced to seek health care services from private sector by
paying higher user fee.
 Out of pocket expenditure on health at 80%.
Access to Health Services in India:
 India has 48 doctors per 100,000 persons which is fewer than in developed
nations
 Wide urban-rural gap in the availability of medical services: Inequity
 Poor facilities even in large Government institutions compared to corporate
hospitals (Lack of funds, poor management, political and bureaucratic
interference, lack of leadership in medical community).
Health Equity:
 Health equity is different from health equality, as it refers only to the absence
of disparities in controllable or remediable aspects of health.
 Health equity falls into two major categories: horizontal equity, the equal
treatment of individuals or groups in the same circumstances; and vertical
equity, the principle that individuals who are unequal should be treated
differently according to their level of need.

11.  National Urban Health Mission (2013) had some
success, but it does not address India’s biggest
healthcare concern. The rural regions have less access to
modern medical treatments and depend more on
traditional treatment such as Ayurveda, Homeopathy
andUnani.
 National Rural Health Mission was launched in 2005 to
improve the accessibility of health services in rural
regions areas.
 The rural population has significantly less financial
capital and relies heavily on government funded
medical facilities.
 There are large gaps between TFR and IMR in rural
and urban, which often used as indicators of the level
of health in a country.

12. Country Total % of
GDP spent on
healthcare
Private
Expenditure %
Per capita
spent on
healthcare (US
$)
Per capita
government
spends on
healthcare
(US$)
India 4.1 70.8 132 39
USA 17.9 46.9 8362 4437
UK 9.6 16.1 3480 2919
South Africa 8.9 55.9 935 412
China 5.1 46.4 379 203
Brazil 9 53 1028 483
Pakistan 2.2 61.5 59 23

13.  70 percent of the Indian population lives in rural areas while only two
percent qualified medical doctors are available in these areas.
 Indian health care today is urban-centric. It needs to be reformed
through growth of medical infrastructure and professionals. State-
sponsored or community health insurance plans provide coverage for
inpatient primary care. However, secondary/tertiary and outpatient
care is very underdeveloped and is need of improvement.
 The insurance payment structure is almost exclusively retroactive.
Beneficiaries need a plan which can cover medical costs up front
instead of paying out-of-pocket and waiting long periods of time to get
reimbursed.
 India has been limited to critical illness coverage for inpatient surgical
procedures and often one-time lump-sum payouts. The lack of clarity
in the government’s insurance and health care regulatory policies has
had a limiting effect on the growth of private health insurance in
India.

14.  Access: More public investment in health care access and financial protection
measures for the poor is the need of the hour. Reducing inequity to reach the poorest
and minimizing disparity on account of gender, poverty, caste, disability, other forms
of social exclusion and geographical barriers.
 Universality: Systems and services are to be designed to cater the entire population-
not only a targeted sub-group. Care to be taken to prevent exclusions on social or
economic grounds and health insurance should be strengthened.
 Patient Centered & Quality of Care: Health Care services would be effective, safe,
and convenient, provided with dignity and confidentiality with all facilities across all
sectors being assessed, certified and incentivized to maintain quality of care.
 Inclusive Partnerships: The task of providing health care for all cannot be undertaken
by Government alone. It would also require the participation of communities – who
view this participation as a means and a goal, as a right and as a duty. It would also
require the widest level of partnerships with academic institutions, not for profit
agencies and with the commercial private sector and health care industry to achieve
the goals.
 Pluralism: Patients who so choose and when appropriate, would have access to
AYUSH care providers based on validated local health traditions. These systems
should have Government support and supervision to meet the national health goals
and objectives.

15.  Subsidiary: For ensuring responsiveness and greater participation, increasing transfer
of decision making to a decentralized level as is consistent with practical
considerations and institutional capacity should be promoted. (Nothing should be
done by a larger and more complex organization which can be done as well by a
smaller and simpler organization).
 Accountability: Financial and performance accountability, transparency in decision
making, and elimination of corruption in health care systems, both in the public
systems and in the private health care industry, would be essential.
 Professionalism, Integrity and Ethics: Health workers and managers should perform
their work with the highest level of professionalism, integrity and trust and be
supported by a systems and regulatory environment.
 Learning and Adaptive System: Constantly improving dynamic organization of health
care which is knowledge and evidence based, reflective and learning from the
communities they serve, the experience of implementation itself, and from national
and international knowledge partners is essential.
 Improving population health status through concerted policy action in all sectors and
expand preventive, promotive, curative, palliative and rehabilitative services provided
by the public health sector.

16.  Achieving a significant reduction in out of pocket expenditure due to
health care costs and reduction in proportion of households experiencing
catastrophic health expenditures and consequent impoverishment.
 Assuring universal availability of free, comprehensive primary health
care services, as an entitlement, for all aspects of reproductive, maternal,
child and adolescent health and for the most prevalent communicable and
non-communicable diseases in the population.
 Enabling universal access to free essential drugs, diagnostics, emergency
ambulance services, and emergency medical and surgical care services in
public health facilities, so as to enhance the financial protection role of
public facilities for all sections of the population.
 Ensuring improved access and affordability of secondary and tertiary
care services through a combination of public hospitals and strategic
purchasing of services from the private health sector.
 Influencing the growth of the private health care industry and medical
technologies to ensure alignment with public health goals, and enable
contribution to make health care systems more effective, efficient,
rational, safe, affordable and ethical.

17.  Public expenditure:
Since about 50% of health expenditure goes into human resources for
health, an equitous growth of health and education sectors would also
lead to increased employment in many areas and communities, which
do not otherwise benefit from the economic growth rate, particularly
where jobless growth is a phenomenon. High public investment in
health care is one of the most efficient ways of ameliorating inequities,
and for this reason, this commitment to higher public expenditures is
essential.
 Ensuring Adequate Investment: The National Health Policy accepts and
endorses the understanding that a full achievement of the goals and
principles as defined would require an increased public health
expenditure to 4 to 5% of the GDP.
 Financing:
The major source of financing would remain general taxation. With the
projection of a promising economic growth, the fiscal capacity to
provide this level of financing should become available. The
Government would explore the creation of a health cess on the lines of
the education cess for raising the necessary resources.

18.  Corporate social responsibility has now been made mandatory- and
this avenue should be maximally leveraged. Though actual CSR
flows to health care may be modest in comparison to needs, these
could be leveraged for well-focused programmes, communities or
geographies with special levels of vulnerability which require special
attention.
 Governance: Federal Structure- Role of State and Role of Center:
One of the most important strengths and at the same time challenges
of governance in health is the distribution of responsibility and
accountability between the Center and the States. Though health is a
State subject, the Center has accountability to Parliament for central
funding – which is about 36% of all public health expenditure and in
some states over 50%. Further it has its obligations under a number
of international conventions and treaties that is a party to. Further,
disease control and family planning are in the concurrent list and
these could be defined widely. The way forward is for equity sensitive
resource allocation, strengthening institutional mechanisms for
consultative .

19. The health situation in India has improved significantly in
the last few decades. The policy and programmatic
interventions have succeeded in reducing the burden of
communicable diseases and achieved a big successes like
elimination of polio from India. Recent rapid economic
growth provides a unique opportunity to increase financial
commitments to support the public health system and
research. India can also draw from its booming technology
sector to innovate and strengthen the development of health
information systems, which has already begun.
Furthermore, an opportunity exists to harness the
capability of the domestic pharmaceutical industry by
encouraging it to take greater responsibility for delivering
equity in health care.