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

Public Health Issues, Priorities, and the Role of the GovernmentIndia is witnessing changes in populationstructure, like an increasing ageingpopulation due to increased life expectancy,improved health care, and nutrition. Thepopulation growth rate is unacceptably high.The population has increased from 370million in 1951 to about 1 billion in 2001, thusoutstripping resources and adverselyinfluencing health, especially that of womenand children. Increasing unemploymenthas led to migration to urban areas,thereby creating additional pressure onalready stressed civic amenities and healthcare facilities.Table 2. Top Ten Specific Causes of Death in India, 1998Cause India India/World RatioThousands Percentage PercentageIschaemic heart disease 1,471 15.8 19.9Acute respiratory infection 969 10.4 28.1Diarrhoeal diseases 711 7.6 32.1Cerebrovascular disease 557 6.0 10.9Tuberculosis 421 4.5 28.1Road traffic injury 217 2.3 18.5Measles 190 2.0 21.4HIV/AIDS 179 1.9 7.8Tetanus 165 1.8 40.3COPD 153 1.6 6.8Total deaths 9,337 100.0 17.3Total population 982,223 100.0 16.7The major consequence of India’s health andTable 3. Ten Specific Causes of Disability: Adjusted Life Yearsdemographic transition is an increase in theLost in India, 1998disease burden due to diseases associatedwith ageing, such as cardiovascular diseases, Cause India India/World Ratiohypertension, stroke, metabolic diseases, andDALYs Percentage Percentagecancers. There is also a lack of access to healthAcute lower respiratory infections 24,806 9.2 30.1Diarrhoeal diseases 22,005 8.2 30.1care among the ageing population. PoorIschaemic heart disease 11,697 4.3 22.5social support from the public system andFalls (injuries) 10,898 4.1 40.3changing social norms have left this segment Unipolar major depression 9,679 3.6 16.6of the population in a dismal situation.Tuberculosis 7,577 2.8 26.9Complexity of the Health SystemRoad traffic injuries 7,204 2.7 18.5Measles 6,474 2.4 21.4The health system has grown complex. This Anaemia 6,302 2.3 25.5complexity has arisen from the vastFire-related injuries 5,723 2.1 47.8expansion of the health care network andAll causes 268,953 100.0 19.5inclusion of a wide range of services—superspecialtyvis-à-vis primary health care. A hugeTotal population 982,223 100.0 16.7workforce is engaged in health delivery, both Table 4. Deaths by Broad Causesin the public and private sectors. There areseveral categories of the health workforce thatDevelopingRegionsDevelopedRegionsprovide health care. Lack of both properattitude and motivation have caused a seriousproblem in the functioning of the healthsystem. There is a clear lack of leadership andmanagerial skills at all levels of the system. InCommunicable diseases, maternal,perinatal, and nutritional conditionsNon-communicable diseasesInjuries41.9%47.4%10.7%6.1%86.2%7.6%addition, the health system is poorly managed. The quality of services is far from satisfactory,thus resulting in poor utilization of public services. In addition to the allopathic system, thereare other systems of medicine that exist concurrently—Ayurveda, Unani, Siddha, homeopathy,and traditional healing. The public health system today faces a major challenge.15