The doctor is in

Written by Sushila Ravindranath | Sushila Ravindranath | Updated: Jun 30 2009, 03:57am hrs
The relationship between health and the economy, though complex, is a well established one. According to studies conducted by the European Union, better health is a major contributor to economic growth. Good health increases earnings and labour supply. Unfortunately in low income countries like India, because of lack of resources, only lip service is paid to healthcare. To fill the gaping holes in government provided services, the private sector has rushed in. But a majority of Indias population finds it nearly impossible to afford private hospitals. Plus, per capita hospital beds in our country are among the lowest in the world.

According to Dr Pratap Reddy, chairman Apollo Hospital Group, With almost 2.5 million births per year, India needs an annual incremental addition to healthcare facilities equivalent to almost half of what a UK or a France or an Italy may need for their entire population. While India has made remarkable achievements in improving its health indices since Independence, we still lag behind other emerging economies like Brazil, Russia and China. We always compare ourselves with China. But China has 2.2 beds per thousand population and Russia as many as 9.7, while we are way behind at 0.7 compared to the global average of 2.6. We need to put up at least 100,000 beds a year. And investment for that is a huge amount. To reach developed country healthcare norms by 2027, India will require an astronomical trillion dollars.

The situation is particularly bad in rural areas where a major part of the population lives. It continues to suffer from diseases and ultimately death due to malnutrition, preventable communicable diseases and complications of pregnancy and childbirth. The country is also in the midst of a demographic transitionwith the decline in fertility rates and mortality leading to an ageing of the population and chronic disease burden. Non-communicable diseases such as cardiovascular diseases, cancer, blindness, mental illness and ill effects of tobacco use have imposed further pressure on the already over- stretched healthcare system in the country.

There is a large difference in the access to quality healthcare available in developed and less developed states of the country. The highest financial burden of ill health is on the vulnerable sections of the population, the poor, the women and the scheduled castes and tribes, especially those living in remote rural areas. The country therefore has to deal with multiple health crises, rising costs of healthcare and mounting expectations of the people.

Another major concern is that the Indian public spending on health is amongst the lowest in the world (less than 1% of GDP), whereas its proportion of private spending on health is one of the highest. Households in India spend about 5-6% of their consumption expenditure on health.

To bring about a dramatic improvement in the health system and the health status of people, especially those who live in rural areas, the National Rural Health Mission was launched in 2005. The Mission seeks to provide universal access to equitable, affordable and quality healthcare that is accountable as well as responsive to peoples needs, reduction of child and maternal deaths as well as population stabilisation, gender and demographic balance.

Although people in the sector know it and health officials in the country know it, the fact that Tamil Nadu has done especially well in implementing the mission is not much publicised. Comparisons of Tamil Nadu data with the rest of India, its progress compared to national goals, show that the southern state has moved much more forward than the others.

Tamil Nadu has done far better in bringing down maternal mortality rate (rate of death per 100,000 live births), infant mortality rate (rate of death per 1,000 children before they are one), and also total fertility rate. Tamil Nadu has the lowest population growth rate in the country, next only to Kerala. After the introduction of NRHM, health officials in the state have been working to improve healthcare at primary, secondary and tertiary levels. Now more and more women in Tamil Nadu are delivering their babies in the Primary Health Centres. The PHCs have been renovated and improved using the funds received from the NRHM. A medical team from every PHC visits the villages covered by them, tells the people about the facilities available and enrolls all the pregnant women. Mothers are brought to the centres on maternity picnics.

What the state has done is to build up healthcare plans from the village level to create district health action plans. The planning has been decentralised. Village health and sanitation committees have been set up. The focus has been on building trust in the community. There is a lot of flexibility in funding possible under the Mission. Inter facility transfer can take place between one centre and another. Funds, functions and functionaries are made available to local community organisations. NGOs are encouraged to come in as implementers.

Tamil Nadus health sector officials are committed and quite passionate about their work. They say that while the state has made significant progress in most of its indicators when compared to the rest of the country, there is still a lot of work to be done. What they want is to achieve the goal of health for all in the state in the foreseeable future.