Thursday November 23, 2017

Indian healthcare needs urgent reforms: The Lancet

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London: Indian healthcare system needs urgent reforms across several key challenges if the country is to achieve the government’s vision of assuring health for all, says a paper in The Lancet.

The paper, authored by professor Vikram Patel from London School of Hygiene & Tropical Medicine and colleagues, has documented India’s progress on major health indicators in the past decade but also its many deficiencies.

Key health indicators for Indian states

“The health time-bomb ticks on due to the rising burden of non-communicable diseases. There are widespread inequities in health outcomes that are apparent in the large morbidity and mortality differentials across socio-economic status, caste, class, sex, and geographic location,” Patel said.

The most disturbing indicator of the deficiencies of the Indian healthcare system is the observation that health care costs are driving millions into poverty.

The authors argue not only for more resources but for an integrated national healthcare system, built around a strong public primary care system with a clearly defined supportive role for the private and indigenous sectors.

The system should address acute as well as chronic health care needs and should be cashless at the point of service delivery, the authors said.

According to the paper, India continues to lag behind regional neighbours especially on health indicators like mortality rates for children aged under five years, with India recording 27 percent of all neonatal deaths and 21 percent of all child deaths in the world.

The paper calls for strengthening the country’s weak primary health system.

“Second is the challenge of skilled human resources, where an overall shortage was further compounded by inequitable distribution of skilled workers,” the paper said.

“Also, India needs to better harness and regulate its large private sector” in 2014, more than 70 percent of outpatient care and 60 percent of inpatient care was provided in the private sector.

“However, lack of regulation has led to corruption across the sector, with consequent poor quality of care and impoverishment of patients,” it added.

According to the authors, dismally low public spending on health has crippled the public sector and created large barriers in quality and access.

Gaps in the availability of health professionals in India

The total expenditure on health in India fell from 4.5 percent of gross domestic product (GDP) in 2004-05 to 4.0 percent of GDP in 2013-14.

Real expenditure and government expenditure on health per head from 2004 to 2014

With India spending as little 0.1 percent of its GDP on publicly funded drugs, close to two-thirds of the total out-of-pocket expenditure on health was incurred on drugs, often used irrationally.

Out-of-pocket expenditures on health per episode of inpatient and outpatient care in India

“Only a radical restructuring of India’s healthcare system will assure healthcare for all Indians,” Patel said.(IANS)

(Picture courtesy: www.thelancet.com)

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Infant Mortality Rate declined in 2016, shows Health Ministry data

The Sample Registration System showed a significant 8% decline in country's IMR, despite the death of infants being more in rural areas

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Infant Mortality Rate in India
Infant Mortality Rate declines in India. Pixabay
  • The Infant Mortality Rate in India has declined from 37 per 1000 live births in 2015 to 34 per 1000 live births in 2016
  • The Sample Registration System showed a significant 8% decline in country’s IMR
  • According to the SRS Bulletin there has been a steady decline in the gender gap in India for child survival

New Delhi, October 2, 2017: The Infant Mortality Rate, IMR in India has declined by three points, from 37 per 1000 live births in 2015 to 34 per 1000 live births in 2016, according to the latest Ministry of Health and Family welfare’s data released on Friday.

This is indeed a progress looking at the two points decline last year. The 2019 target of IMR 28 per 1000 births, however, is still a long way to go.

The Sample Registration System showed a significant 8% decline in country’s IMR, despite the death of infants being more in rural areas. India has also recorded a remarkable drop in birth cohort, which has come down to below 25 million for the first time, according to the system.

I90000 fewer infant deaths were registered by India in 2016 as compared to 2015. The total estimated drop in the number of infant deaths have come down from 930000 (9.3 Lakhs) in 2015 to 840000 (8.4 lakhs) in 2016, mentions the Hans India report.

According to the SRS Bulletin there has been a steady decline in the gender gap in India for child survival. There has been reduction in the gender difference between female and male IMR.

“We are meeting our targets faster than the global targets, which means our efforts are showing results,” Union health minister JP Nadda had said during a post Cabinet briefing recently, according to the Hindustan Times report.

Also readSafe Rest Practices for Infants made Readily Available to New Parents through Emails and Texts!

“The results signify that the strategic approach of the ministry has started yielding dividends and the efforts of focusing on low performing states is paying off,” stated a health ministry statement.

“The countrywide efforts to increase the health service coverage through various initiatives, including strengthening of service delivery and drugs and diagnostics have worked well,” it further said.

All the states except Uttarakhand, among the Empowered Action Group (EAG) States and Assam have reported decline in IMR in comparison to 2015.

The report suggests this decline as of 4 points in Bihar, 3 in Assam, Jharkhand, Uttar Pradesh, Madhya Pradesh, and decline of two points in Chhattisgarh, Rajasthan and Odisha.

-prepared by Samiksha Goel of NewsGram. Twitter @goel_samiksha

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Why More than 580 Million People in India Have Poor Healthcare?

The maternal mortality ratio -- deaths of mothers per 100,000 births -- in these states is 32 per cent higher (244) than the national average (167)

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Healthcare
Healthcare in India. Pixabay
  • India’s average spending on health, as a proportion of GDP, is already the lowest among BRICS nations
  • It accounts for 70 percent of the country’s infant deaths, 75 percent of under-five deaths and 62 per cent of maternal deaths

July 07, 2017: Nine of India’s poorest states — home to 581 million or 48 percent of the population — account for 70 percent of the country’s infant deaths, 75 percent of under-five deaths and 62 per cent of maternal deaths, but do not spend even the money they have set aside for healthcare, according to an IndiaSpend analysis of 2017 Reserve Bank of India data on state budgets.

The data also reveal:

— The maternal mortality ratio — deaths of mothers per 100,000 births — in these states is 32 percent higher (244) than the national average (167).

— 38 per cent and 40 per cent children in these states are underweight (low weight-for-age) and stunted (low height-for-age), respectively, higher than the national average of 36 per cent and 38 per cent, respectively, according to 2015-16 national health data, the latest available.

— Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan — with 372 million people, more than the combined populations of US, Australia, Sweden, and Greece –together contribute to about 58 percent of all child deaths in India.

The nine poorest large states — in official jargon called “high-focus”, a term that implies they need special attention — spent an average of 4.7 percent of their social sector expenditure on public health care and family welfare annually, marginally less than the national average of 4.8 percent. Social sector expenditure includes water supply and sanitation, housing and urban development.

India’s average spending on health, as a proportion of GDP, is already the lowest among BRICS nations.

The “high-focus” states are Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand, Uttar Pradesh and Assam.

“In 2005, it was observed by (the) Government of India that some states were performing poorly in various indicators,” Avani Kapur, Senior Researcher, Accountability Initiative, an advocacy, told IndiaSpend. “So, these states were clubbed together as high-focus states and additional resources were given to improve those indicators.”

ALSO READ: “Dual-Disease Burden”? India’s Great Healthcare Challenge and Opportunity 

Of the nine poorest states, Rajasthan spent the highest (5.6 percent) and Bihar the lowest (3.8 percent) proportion of aggregate expenditure on public health care and family welfare, according to the RBI data on 2014-15 actual spending, lower than the budgeted 4.1 percent for Bihar and 6.6 per cent for Rajasthan.

Seven of the nine “high-focus” states report such underspending.

“High focus states allocate large amounts to social sector to improve their indicators but in reality, they spend only a small amount, compared to what is allotted,” Kapur said. “Hence, it is necessary to consider actual accounts in order to know the proper outcomes.”

So, while some “high-focus” states spent less money than set aside by their budgets, other states outspent — by proportion as ratio to aggregate expenditure — other larger states on healthcare and family welfare, but that had no relation to their healthcare indicators.

For instance, Rajasthan (68.6 million people) reported an MMR of 244 deaths per 100,000 births in 2011-13, the second lowest in India and worse off than Bangladesh and Nepal, both poorer countries, by per capita income. In contrast, Andhra Pradesh (84.6 million people), another big state, spent 4.1 per cent of total expenditure on public healthcare and family welfare but reported an MMR of 92, according to government data.

Since 2008, Rajasthan increased its spending by 0.8 per cent and its MMR decreased 23 per cent while Andhra Pradesh’s spending increased by 0.5 per cent and MMR decreased 31 per cent.

Assam, which spends 4.2 per cent of its total expenditure on health and has 31.2 million people, has an MMR of 300 deaths per 100,000 births — comparable to Rwanda and Sudan — while Kerala, which spends 5.3 per cent on 33.4 million, reported an MMR of 61, comparable to Sri Lanka and Poland.

Madhya Pradesh, which reported an infant mortality rate (IMR) — deaths per 1,000 live births — of 51 in 2015-16, spends 4.3 per cent of total expenditure on healthcare (against the budgeted 5 per cent) and is worse off than some of the world’s poorest countries, such as the Gambia and Ethiopia.

In the nine “high-focus” states, 72.6 per cent of all births were in healthcare institutions, a steady improvement but below the national average of 78.9 per cent, according to the 2015-16 National Family Health Survey (NFHS-4) data, the latest available.

Promoting community-based education on improved maternal and newborn care, and home-based treatment for newborn infections could enhance child survival in the “high- focus” states “significantly”, said a 2012 PLOS-ONE study. (IANS)

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Telangana Government likely to introduce “Bike Ambulances” to help patients in Remote areas of the State

It would be used in remote areas, mainly inhabited by tribals and also congested localities in Hyderabad and other cities

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Indian Ambulance, Wikimedia

Hyderabad, Dec 29, 2016: The Telangana government will soon introduce the facility of ‘bike ambulances’ to help patients in remote areas of the state.

Health Minister C Laxma Reddy said,” The ‘bike ambulances’ would be used in remote areas, mainly inhabited by tribals and also congested localities in Hyderabad and other cities.”

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According to PTI, the state government will also increase the number of vehicles transporting bodies of the poor from major state-run hospitals to their native places.

However, it will be interesting to see that how does Telangana government manage the bike ambulance and how will the new feature of the state government’s health care initiative unfold.

– prepared by Shambhavi Sinha of NewsGram. Twitter:  @shambhavispeaks