Privatisation of Health Care in India - Indian Institute of Public ...

More documents

Recommendations

Info

Privatisation of Health Care in India3.1. Evolution of Health Services inIndia from the Forties to the lateNinetiesHealth services development in India can broadly be dividedinto three phases. The first phase of developmentwas the post-Independence period, which witnessed thegrowth of health services in the public sector up to theseventies. Investments in the health sector were meagre,but an effort was made to build a network of services inboth rural and urban areas. This phase was followed bythe period from the late seventies to the late eighties whenthere were cutbacks on public spending and concessionsgiven to the private sector. During the third phase Indiawent in for loans from the IMF and World Bank. This wasthe period when several state governments received loansfor reforming the publicly provided health services.Like many of the newly liberated countries during the 20 thcentury, the leadership of the Indian nationalist movementhad committed itself to principles of universality and anationalised health service system to ensure that all sectionsof the population get access to services. The vision at thatpoint in time was to build self-reliance in the economy andsocial sectors and hence, in health care, the emphasis wason the development of institutions, manpower, research,pharmaceuticals and technology.The nationalist movement and its commitment to democraticpolitics played a very important role in ensuring thatthe needs of the majority were represented (Bhargava,2000). This understanding received support from varioussections of civil society that included the political parties,big business groups, professional bodies and others. It isindeed interesting to note that different sections of thepolitical spectrum had clearly articulated the need for astate-supported health service system. These sections includedthe national bourgeoisie, the left parties and the IndianNational Congress. Each of them had clarified theirrespective positions through well-articulated plandocuments.Given the poor health of a majority of Indians, the thrustwas to invest in preventive and curative care in addition toimproving the overall living conditions of the population.The Bhore Committee report (Government of India, 1996)was an attempt at designing a health service system basedon the needs of the majority who belonged to the deprivedsections of the population. As the Bhore Committeeobserved, the majority of the Indian population wassuffering from malnutrition and anaemia. The major killerswere a host of communicable diseases more commonlyreferred to as diseases of the poor. Therefore, thepolitical leadership had to take cognisance of the extent ofthe problem and tackle it through state investment, sincethe market was restricted to individual private practitioners,both in allopathic and other systems of medicine.Due to limited private capital, even the representatives ofbig business houses relied on state investment in educationand health.Within the health services, the professional organisationssupported state investment, but did not want it to interferewith their autonomy to continue private practice. It is indeedinteresting that while the ‘left’ parties called for theabolition of private interests within the medical and pharmaceuticalsectors, the professional bodies wanted thedoctors to be allowed to continue their private practice.The Bhore committee accommodated the interests of theprofessional bodies by not taking measures to eliminateprivate interests both within and outside the public healthservice system.Thus, even at the time of Independence a substantial percentageof government doctors were practicing in the privatesector as individual practitioners, but the number ofinstitutions was very small. Private interests were also presentin the pharmaceutical industry during this period (Jesaniand Anantharam, 1993; Baru, 1998).A survey of the health status of the population during thelate forties revealed that death rates, infant mortality andmaternal mortality rates were very high and the major causesof death were a host of communicable diseases. Keepingin view the poor health conditions of the majority, thereport emphasised the need for strong primary health careservices supported by secondary and tertiary levels of care.It was estimated that around 12 percent of the GNP would8
Private Health Services in India: An Overviewneed to be invested in the health sector in order to providehealth services across the country. In addition, the reportrecommended investment in the pharmaceutical sector inorder to develop indigenous capabilities and reduce excessivereliance on the MNCs. The Bhore Committee, in1946, symbolised the Indian state’s effort to plan and deliverhealth services, which would be accessible to all itscitizens. The period of the sixties reflected the real growthperiod of health services, but even at that time the investmentswere far from adequate. Thus, the Bhore committee’svision suffered a setback during the sixties with most ofthe investment going into the secondary and tertiary levelsof care and primary health services remaining weakly developed(Banerji, 1985; Qadeer, 1985).In terms of structure, the Bhore committee had envisioneda three-tier model with a strong primary health servicenetwork as a base and supported by secondary and tertiarylevels of care. In order to build an extensive networkof services, the committee had suggested fairly high levelsof investment of up to 12 percent of the GDP. Despitethe rhetoric of primary health care, the structure of provisioningwas largely curative, biased towards urban areasand in the secondary and tertiary levels of care. The structuresof provisioning largely reflected the needs and aspirationsof the middle classes from both urban and ruralareas that resulted in the growth of the secondary and tertiarylevels and the neglect of primary level of care.Several scholars have often criticised this and some haveeven questioned whether India can be characterised as beinga ‘welfare state’ at all (Jayal, 1999). Despite the incrementalnature of health service planning, India did manageto build a fairly extensive network of services, createdindigenous capacity for training personnel for various levelsof care and invested in research and pharmaceuticalcapability. However, the low levels of investments in healthservices stunted the growth of the public sector, whichprovided the space for the growth and expansion of theprivate sector during the last three decades. Apart fromthe growing presence of the private sector, the public sectorwas marked by rural/urban, regional and class inequalities.These trends were questioned during the mid seventieswhen a progressive government was in power and setup a committee.The seventies were marked by a number of debates concerningthe problems of health services development andsuggestions for change within the country. Some of themwere seriously reviewed by national bodies and they wereextremely critical, but also offered alternatives to remedysome of the problems (ICSSR/ICMR Committee report,1981) 1 . The reviews discussed the under-funding of the healthsector and the structural inequalities within it. The critiquesemphasised the need for reorienting health services to ruralareas and also to make medical education more relevant tothe needs of rural areas. However, the oil shock of the lateseventies had a negative impact on the financial conditionand India, along with several other developing countries,found herself caught in the world recession. Due to thefinancial crunch most third world governments during theeighties were in no position to increase investments in health.This meant stagnation in the growth of public services, whichwas an important reason for the growth of market forcesin the health sector (Baru, 1998).The growth of the private sector and the gradual neglectof the public sector, have to be seen in terms of the changesin the social structure after Independence, in the rural/urbanareas and across regions in India. After Independencethe growth of the middle classes was not merely restrictedto urban areas. With agrarian prosperity as a result of thegreen revolution, there was a rise in the rich and middlepeasantry, who were largely drawn from the backwardcastes. This was mainly seen in some northern, western andsouthern states in the country (Kamat, 1985). These sectionshad made use of public investment in education as avehicle for social mobility in order to challenge traditionalsocial hierarchies. As a result, these upwardly mobile sectionsinvested heavily in the education of their children forsocial mobility and some of them, from the more prosperousareas of the country migrated to the UK and USAas qualified professionals during the late sixties and seventies(Baru, 1998; Omvedt, 1981; Khadria, 1999). Thus a1ICSSR/ICMR is the Indian Council for Social Science Research and Indian Council for Medical Research9
Page 3 and 4: Table of Contents123456Introduction
Page 5 and 6: Chhattisgarh Infrastructure ReportL
Page 7 and 8: Table of Contents123456Introduction
Page 9 and 10: Privatisation of Health Care in Ind
Page 11 and 12: Globalisation and Health Services:
Page 13 and 14: 3Private Health Services in India:A
Page 15: Private Health Services in India: A
Page 19 and 20: 4Structure and Characteristics of P
Page 21 and 22: Structure and Characteristics of Pr
Page 23 and 24: Structure and Characteristics of Pr
Page 25 and 26: Utilisation of Private Health Servi
Page 35 and 36: 6ConclusionThis study has explored
Page 37 and 38: ReferencesAcharya, A.; Baru, R. and
Page 39 and 40: ReferencesShah, G. 1997. Public Hea

Privatisation of Health Care in India - Indian Institute of Public ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?