Tuesday June 25, 2019

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.”

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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)

Next Story

IoT in Healthcare at Serious Cyber Attack Risk, Say Experts

To ensure security, medical device designers (particularly those with IoT components) should have a 360 degree view of the various parts of the network, said Fishman

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Misuse of antibiotic drugs have lead to the threat of antimicrobial resistance, Pixabay

While the healthcare industry is rapidly adopting new-age technologies such as the Internet of Things (IoT) and Artificial Intelligence (AI) to improve access and outcomes especially in the rural areas, companies must ensure that the technology acts with responsibility and transparency, say experts.

In recent years, India has seen IoT adoption in education, governance and financial services. The technology has also enabled doctors see and interact with patients in remote telemedicine centres – with the case history and medical data automatically transmitted to the doctor for analysis.

“India has an acute shortage of doctors which impacts both the quality and reach of healthcare services in rural and urban centres,” John Samuel, Managing Director (health and public service) at Accenture, told IANS.

“A digital platform powered by advanced digital technologies can enable continuous remote patient monitoring and reporting, allowing hospitals to extend care to more people, and reduce the burden on healthcare infrastructure,” Samuel added.

According to the “IoT India Congress 2018”, the Indian IoT market is expected to grow from $1.3 billion in 2016 to $9 billion by 2020 across sectors such as telecom, health, vehicles and homes, among others.

It is emerging as the next big thing to become a $300 billion global industry by 2020 and India is all set to capture at least 20 per cent market share in the next five years, says a Nasscom report.

However, lack of basic security awareness among staff as well as state-of-the-art cybersecurity solutions has made the healthcare industry a favourite target for hackers.

A 2016 report from cybersecurity firm SecurityScorecard found that healthcare is the fifth highest in ransomware counts among all industries, and more than 77 per cent of the entire healthcare industry has been infected with malware since August 2015.

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Among them was the notorious WannaCry ransomware attack in 2016 which affected over 300,000 machines across 150,000 countries, including the UK’s National Health Service (NHS).

“Despite suffering from ransomware attacks, organisations remain unprepared for the next round of large-scale attacks,” Yariv Fishman, Head of Product Management (Cloud Security and IoT) at Check Point Software Technologies, told IANS in an email interaction.

Fishman pointed out that it is not mandatory for medical device manufacturers to include cybersecurity capabilities as part of their offerings.

Once integrated into a hospital, medical devices are fully utilised to meet patient care requirements.

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As a result, even if a software patch that may prevent a potential cyber-attack is available, it usually takes lot of time for implementation.

Other reasons include old or unpatched operating systems and flat networks in which, guests, patients, doctors and connected medical devices, all share the same network.

To ensure security, medical device designers (particularly those with IoT components) should have a 360 degree view of the various parts of the network, said Fishman.

“They also need to segment parts of the network in order to contain malware attacks and mitigate the potential risk of one part of the network attacking other parts and integrate threat prevention solutions,” he noted. (IANS)