india health system
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Comparative analysis of healthsystem of Nepal and India
Presented by:
Suvash Regmi
Suraksha ShahLipasha Shrestha
Priyankya Aryal
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Introduction
India and Nepal are the South Asian
neighboring nations sharing culture, tradition
and political scenario.
Both the countries are dependent on
agriculture in a large scale. Agriculture plays
a vital role in the living style of the people in
these respective countries.
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CONTD..
All the sectors have been under political
influence since their independence from
foreign rule and anarchism respectively.
Both these countries have similarities in thehealth system and health services provided.
Heath system in both countries are to a large
extend privatized as the public sector is notmuch effective regarding the tertiary care.
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CONTD
Lack of human resource, skilled human
resource, logistics, updated equipments,
methods, research in health, awareness level
of the citizens, not following the healthreferral system, poverty, illiteracy etc. are the
reasons behind lagging in availability and
accessibility of health services that results in
poor health status of these two countries.
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CONTD.
The factors affecting health of population are
based on the following trends which are
similar in both the countries and statisticalinfluence only being a difference, not the
problems and services provided in health
sector.
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Factors affecting health inboth countries
Economic trend
Poverty
Demography Food supply and nutritional status
Social Trends
Lifestyle and Risk Factors
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PROBLEMS, CONSTRAINTS,CHALLENGES
Difficult to get trained human resource to
work in remote areas.
Lack of awareness in legalization of safeabortion.
Difficult terrain is a challenge to reaching the
most at-risk populations.
International Non-Government Organisations
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Contd..
Ensuring effective synergy, coordination and
collaboration with key public and private
Sector stakeholders is essential to program
success.
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Health System in India
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Introduction
The political economy context
The organisational structure and delivery
mechanism
Top 5 Diseases
Health financing mechanisms
Coverage patterns Current status of health and health care
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The Political Economy Context
A democratic federal system which is subdivided into
28 States, 7 union territories and 593 districts
In most of the states three local levels of government(Panchayati-raj)
Per capita income US $890. 435 million Indians are estimated to live on less than US $ 1 a
day
36% of the total number of the worlds poor are in India
Tax based health finance system with health insurance
80% health care expenditure born by patients and theirfamilies as out-of -pocket payment (fee for service and drugs)
Expenditure on health care is second major cause ofindebtedness among rural poor
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Characteristics of IndianHealth System
Complex mixed health system
- Publicly financed government
health system
- Fee-levying private health sector
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Different Phases of IndianHealth System Development
Pre-independence phase
Development centred phase
Comprehensive Primary Health Care phase Neoliberal economic and health sector reform
phase
Health systems phase
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Main Systems of Medicine
Western allopathic
Ayurveda
Unani Siddha
Homeopathy
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Government Health System
Three levels of responsibilities-
- First-
- health is primarily a state responsibility
- Second-- the central government is responsible for developing andmonitoring national standards and regulations
- sponsoring various schemes for implementation by stategovernments
- providing health services in union territories
- Third-
- both the centre and the states have a joint responsibility
for programmes listed under the concurrent list.Prepared by Suvash Regmi
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Administrative Structure
1. Central Ministries of Health and FamilyWelfare
- Responsible for all health related
programmes
- Regulatory role for private sector
2. State Ministries of Health and Family
Welfare3. District Health Teams headed by Chief
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Service Delivery Structure
Sub Health Centres- staffed by a trainedfemale health worker and/or a male health workerfor a population of 5000 in the plains and a
population of 3000 in hilly and tribal areas. Primary Health Centres-
staffed by a medical officer and other paramedicalstaff for a population of 30,000 in the plains and a
population of 20,000 in hilly, tribal and backwardareas. A PHC centre supervises six to eight subcentres.
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Service Delivery Structure
Community health centres- with 30-50 beds
and basic specialities covering a population
of 80,000 to 120,000. The CHC acts as a
referral centre for four to six PHCs.
District/General hospitals- at district level with
multi speciality facilities (City dispensaries)
Medical colleges, All India institute of MedicalSciences and quasi government institutes.
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Physical infrastructures
Regarding the hospitals and hospital beds, the scenario presents the
dominance of healthcare facilities in the private sector. Public health
infrastructure in rural areas consists of a three-tier system, a sub centre for
every 5,000 population with a male and female worker; a PHC for every
30,000 population with a medical doctor and other para medical staff, and a
Community Health Centre (CHC) for every 100,000 population with 30 bedsand basic specialists. In urban areas, it is two tier systems with Urban
Health Centre (UHC)/Urban Family Welfare Centre (UFWC) for every
100,000 population followed by general hospital.
In 2001, there were about 1,37,311 Sub Centres (SCs), 28,000dispensaries, 22,842 PHCs, 3,043 CHCs and 3,500 UFWCs and an
additional 12,000 secondary and tertiary hospitals in the public sector,
besides an estimated 68 percent of total hospitals in the private sector.
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Health Care Workforce
Community and traditional health workers density (per 10 000
population)
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Contd
Number of nursing and midwifery personnel
1,372,059 (2004)
Number of other health service providers
695,024 (2003)
Number of Pharmaceutical personnel
559,408 (2003)
Number of Physicians
645,825 (2004)
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Contd..
Nursing and midwifery personnel density (per 10,000
population)
13.00 (2004)
Other health service providers density (per 10,000population)
7.00 (2003)
Pharmaceutical personnel density (per 10,000
population) 5.00 (2003)
Physicians density (per 10,000 population)
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Contd.
SC/Public Health Center (PHC)/Community
Health Centers (CHC) - 1,63,181
Dispensaries & Hospitals - 43,322
Beds (Pvt & Public) - 8,70.161
Doctors (Allopathy) - 5,03,900
Nursing Personnel) - 7,37,000 *MOHFW
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Top Five Diseases
HIV/AIDS
MALARIA
TUBERCULOSIS DENGUE
PNEUMONIA
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Health Financing Mechanisms..
Revenue generation by tax
Out of pocket payments or direct payments Private insurance
Social insurance
External Aid supported schemes
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Spending on Health
National health Accounts and Health statistics by
2010 show increase in the expenditure by
government as a percentage of GDP from the
the then existing 0.9 percent to 2 percentincrease share of central grant to constitute at
least 25 percent of total spending by 2010,
increase State sector health spending from 5.5
percent to 7 percent of the budget by 2010 andfurther increase it by 8 percent by 2010.
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CONTD..
Out of this only 15 % is publicly financed
4% from social insurance, 1% by private
insurance remaining 80% is out of pocket
spending ( 85% of which goes in privatesector)
Only 15% of the population is in organised
sector and has some sort of social securitythe rest is left to the mercy of the market
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The Aspects of Neoliberal Economic
Reforms Affecting Public Health
Increasing unregulated privatisation of the health caresector with little accountability to patients
Cutting down government Health care expenditure
Systematic deregulation of drug prices resulting in
skyrocketing prices of drugs and rising cost of healthservices
Selective intervention approach instead comprehensiveprimary health care
Measure diseases in terms of cost effectiveness Techno centric approach( emphasis on content instead
processes)
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Contradictions
India has the largest numbers of medical
colleges in the world
It produces the largest numbers of doctors
among developing countries
It gets medical Tourists from developed
countries
This country is fourth largest producer of
drugs by volume in the world
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But... the current situation.
Only 43.5% children are fully immunised. 79.1% of children from 6 months to 5 years of age are
anaemic. 56.1% ever married women aged 15-49 are anemic. Infant Mortality Rate is 58/1000 live births for the country with
a low of 12 for Kerala and a high of 79 for Madhya Pradesh. Maternal Mortality Rate is 301 for the country with a low of
110 for Kerala and a high of 517 for UP and Uttaranchal in the2001-03 period.
Two thirds of the population lack access to essential drugs. 80% health care expenditure born by patients and their
families as out-of -pocket payment (fee for service and drugs) Health inequalities across states, between urban and rural
areas, and across the economic and gender divides havebecome worse
Health, far from being accepted as a basic right of the people,is now being shaped into a saleable commodity
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Contd.
poor are being excluded from health services
Increased indebtedness among poor
(Expenditure on health care is second
major cause of Indebtedness amongrural poor)
Difference across the economic class spectrumand by gender in the untreated illness has
significantly increased Cutbacks by poor on food and other
consumptions resulting increased illnesses andincreasing malnutrition
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Health Inequities
The infant mortality Rate in the poorest 20% of thepopulation is 2.5 times higher than that in the richest20% of the population
A child in the Low standard of living economicgroup is almost four times more likely to die inchildhood than a child in a better of high standardliving group
A person from the poorest quintile of the population,
despite more health problems, is six times less likelyto access hospitlisation than a person from richestquintile.
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Health Inequities
A girl is 1.5 times more likely to die before
reaching her fifth birthday
The ratio of doctors to population in rural
areas is almost six times lower than that for
urban areas.
Per person, government spending on public
health is seven times lower in rural areascompared to government spending urban
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Diseases such as dengue fever, hepatitis,tuberculosis,
malaria and pneumonia continue to plague India due to
increased resistance to drugs. And in 2011, India finally
developed a totally drug-resistantform of
tuberculosis. India is ranked 3rd among the countries
with the most number of HIV-infected. Diarrheal
diseases are the primary causes of early childhood
mortality. These diseases can be attributed to poor
sanitation and inadequate safe drinking water in India. However in 2012, India was polio free for the first time in
its history.
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Thank You.
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