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

Public Health Issues, Priorities, and the Role of the GovernmentRising expectations for better services and the inability of the public system to meet health careneeds have complicated the health system in India. The referral system does not work andprimary health care institutions are bypassed, thus crowding higher-level health facilities. Thereis also the issue of a competing private sector, which poses a serious challenge. Private sectorservices are generally perceived as higher quality services and so despite its higher costs, theprivate sector seriously undermines utilization of the public sector.The public health system operates under severe financial constraints. The Eighth Five-Year Planmade a provision of 11,000 crore rupees for health care. However, a majority of the funds (about90%) are used for salary and related budget items, thus leaving little for other purposes. There isa severe resource crunch and health services are starved for funds.In summary, the health systems work under severe constraints including the following.l Inequity: Lack of access to quality basic health services by the poorllInefficiency: Inferior deployment and supervision of health functionaries and underutilizationand over-crowding of some public health facilitiesRising costs: New medical technologies and ignorant clients; provider-induced demandfor costly test procedures and treatments and continued use of branded instead ofgeneric drugs.InequityThere is appalling inequity in the distribution and use of health care expenditure. Recent workhas provided astonishing data on health expenditure. According to these studies, the poor pay19% of their incomes on health care while the rich pay only 2% of their incomes. Recentstudies report that over 80% of people use the private sector for health care; use of publicservices is marginal. About 55% of in-patients and 80% of out-patients use the private sector. Itis further reported that household expenditures account for a major share of health careexpenses, even for the public sector.The inequity is multi-dimensional. Social inequity is evident from selected health indicatorsfrom the various population groups, namely, those living below the poverty line, women, andmarginalized groups (Scheduled Class/Scheduled Tribe). Not only do these people have poorhealth status (see Table 5), but they also experience low effectiveness of health services (seeTables 6 and 7).Challenges for Indian Policy-Makers and Programme ManagersDespite significant achievements during the past five decades, much still needs to be done.lllA large “unfinished agenda” of communicable diseases and maternal and nutritionaldisorders still exists in the developing world.There is a need to cope with ageing populations and the consequent burden of degenerativediseases and hitherto neglected injuries and accidents.There is a need to be prepared to meet emerging diseases, such as tobacco-related diseasesand HIV/AIDS.16