Human Development in India - NCAER

7Health and Medical CareThroughout the preceding chapters, this report has notedthe disparities in different indicators of human development.These inequalities are arrayed against two axes: one reflectshousehold background, such as caste, religion, education,and income, and the other reflects the characteristics of thearea the respondents live in, as characterized by urban or ruralresidence, level of infrastructure development, and state ofresidence. While both sets of inequalities are reflected in mostindicators of human development, their relative importancevaries. As this chapter discusses a variety of health outcomesand health care, it is striking how regional inequalities dwarfinequalities in the household background. A poor, illiterateDalit labourer in Cochi or Chennai is less likely to sufferfrom short- and long-term illnesses, and has greater accessto medical care than a college graduate, forward caste, orlarge landowner in rural Uttar Pradesh. Social inequalitiesmatter, but their importance is overwhelmed by state andrural–urban differences.Another theme to emerge from the IHDS data is thedominant position of the private sector in medical care. Inthe early years following independence, discourse on healthpolicy was dominated by three major themes: providingcurative and preventive services delivered by highly traineddoctors, integrating Indian systems of medicine (for example,Ayurvedic, homeopathic, unani) with allopathic medicine,and serving hard to reach populations through grassrootsorganization and use of community health care workers. 1This discourse implicitly and often explicitly envisioned ahealth care system dominated by the public sector. Publicpolicies have tried to live up to these expectations. A vastnetwork of Primary Health Centres (PHCs) and sub-centres,as well as larger government hospitals has been put in place,along with medical colleges to train providers. Programmesfor malaria, tuberculosis control, and immunization are buta few of the vertically integrated programmes initiated bythe government. A substantial investment has been madein developing community-based programmes, such asIntegrated Child Development Services, and networks ofvillage-level health workers. In spite of these efforts, growthin government services has failed to keep pace with theprivate sector, particularly in the past two decades. 2The results presented in this chapter show that Indianfamilies, even poor families, receive most of their medicalcare from private practitioners. Maternity care is a partialexception here. For most other forms of care, however, thepublic sector is dwarfed by the reliance on the private sector,even though the quality of private sector providers andservices remains highly variable.MEASURING HEALTH OUTCOMES ANDEXPENDITURESThis chapter reviews health outcomes and expenditures infour main sections:1These themes were emphasized in reports from three major committees around independence: the Bhore Committee Report of 1946, the ChopraCommittee Report of 1946, and the Sokhey Committee Report of 1948.2For a description of Indian health services and debates surrounding the role of government, see Gangolli et al. (2005).