Health Policy Issues and Health Programmes in ... - Amazon S3

Public Health Issues, Priorities, and the Role of the GovernmentSession 1Public Health Issues, Priorities, andthe Role of the GovernmentS D Gupta, Director, Indian Institute of Health and Management Research, JaipurBackgroundSince the inception of the formal health care system in India, which is based on theconcept of comprehensive health care, major gains have been recorded over thepast five decades in people’s health status. The life expectancy has risen from 36years in 1951 to 62 years in 1995. The crude death rate (CDR), which was as high as27 per 1000 persons, decreased to 8.7 per 1000. Similarly, a significant decline hasbeen recorded for the infant mortality rate (IMR)—down from 145 per 1000 livebirths to 71 per 1000 live births. There has been a spectacular decline in mortalityresulting from major communicable diseases including plague, malaria, choleraand smallpox. Major epidemics have been brought under control and smallpoxhas been eradicated. Poliomyelitis, which is responsible for a high disability rate,is on the verge of being eliminated.Further, health care development has registered high growth for infrastructureand human resources. Vast health care infrastructure and a huge network ofhealth institutions have been created in the public system. Presently, there are21,853 primary health centres (PHCs) and 132,778 health sub-centres havebeen established to provide primary health care and reproductive healthservices. A huge workforce, which includes 360,100 doctors and 620,000 nurses,has been recruited and engaged in health care delivery in both urban anddistant rural areas. In the past 50 years, the accessibility and availability ofhealth care has improved tremendously as a result of enhanced geographicalreach and skilled manpower.However, despite significant and major gains, the health status of the peopleremains dismally poor. Important key features of the current health status are:l high IMRs;l high maternal mortality rates (MMRs);l a large portion of deaths attributable to acute communicable diseases;l common killers such as malaria, tuberculosis, and diarrhoeal disease; andl high prevalence of malnutrition and other nutrition disorders.13