The 2010 maternal mortality rate per 100,000 births Ior India is 230. This is compared with 253. In 2008 and 523. In 1990. The aim oI this report is to highlight ways in which the Millennium Development Goals can be achieved.
The 2010 maternal mortality rate per 100,000 births Ior India is 230. This is compared with 253. In 2008 and 523. In 1990. The aim oI this report is to highlight ways in which the Millennium Development Goals can be achieved.
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The 2010 maternal mortality rate per 100,000 births Ior India is 230. This is compared with 253. In 2008 and 523. In 1990. The aim oI this report is to highlight ways in which the Millennium Development Goals can be achieved.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online from Scribd
In June 2011, the United Nations Population Fund released a report on The State oI the World's MidwiIery. It contained new data on the midwiIery workIorce and policies relating to newborn and maternal mortality Ior 58 countries. The 2010 maternal mortality rate per 100,000 births Ior India is 230. This is compared with 253.8 in 2008 and 523.3 in 1990. The under 5 mortality rate, per 1,000 births is 68 and the neonatal mortality as a percentage oI under 5's mortality is 52. The aim oI this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 Reduce child mortality and Goal 5 improve maternal death. In India the number oI midwives per 1,000 live births is unavailable and 1 in 140 shows us the liIetime risk oI death Ior pregnant women. |30|
Disease India suIIers Irom high levels oI disease including Malaria, |31| and Tuberculosis where one third oI the world`s tuberculosis cases are in India. |32| In addition, India along with Nigeria, Pakistan and AIghanistan is one oI the Iour countries worldwide where polio has not as yet been eradicated. Ongoing government oI India education about HIV has led to decreases in the spread oI HIV in recent years. The number oI people living with AIDS in India is estimated to be between 2 and 3 million. However, in terms oI the total population this is a small number. The country has had a sharp decrease in the estimated number oI HIV inIections; 2005 reports had claimed that there were 5.2 million to 5.7 million people aIIlicted with the virus. The new Iigures are supported by the World Health Organization and UNAIDS. |33||34||35|
Pollution According to the World Health Organization 900,000 Indians die each year Irom drinking contaminated water and breathing in polluted air. |36| As India grapples with these basic issues, new challenges are emerging Ior example there is a rise in chronic adult diseases such as cardiovascular illnesses and diabetes as a consequence oI changing liIestyles. |37|
Malnutrition HalI oI children in India are underweight, one oI the highest rates in the world and nearly same as Sub-Saharan AIrica. |38| India contributes to about 5.6 million child deaths every year, more than halI the world's total. |39|
Water and sanitation Water supply and sanitation in India is a matter oI concern. As oI 2003, it was estimated that only 30 oI India's wastewater was being treated, with the remainder Ilowing into rivers or groundwater. |40| The lack oI toilet Iacilities in many areas also presents a major health risk; open deIecation is widespread even in urban areas oI India, |41||42| and it was estimated in 2002 by the World Health Organisation that around 700,000 Indians die each year Irom diarrhoea. |40| No city in India has Iull-day water supply. Most cities supply water only a Iew hours a day. |43| In towns and rural areas the situation is even worse. HIVJAIDS in India India has the world's third-largest population suIIering Irom HIV/AIDS. |1|
However, the estimated number oI human immunodeIiciency virus (HIV) inIections in India has declined drastically in recent yearsIrom 5.5 million in 2005 to below 2.5 million in 2007. These new Iigures are supported by the World Health Organization and UNAIDS. |2||3||4| According to the United Nations 2011 Aids report, there has been a 50 decline in the number oI new HIV inIections in the last 10 years in India |5|
In 1986, HIV started its epidermic in India, attacking sex workers in Chennai, Tamil Nadu. Setting up HIV screening centres was the Iirst step taken by the government to screen its citizens and the blood bank. To control the spread oI the virus, the Indian government set up the National AIDS Control Programme in 1987 to co-ordinate national responses such as blood screening and health education. In 1992, the government set up the National AIDS Control Organisation (NACO) to oversee policies and prevention and control programmes relating to HIV and AIDS and the National AIDS Control Programme (NACP) Ior HIV prevention. The State AIDS Control Societies (SACS) was set up in 25 societies and 7 union territories to improving blood saIety. In 1999, the second phase oI the National AIDS Control Programme (NACP II) was introduced to decrease the reach oI HIV by promoting behaviour change. The prevention oI mother-to-child transmission programme (PMTCT) and the provision oI antiretroviral treatment were materialized. In 2007, the third phase oI the National AIDS Control Programme (NACP III) targeted the high-risk groups, conducted outreach programmes, amongst others. It also decentralised the eIIort to local levels and non-governmental organisations (NGOs) to provide welIare services to the aIIected [bW^nmWnt p[iciW_ f[^ HIVJAIDS: Soon aIter the Iirst cases emerged in 1986, the Government oI India established the National AIDS Committee within the Ministry oI Health and Family WelIare. |19|
This Iormed the basis Ior the current apex Government oI India body Ior HIV surveillance, the National AIDS Control Organisation (NACO). The majority oI HIV surveillance data collected by the NACO is done through annual unlinked anonymous testing oI prenatal clinic (or antenatal clinics) and sexually transmitted inIection clinic attendees. Annual reports oI HIV surveillance are Ireely available on NACO's website. The Iirst National AIDS Control Programme (NACP) was implemented over seven years (1992-1999), Iocused on monitoring HIV inIection rates among risk populations in selected urban areas. |19| The second phase ran between 1999 and 2006 and the original program was expanded at state level, Iocusing on targeted interventions Ior high-risk groups and preventive interventions among the general population. |19| A National Council on AIDS was Iormed during this phase, consisting oI 31 ministries and chaired by the Prime Minister. |19| HIV/Aids was understood not purely as a health issues, but also a development issue and as such it was mainstreamed into all ministries and departments. |19| The third stage dramatically increased targeted interventions, aiming to halt and reverse the epidemic by integrating programmes Ior prevention, care, support and treatment. |19|
By the end oI 2008, targeted interventions covered almost 932,000 oI those most at risk, or 52 oI the target groups (49 oI FSWs, 65 oI IDUs and 66 oI MSM). |19| In 2009 India established a "National HIV and AIDS Policy and the World oI Work", which sough to end discrimination against workers on the basis oI their real or perceived HIV status. |19| Under this policy all enterprises in the public, private, Iormal and inIormal sectors are encouraged to establish workplace policies and programmes based on the principles oI non-discrimination, gender equity, health work environment, non-screening Ior the purpose oI employment, conIidentiality, prevention and care and support. |19| Researchers at the Overseas Development Institute have called Ior greater attention to migrant workers, whose concerns about their immigration status may exclude them Irom these policies and leave them particularly vulnerable. |19|
anding HIV spending increased in India Irom 2003 to 2007, and Iell by 15 in 2008 to 2009. Currently, India spends about 5 oI its health budget on HIV/AIDS. Spending on HIV/AIDS may create a burden in the health sector which Iaces a variety oI other challenges like malaria, diabetes, heart disease and cancer. Thus, it is crucial Ior India to step up on its prevention eIIorts to decrease its spending oI the health budget on HIV/AIDS in Iuture. |16|
MWdica T[a^i_m India is quickly becoming a hub Ior medical tourists seeking quality healthcare at an aIIordable cost. Nearly 450,000 Ioreigners sought medical treatment in India last year with Singapore not too Iar behind and Thailand in the lead with over a million medical tourists. |44| As the Indian healthcare delivery system strives to match international standards the Indian healthcare industry will be able to tap into a substantial portion oI the medical tourism market. Already 13 Indian hospitals have been accredited by the Joint Commission International (JCI). Accreditation and compliance with quality expectations are important since they provide tourists with conIidence that the services are meeting international standards. Reduced costs, access to the latest medical technology, growing compliance to international quality standards and ease oI communication all work towards India`s advantage. It is not uncommon to see citizens oI other nations seek high quality medical care in the US over the past several decades; however in recent times the pattern seems to be reversing. As healthcare costs in the US are rising, price sensitivity is soaring and people are looking at medical value travel as a viable alternative option. In the past the growth potential oI the medical travel industry in India has been hindered by capacity and inIrastructure constraints but that situation is now changing with strong economic progress in India as well as in other developing nations. |45| With more and more hospitals receiving JCI accreditations outside the US, concerns on saIety and quality oI care are becoming less oI an issue Ior those choosing to travel Ior medical treatment at an aIIordable cost. The combined cost oI travel and treatment in India is still a Iraction oI the amount spent on just medical treatment alone in western countries. In order to attract Ioreign patients many Indian hospitals are promoting their international quality oI healthcare delivery by turning to international accreditation agencies to standardize their protocols and obtain the required approvals on saIety and quality oI care. |46|
ati[na Ra^a HWatb Mi__i[n {RHM] The National Rural Health Mission (NRHM) was launched on April 12, 2005 by the Prime Minister oI India with the objective oI providing accessible and aIIordable quality health services to the poor households in the remote and rural parts oI the country. The detailed Framework Ior Implementation was approved by the Union Cabinet in July 2006. |16| It is being operationalized throughout the country with special Iocus on 18 States which include 8 Empowered Action Group States (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttaranchal, Orissa and Rajasthan), 8 NE States, Himachal Pradesh, and Jammu and Kashmir. These states have been classiIied as special Iocus states because they do not have satisIactory health indicators and the government wanted to ensure that greatest attention is given where required. Immunization is one oI the major areas under National Rural Health Mission (NRHM) and under the NRHM immunization programme, the Government oI India provides vaccination to prevent six vaccine preventable diseases i.e. Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, and Measles. In order to strengthen routine immunization, the government has launched newer initiatives as a part oI the state Programme Implementation Plan (PIP). These initiatives include supply oI vaccines, supply oI vaccine van at the rate oI one per district, and mobility support to State Immunization OIIicer, District Immunization OIIicer and other OIIicers as per the state plan Ior monitoring and supportive supervision. In June 2002, a pilot project Ior the introduction oI Hepatitis-B vaccine was launched by the Prime Minister and under this pilot project, 33 districts and 15 metropolitan cities implemented Hepatitis B vaccination. AIter the success oI pilot project, the Hepatitis B programme was expanded to 10 states, that is, Andhra Pradesh, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Punjab, Tamil Nadu and West Bengal in a phased manner. |17|
The Union Ministry is launching National Urban Health Mission (NUHM) in Public Private Partnership mode in order to address the primary health needs oI people who live in urban areas. NURM will complement the activities undertaken by NRHM in rural areas. Poor Iamilies, slum dwellers, migrant workers and extremely vulnerable population living in urban areas would be identiIied by the Urban Local Body (ULB) and would be covered under the scheme. Those Iamilies would then be issued a photo Family Health Card. There are 427 cities (including state capitals) that have a population oI one lakh and above which would be covered by NURM. Out oI these, one hundred constitute hi-Iocus cities. |18|
^ima^ _W^bicW_ Health care Iacilities and personnel increased substantially between the early 1950s and early 1980s, but because oI Iast population growth, the number oI licensed medical practitioners per 10,000 individuals had Iallen by the late 1980s to three per 10,000 Irom the 1981 level oI Iour per 10,000. In 1991 there were approximately ten hospital beds per 10,000 individuals. For comparison, in China there are 1.4 doctors per 1000 people ational Centre for Disease Control (CDC) ational Centre for Disease Control (CDC) (previously known as National Institute oI Communicable Diseases) is an institute under the Indian Directorate General oI Health Services, Ministry oI Health and Family WelIare. It was established in July 1963 Ior research in epidemiology and control oI communicable diseases. |1| Currently it has eight branches at Alwar, Bangalore, Calicut, Coonoor, Jagdalpur, Patna, Rajahmundry and Varanasi to advise the respective state governments on public health. |2| The origin oI NICD can be traced back to Central Malaria Bureau, which was established at Kasauli, Himachal Pradesh, India in 1909. It was renamed as the Malaria Institute oI India in 1938 and in 1963 renamed as the NICD. |3| On 30 July 2009, it was named as National Centre Ior Disease Control. |4| Doctors Irom NICD had been previously summoned to investigate potential outbreaks oI diseases including suspected cases oI Pneumonic plague in Punjab in 2002 |6| , SARS oubreaks in 2004 |7| , meningitis outbreak in Delhi in 2005, |8| and avian inIluenza in 2006. |9|
pWndita^W In the mid-1990s, health spending amounted to 6 oI GDP, one oI the highest levels among developing nations. The established per capita spending is around Rs 320 per year with the major input Irom private households (75). State governments contribute 15.2, the central government 5.2, third-party insurance and employers 3.3, and municipal government and Ioreign donors about 1.3, according to a 1995 World Bank study. OI these proportions, 58.7 goes toward primary health care (curative, preventive, and promotive) and 38.8 is spent on secondary and tertiary inpatient care. The rest goes Ior nonservice costs. The FiIth (197478) and Sixth Five-Year Plans and (198084) included programs to assist delivery oI preventive medicine and improve the health status oI the rural population. Supplemental nutrition programs and increasing the supply oI saIe drinking water were high priorities. The sixth plan aimed at training more community health workers and increasing eIIorts to control communicable diseases. There were also eIIorts to improve regional imbalances in the distribution oI health care resources. The Seventh Five-Year Plan (198589) budgeted Rs 33.9 billion Ior health, an amount roughly double the outlay oI the sixth plan. Health spending as a portion oI total plan outlays, however, had declined over the years since the Iirst plan in 1951, Irom a high oI 3.3 oI the total plan spending in FY 1951-55 to 1.9 oI the total Ior the seventh plan. Mid-way through the Eighth Five-Year Plan (199296), however, health and Iamily welIare was budgeted at Rs 20 billion, or 4.3 oI the total plan spending Ior FY 1994, with an additional Rs 3.6 billion in the nonplan budget.
CWnt^a g[bW^nmWnt_ ^[W Critics say that the national policy lacks speciIic measures to achieve broad stated goals. Particular problems include the Iailure to integrate health services with wider economic and social development, the lack oI nutritional support and sanitation, and the poor participatory involvement at the local level. Central government eIIorts at inIluencing public health have Iocused on the Iive- year plans, on coordinated planning with the states, and on sponsoring major health programs. Government expenditures are jointly shared by the central and state governments. The 1983 National Health Policy is committed to providing health services to all by 2000. In 1983 health care expenditures varied greatly among the states and union territories, Irom Rs 13 per capita in Bihar to Rs 60 per capita in Himachal Pradesh, and Indian per capita expenditure was low when compared with other Asian countries outside oI South Asia. Although government health care spending progressively grew throughout the 1980s, such spending as a percentage oI the gross national product (GNP) remained Iairly constant. In the meantime, health care spending as a share oI total government spending decreased. During the same period, private-sector spending on health care was about 1.5 times as much as government spending. HWatbca^W Inf^a_t^acta^W The Indian healthcare industry is seen to be growing at a rapid pace and is expected to become a US$280 billion industry by 2020. |2| The Indian healthcare market was estimated at US$35 billion in 2007 and is expected to reach over US$70 billion by 2012 and US$145 billion by 2017. |3| According to the Investment Commission oI India the healthcare sector has experienced phenomenal growth oI 12 percent per annum in the last 4 years. |4| Rising income levels and a growing elderly population are all Iactors that are driving this growth. In addition, changing demographics, disease proIiles and the shiIt Irom chronic to liIestyle diseases in the country has led to increased spending on healthcare delivery. |5|
Even so, the vast majority oI the country suIIers Irom a poor standard oI healthcare inIrastructure which has not kept up with the growing economy. Despite having centers oI excellence in healthcare delivery, these Iacilities are limited and are inadequate in meeting the current healthcare demands. Nearly one million Indians die every year due to inadequate healthcare Iacilities and 700 million people have no access to specialist care and 80 oI specialists live in urban areas. |6|
In order to meet manpower shortages and reach world standards India would require investments oI up to $20 billion over the next 5 years. |7| Forty percent oI the primary health centers in India are understaIIed. According to WHO statistics there are over 250 medical colleges in the modern system oI medicine and over 400 in the Indian system oI medicine and homeopathy (ISM&H). India produces over 25,000 doctors annually in the modern system oI medicine and a similar number oI ISM&H practitioners, nurses and para proIessionals. |8| Better policy regulations and the establishment oI public private partnerships are possible solutions to the problem oI manpower shortage. India Iaces a huge need gap in terms oI availability oI number oI hospital beds per 1000 population. With a world average oI 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population. |9| Moreover, India Iaces a shortage oI doctors, nurses and paramedics that are needed to propel the growing healthcare industry. India is now looking at establishing academic medical centers (AMCs) Ior the delivery oI higher quality care with leading examples oI The Manipal Group & All India Institute oI Medical Sciences (AIIMS) already in place. As incomes rise and the number oI available Iinancing options in terms oI health insurance policies increase, consumers become more and more engaged in making inIormed decisions about their health and are well aware oI the costs associated with those decisions. In order to remain competitive, healthcare providers are now not only looking at improving operational eIIiciency but are also looking at ways oI enhancing patient experience overall. |10|
India has approximately 600,000 allopathic doctors registered to practice medicine. This number however, is higher than the actual number practicing because it includes doctors who have emigrated to other countries as well as doctors who have died. India licenses 18,000 new doctors a year. |11|
Wdit] St^acta^W [f HWatbca^W S_tWm The Indian healthcare system can be divided into national, state, district, community, primary health care centre and sub-centre levels. At the national level is the Union Ministry oI Health and Family WelIare which consists oI six departments Department oI Health and Family WelIare, Department oI AYUSH, Department oI Health Research, Department oI NACO, Department oI AIDS Control, and Central Health Service. |12| The Union Ministry is responsible Ior the Iormulation oI health policies and their implementation across the country. The Department oI Health is responsible Ior providing healthcare services to the masses. This includes organizing awareness campaigns and immunization campaigns, providing preventive medicine (vaccines such as polio, DPT, etc.), and public health services. The Department oI Family WelIare is responsible Ior matters pertaining to Family WelIare, Reproductive Health, Maternal Health, Paediatrics, InIormation, Education and Communication, Cooperation with NGOs, International Aid Groups, and Rural Health Services. In November 2003, the Department oI Indian Systems oI Medicine and Homoeopathy (ISM&H) was renamed as the Department oI Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) with the objective oI the development oI Education and Research in Iields oI Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy systems |13| . Other than these Iour departments, there is the Directorate General oI Health Services (Dte.GHS) which supports the Department oI Health & Family WelIare by rendering technical advice on all matters oI medical and public health. DGHS is also involved in the implementation oI various health services. |14| DGHS manages Central Drugs Standard Control Organizations (CDSCO), State Drugs Standard Control Organization and Central Government Health Scheme (CGHS). The CDSCO and State Drugs Standard Control Organization monitor the licensing oI drug manuIacturing establishments, quality oI drugs and drug approval. The Central Government Health Scheme (CGHS) provides comprehensive healthcare Iacilities Ior the employees oI Central Government, retired personnel and their dependents who reside in the cities covered by CGHS. The active employees oI the deIense services are also covered under the CGHS. At the state level is the State Department oI Health and Family WelIare which is supported by the State Directorate oI Health Services. The state department`s organization is similar to that oI the Union Ministry oI Health and Family WelIare. Headed by the Director oI Health Services, the State Directorate oI Health Services provides technical advice to the State Department oI Health and Family WelIare. In the states oI Bihar, Madhya Pradesh, Uttar Pradesh, Andhra Pradesh, Karnataka and others, regional set-ups have been created wherein each regional or zonal set- up covers three to Iive districts and acts under the authority delegated by the State Directorate oI Health Services. The district oIIicer who has overall control is designated as the ChieI Medical and Health OIIicer (CMO) or District Medical and Health OIIicer (DMO) and is responsible Ior implementing the programmes according to the policies laid down at the state and centre levels. Healthcare services are provided through the oIIice oI Assistant District Health and Family WelIare OIIicer (ADHO) at the Taluka level. To provide basic healthcare services at the community level, one Community Health Centre (CHC) has been established Ior every 80,000 to 120,000 people. A Primary Health Centre covers about 20,000 people and is staIIed with one medical oIIicer and two health assistants. At the lowest level in the chain is the sub-centre which serves about 5,000 people (about 3,000 in diIIicult terrain)
Social Issues- Health:Issues , vital statistics, Govt, schemes, management solution