Human Development in India - NCAER

health and medical care 105Figure 7.8Source: IHDS 2004–5 data.Self-reported Health Being Good or Very Good for WomenAged 15–49 by Number of Children(48 per cent) than in Orissa (72 per cent). That Orissa isone of the poorest states in India and documented higherself-reported short-term illnesses than Punjab (137 versus117 per 1,000) suggests the need for caution in interpretingthese reports.In summary, looking across various dimensions of selfreportedhealth status discussed in this section, poor healthis a consequence of biology, behaviour, and aging, but thoseoutcomes also appear to be socially structured. While educationand income play some role in the prevalence of illnesses,rural–urban and state differences are particularly important.Although not all health problems show the same statewisepatterns, the south is noticeably healthier along severaldimensions, while the poorer Hindi heartland (that is, UttarPradesh, Bihar, and Madhya Pradesh) reports more illnessand disability. In Chapter 8, we note similar differences ininfant and child mortality, with Kerala’s infant mortality atnine per 1,000 births (rivalling that of developed countries)and infant mortality for Uttar Pradesh at 80 per 1,000. Thissuggests that the regional differences in morbidity are notsimply due to differences in reporting.Next, we will see that similar geographic differences arefound for medical care. Unfortunately, the areas with themost need because of the high prevalence of illnesses are theareas with the worst medical care.MEDICAL CAREA massive expansion of government health facilities occurredunder the 6th and 7th Five Year Plans in the 1980s with agoal of providing one health sub-centre per 5,000 populationand a PHC per 30,000 population. In 2005, access to somesort of government medical facilities was almost universalin urban areas. Even for the rural population, a substantialproportion lived in villages with at least a sub-centre, and avast majority had a sub-centre in a neighbouring village. TheIHDS documents that about 86 per cent of the householdsat least have a government sub-centre within three kilometres.However, most individuals seem to seek medical carefrom private providers. This is true for both short-term andlong-term illnesses, although slightly less so for long-termillness. Maternity care is the one exception. More womenrely on government doctors and midwives for pregnancy andbirths than go to private clinics (although the majority stillhave births at home). The poor, the elderly, and women makesomewhat more use of the government services, in general,but the majority of all groups use private sector care for mostillnesses. Government-provided medical care is more commonin some parts of India, but only in a few areas is it themost common choice for medical care.It is important to keep in mind the diversity of medicalfacilities in India. Government facilities range from placeslike the All India Institute of Medical Sciences, capable ofperforming complex surgeries, to poorly equipped villagesub-centres. The private sector is even more diverse. It consistsof facilities ranging from dispensaries run by untrainedand unlicensed individuals to high technology, for-profithospitals catering to medical tourists from abroad. The IHDSsurveyed one predominant private facility and one governmentmedical facility in each village/urban block. This is anationwide sample, but should not be seen as being representativeof health facilities in India because the samplingframe did not consist of all possible facilities. Nonetheless,the results presented in Box 7.2 provide an interesting snapshotof the private and public health facilities in India andare important in informing the results on the source and costof medical care discussed below.