Indian government officials say the country’s public health infrastructure is sorely deficient, but they argue it is improving because of several initiatives underway.
They acknowledge the government has spent too little–around 1% of gross domestic product–on public health. But they say India will likely double that proportion to at least 2% in the five-year plan beginning in 2012.
“Now you will see more improvements,” said Anuradha Gupta, joint secretary of reproductive and child health at the National Rural Health Mission, a division of the Indian health ministry. But, she added in an interview: “There is still a very long road to cover.”
The poor state of public health, outlined in an exhaustive government report in 2005, led to the creation of the National Rural Health Mission, which is charged with improving healthcare in rural India, where the majority of the 1.2 billion people still reside. That health mission has spear-headed several grassroots programs to improve primary healthcare, and India’s high rates of maternal mortality and infant mortality have declined in recent years. Still, these rates remain far higher than many other emerging economies.
K. Srinath Reddy, head of the Public Health Foundation of India, a public-private partnership focusing on research and training, says India’s failure to develop a strong public health system has left it struggling with developing world problems—such as high rates of infant and child mortality as well as infectious diseases, such as malaria and tuberculosis.
On top of these developing world problems, India’s dilapidated public health infrastructure now faces the dual burden of chronic diseases that accompany more affluent lifestyles—diabetes and heart disease.
“This results in the dual burden being more acutely felt” in India, Dr. Reddy said. “The total neglect of public health has conspired to create this crisis in India’s health.”
P.K. Pradhan, managing director of the National Rural Health Mission, says in an interview that the agency has focused on improving primary healthcare by creating a new cadre of first-line medical officers, one for every 1,000 people, known as accredited social health activists. These part-time workers, chosen from the communities where they live, serve as the liaisons with the government’s public healthcare system.
But because healthcare in India is the primary responsibility of the states, Mr. Pradhan says his health mission’s job is limited to conceptualizing these types of programs and funding them. Implementation falls to the states.
Indeed, much of the burden for public health falls on states, and while some, such as Gujarat, have made strides, many others, such as Uttar Pradesh, in central India, are performing poorly.
A team of central government investigators who visited 11 districts in Uttar Pradesh in May found gross misuse of funds from Mr. Pradhan’s health mission by state and local authorities as well as “irregularities” in the way no-bid contracts were awarded for everything from hospital cleaning to drinking water supply, according to a summary of the investigators’ report reviewed by The Wall Street Journal.
According to the report, 620 of the 779 ambulances the state purchased were lying idle at a warehouse and more than 50% of government funds allocated between 2009 and 2011 had not yet been spent
Mr. Pradhan says misuse of funds was not widespread but limited to Uttar Pradesh, and that many states were doing a great job of implementing his health mission programs.
Among the programs he touted were a series of incentives offered to health activists in an effort to improve maternal and child health. The government gives these health activists 350 rupees, or about $8, for every mother brought into a hospital to deliver a baby, he says.
The health mission also offers cash incentives to the mothers themselves for delivering their babies in hospitals: 1,400 rupees, or about $32, for every child born in a hospital, Mr. Pradhan says.
Mr. Pradhan says the program has been so successful that 17 million women delivered their babies in hospitals in 2010, compared to just 750,000 in 2006.
Still, he and Ms. Gupta acknowledge that many women show up at these government hospitals to find them overcrowded, understaffed and lacking medicines and supplies. They say these problems would be solved in coming years as the government focuses more on funding infrastructure improvements and training doctors and nurses, who are in extreme short supply in India.
“The glass is half full. We still need to fill it up completely,” Ms. Gupta said.
Meanwhile, Mr. Pradhan says his health mission was adding incentives to draw even more mothers into hospitals. He says there were still nine million at-home births in 2010. During the next few months, he says, the government would begin offering mothers another 1,200 rupees, $27, to cover the cost of transportation to hospital.
Millions of Indians are still so poor that the cost of traveling to a hospital is an impediment to delivering a baby there.
India’s maternal death rate has improved, to 230 deaths per 100,000 births in 2008 from 280 in 2005, according to World Bank data. But its record is still worse than 116 other countries and far worse than China, which improved to 38 maternal deaths per 100,000 births from 44 during the same time period.
India has made some strides in reducing infant mortality but still lags behind many other emerging economies and poorer countries. Infant mortality in India fell to 50 per 1,000 babies in 2009 from 57 in 2005, according to World Bank data, but India’s rate is higher than China and Brazil, both of which lost 17 babies per 1,000 born in 2009. India also ranks behind some of its neighbors, including Bangladesh and Sri Lanka, the same data shows.
To improve India’s high rate of infant mortality, Mr. Pradhan says, his health mission is also giving health activists cash incentives of 250 rupees, or about $6, for every baby that doesn’t die in its first 28 days of life.
To improve critically ill babies’ chances of survival, Mr. Pradhan says, the mission has offered states financing for the construction of special newborn care units in district hospitals. So far, 243 units have been set up in district hospitals, equipped with incubators and ventilators, he says. By next year, he says he hopes all district hospitals in India will have such centers.
Because clean water and good sanitation are vital to improving public health, Mr. Pradhan says, his mission also offers cash incentives of 10,000 rupees, or $226, to local governing bodies–known as panchayats, for every village health and sanitation committee that gets started. Mr. Pradhan says 440,000 such committees have formed in recent years.
He acknowledges the government’s last comprehensive assessment of healthcare in India called for an increase in the proportion of government spending on healthcare to 2% from 1%, and that this has not happened in the intervening six years since the 2005 report was written.
But Mr. Pradhan says he has recommended that the government, in its next five-year plan that is currently being written for 2012-17, aim to increase the proportion of GDP spent on healthcare to 3%. He says he expects the government will at least reach 2%.
In the years ahead, his health mission will focus on improving district hospitals, which must be better equipped and staffed so sick babies aren’t rushed from there to city hospitals that are already overcrowded, he says. By the time premature and low-birth weight babies arrive at city hospitals that are equipped to save them, they are often too sick to save, he says.
“So what starts out as a low birth weight problem that can be solved ends up as a crisis with infections and malnutrition and the baby can’t be saved,” he said.
India’s ruling coalition, led by the Congress party, has been espousing “inclusive growth” and has adopted
“We have so many competing social priorities that have required enormous expenditure,” Ms. Gupta said. The government had spent millions of dollars on initiatives to improve education and rural employment. It also plans to massively increase food subsidies.
“Given the vastness of the country, improvement takes time,” said Mr. Pradhan. “But things are improving.”
As reported in: http://blogs.wsj.com/indiarealtime/2011/07/30/indias-public-health-crisis-the-government-responds/
They acknowledge the government has spent too little–around 1% of gross domestic product–on public health. But they say India will likely double that proportion to at least 2% in the five-year plan beginning in 2012.
“Now you will see more improvements,” said Anuradha Gupta, joint secretary of reproductive and child health at the National Rural Health Mission, a division of the Indian health ministry. But, she added in an interview: “There is still a very long road to cover.”
The poor state of public health, outlined in an exhaustive government report in 2005, led to the creation of the National Rural Health Mission, which is charged with improving healthcare in rural India, where the majority of the 1.2 billion people still reside. That health mission has spear-headed several grassroots programs to improve primary healthcare, and India’s high rates of maternal mortality and infant mortality have declined in recent years. Still, these rates remain far higher than many other emerging economies.
K. Srinath Reddy, head of the Public Health Foundation of India, a public-private partnership focusing on research and training, says India’s failure to develop a strong public health system has left it struggling with developing world problems—such as high rates of infant and child mortality as well as infectious diseases, such as malaria and tuberculosis.
On top of these developing world problems, India’s dilapidated public health infrastructure now faces the dual burden of chronic diseases that accompany more affluent lifestyles—diabetes and heart disease.
“This results in the dual burden being more acutely felt” in India, Dr. Reddy said. “The total neglect of public health has conspired to create this crisis in India’s health.”
P.K. Pradhan, managing director of the National Rural Health Mission, says in an interview that the agency has focused on improving primary healthcare by creating a new cadre of first-line medical officers, one for every 1,000 people, known as accredited social health activists. These part-time workers, chosen from the communities where they live, serve as the liaisons with the government’s public healthcare system.
But because healthcare in India is the primary responsibility of the states, Mr. Pradhan says his health mission’s job is limited to conceptualizing these types of programs and funding them. Implementation falls to the states.
Indeed, much of the burden for public health falls on states, and while some, such as Gujarat, have made strides, many others, such as Uttar Pradesh, in central India, are performing poorly.
A team of central government investigators who visited 11 districts in Uttar Pradesh in May found gross misuse of funds from Mr. Pradhan’s health mission by state and local authorities as well as “irregularities” in the way no-bid contracts were awarded for everything from hospital cleaning to drinking water supply, according to a summary of the investigators’ report reviewed by The Wall Street Journal.
According to the report, 620 of the 779 ambulances the state purchased were lying idle at a warehouse and more than 50% of government funds allocated between 2009 and 2011 had not yet been spent
Mr. Pradhan says misuse of funds was not widespread but limited to Uttar Pradesh, and that many states were doing a great job of implementing his health mission programs.
Among the programs he touted were a series of incentives offered to health activists in an effort to improve maternal and child health. The government gives these health activists 350 rupees, or about $8, for every mother brought into a hospital to deliver a baby, he says.
The health mission also offers cash incentives to the mothers themselves for delivering their babies in hospitals: 1,400 rupees, or about $32, for every child born in a hospital, Mr. Pradhan says.
Mr. Pradhan says the program has been so successful that 17 million women delivered their babies in hospitals in 2010, compared to just 750,000 in 2006.
Still, he and Ms. Gupta acknowledge that many women show up at these government hospitals to find them overcrowded, understaffed and lacking medicines and supplies. They say these problems would be solved in coming years as the government focuses more on funding infrastructure improvements and training doctors and nurses, who are in extreme short supply in India.
“The glass is half full. We still need to fill it up completely,” Ms. Gupta said.
Meanwhile, Mr. Pradhan says his health mission was adding incentives to draw even more mothers into hospitals. He says there were still nine million at-home births in 2010. During the next few months, he says, the government would begin offering mothers another 1,200 rupees, $27, to cover the cost of transportation to hospital.
Millions of Indians are still so poor that the cost of traveling to a hospital is an impediment to delivering a baby there.
India’s maternal death rate has improved, to 230 deaths per 100,000 births in 2008 from 280 in 2005, according to World Bank data. But its record is still worse than 116 other countries and far worse than China, which improved to 38 maternal deaths per 100,000 births from 44 during the same time period.
India has made some strides in reducing infant mortality but still lags behind many other emerging economies and poorer countries. Infant mortality in India fell to 50 per 1,000 babies in 2009 from 57 in 2005, according to World Bank data, but India’s rate is higher than China and Brazil, both of which lost 17 babies per 1,000 born in 2009. India also ranks behind some of its neighbors, including Bangladesh and Sri Lanka, the same data shows.
To improve India’s high rate of infant mortality, Mr. Pradhan says, his health mission is also giving health activists cash incentives of 250 rupees, or about $6, for every baby that doesn’t die in its first 28 days of life.
To improve critically ill babies’ chances of survival, Mr. Pradhan says, the mission has offered states financing for the construction of special newborn care units in district hospitals. So far, 243 units have been set up in district hospitals, equipped with incubators and ventilators, he says. By next year, he says he hopes all district hospitals in India will have such centers.
Because clean water and good sanitation are vital to improving public health, Mr. Pradhan says, his mission also offers cash incentives of 10,000 rupees, or $226, to local governing bodies–known as panchayats, for every village health and sanitation committee that gets started. Mr. Pradhan says 440,000 such committees have formed in recent years.
He acknowledges the government’s last comprehensive assessment of healthcare in India called for an increase in the proportion of government spending on healthcare to 2% from 1%, and that this has not happened in the intervening six years since the 2005 report was written.
But Mr. Pradhan says he has recommended that the government, in its next five-year plan that is currently being written for 2012-17, aim to increase the proportion of GDP spent on healthcare to 3%. He says he expects the government will at least reach 2%.
In the years ahead, his health mission will focus on improving district hospitals, which must be better equipped and staffed so sick babies aren’t rushed from there to city hospitals that are already overcrowded, he says. By the time premature and low-birth weight babies arrive at city hospitals that are equipped to save them, they are often too sick to save, he says.
“So what starts out as a low birth weight problem that can be solved ends up as a crisis with infections and malnutrition and the baby can’t be saved,” he said.
India’s ruling coalition, led by the Congress party, has been espousing “inclusive growth” and has adopted
several major social programs to try to improve life in rural India. But other social programs have taken priority.
“We have so many competing social priorities that have required enormous expenditure,” Ms. Gupta said. The government had spent millions of dollars on initiatives to improve education and rural employment. It also plans to massively increase food subsidies.
“Given the vastness of the country, improvement takes time,” said Mr. Pradhan. “But things are improving.”
As reported in: http://blogs.wsj.com/indiarealtime/2011/07/30/indias-public-health-crisis-the-government-responds/