Indian is booming, shining, expanding, but some sad facts are hidden amidst all this hype and hoopla, while certain section of Indians are obviously benefiting from this economic boom, the majority are being left far behind.
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The gap between the rich and the poor is widening. The latest Human Development Report rank us 127, a little above our neighbors Pakistan and Bangladesh. Despite this our country has been suffering a lot so far as community heal is concerned.
Community health, etymologically, is concerned with the holistic situations of public health that covers whole lot of heal condition of all sections of the society i.e. poorer sections, child health and women’s condition of health. So far as India is concerned, despite economic growth, living standard of the poorer sections of society still come under highly health risk zone. Infant deaths in India remain high, women still die in childbirth and half our children are malnourished. This is further compounded by a dysfunctional public health system that provides health care to only 20 to 25 percent of the population. The rest of the population is forced to seek health care from the private sector and pay out of pocket at the time of illness. Eighty percent of our healthy care is met through individual household expenditure one of the highest internationally.
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People living in higher income countries spend a very low percent out of pocket payments. Even people living in low income countries like Zambia, Zimbabwe and Brazil have been protected from high medical expenses at the time of illness. Either government health services or health insurance takes care of their medical expenses. On the other hand, if we look at India, our population spends an acceptable amount on health from their own pockets from health care.
In fact, Indians have very little protection against high medical expenses. While the rich and middle class have their employers to pick up the tabs, the story is different for the lower class and the poor. Not only do they loose their source of income at the time of illness, they have to pay considerable amount of money to become better. Studies show that an average of 24 percent of Indians are impoverished because of medical expenses.
In such circumstances there are two alternatives either that government increases its spending on healthcare and thereby improves the quality of care in its institutions and thereby protects the poor from catastrophic health expenditure or the poor resort to some mechanism that protects them when they fall sick. While the former option seems to be materializing in various forms in our country.
Serious gender gaps are visible in health outcomes such as mortality and morbidity rates. High fertility rates and low mean age at marriage has a debilitating impact on health of girls and women. Diseases like, anemia, stemming from nutritional deficiently persist. Health outcomes depend on many factors including sanitation, clear drinking water, food security etc. of the total estimated HIV/AIDS cases in the country, 39 percent are reported to be women. mental health continues to be neglected area and health care delivery system remains ill equipped to tackle these problems, specially in the rural areas. One area that has received insufficient attention is occupational health.
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According to a new report from the United Nations, the World’s response to AIDS is at a crossroads. India now has the largest number of AIDS cases- 5-7 million in 2005 and six High Prevalence states are Tamil Nadu, Maharashtra, Karnataka, Andhra Pradesh, Manipur and Nagaland. The Government of India has launched a comprehensive National AIDS Control Programme from April 1992.
Malari is most vulnerable to tribal and remote areas. As they are inaccessible areas the operation of National Malaria Eradication Programme launched by the Government is difficult. Tuberculosis is serious public health problem in India and it has the largest number of TB and the long treatment period stretching for six months have always made it a difficult public health problem. Poor diagnostic and treatment practices followed by doctors, the emergence of drug-resistance forms of TB and the AIDS epidemic have further complicated the situation.
Leprosy is the oldest disease known to mankind and it continues to be a major health and social problem in India. The National Leprosy Control Programme was launched in 1995 and was redesigned as the National Leprosy Eradication Programme in 1983. “The Global Polio Eradication Initiative” brought a drop in the number of polio cases worldwide and India was committed to obtaining polio-free certification by 2007.
According to epidemiological data released by WHO in 2002, India had the largest number of diabetic patients in the world. The diabetic foot is thus a serious issue of great economic and social importance. To tackle the situation of diabetes, the Government of India so far has not done any specific programme and effort and the situation is going day by day worst.
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India has a long history of Community Health Insurance (CHI). The past decade has seen a remarkable increase in number of people coming under the umbrella of CHIS. The main characteristics of India CHIS are that they are initiated by voluntary organization mainly to increase access to health care for the poorer sections of society, specially Adivasis, self-employed women, farers and Dalits. Unlike the Mediclaim policies, the CHI cover is tailor-made to suit the local reality. Thus, upper limits are moderate and exclusions are minimal.
One of the daunting challenges that surfaced in the wake of the rollback of the state was how the health care needs of the poor and needy could be taken care of and the only solution to provide health care facilities to the poorer sections of the society could be the community health insurance through which the basis health care needs to be taken care of.