National Human Development Report: 2001 - Indira Gandhi Institute ...

NATIONAL HUMAN DEVELOPMENT REPORT 2001 HEALTH ATTAINMENTS & DEMOGRAPHIC CONCERNS 83trends in the developed world, but is adverse for females in the States ofBihar, Gujarat, Haryana, Punjab, Rajasthan and Uttar Pradesh. For Haryanaand Punjab, the sex ratio at birth, in urban areas was at sub-800 levels in1996-98. This points to the possibility of widespread prevalence of pre-natalsex determination and sex selection practices. It highlights the impact ofperverse social and cultural factors related to marriage practices and dowry,as well as role of women in household level decision making in an essentiallypatriarchal social context in these States.Two other demographic concerns that are particularly important fromthe point of a human centric approach to the development process relate tothe issue of ‘greying of the population’ and the incidence of disability in thepopulation. These have been discussed in the Chapter 6.Policies, Interventions and ProspectsIt would not be entirely incorrect to suggest that India’s approach tohealth sector development has not been sufficiently integrated with overallprocess of development. This is reflected, for instance, in the absence of anadequate policy framework that conceives and exploits inter and intrasectoral synergies between development processes directed at improvingavailability of drinking water, sanitation and public hygiene, access toelementary education, nutrition and poverty alleviation, on one hand, withawareness and access to public health and medical services, on other. Therehas been a misplaced emphasis on maintenance and strengthening of privatehealth care services, perhaps, on account of the inertia of colonialinheritance, at the expense of broadening and deepening of public healthcare system targeted at controlling the incidence of disease , particularly ofthe communicable diseases, in rural areas. There are significant rural-urbandisparities in various mortality, morbidity and nutrition indicators.Moreover, there is multiplicity of public programmes and interventions inhealth sector resulting in a thin spread of available resources, manpower andinfrastructure. In States where inter-sectoral linkages that influence healthattainments of people, have existed either for historical reasons, or have beenconsciously forged as a part of planned effort, and where the health concernsof the rural population have been reasonably addressed, results on healthattainments, as well as demographic transition have been quite impressive.The National Health Policy 1983 and the draft National HealthPolicy 2001 recognise these concerns. The Statements have highlighted aneed for time-bound programme for setting up network of comprehensiveprimary health care services, linked with extension and health education. Ittalked of intermediation through ‘health volunteers’ having appropriateknowledge and skill. It emphasised establishment of a referral system toprevent needless load on higher levels of health care hierarchy, at the sametime creating a network of super-specialty services by also encouragingprivate health care facilities for patients who can afford. While there hasbeen noteworthy success in eradication of some communicable diseases andsome are expected to be eliminated in near future, the sustainability of India’shealth care system, as it stands today, is uncertain. Moreover, there is fargreater urgency to ensure an equitable access to health care services andThe approach to healthsector development inthe country has notbeen sufficientlyintegrated with theoverall process ofdevelopment.