Healthcare | SabrangIndia News Related to Human Rights Thu, 14 Nov 2024 10:40:43 +0000 en-US hourly 1 https://wordpress.org/?v=6.2.2 https://sabrangindia.in/wp-content/uploads/2023/06/Favicon_0.png Healthcare | SabrangIndia 32 32 The MVA promise to uphold right to healthcare in Maharashtra: A visionary approach to equitable and comprehensive health access https://sabrangindia.in/the-mva-promise-to-uphold-right-to-healthcare-in-maharashtra-a-visionary-approach-to-equitable-and-comprehensive-health-access/ Thu, 14 Nov 2024 10:40:43 +0000 https://sabrangindia.in/?p=38737 Inclusive, accessible, and sustainable healthcare for every citizen, with a focus on universal access to quality care, strengthening infrastructure, empowering healthcare workers, and addressing health disparities across urban and rural communities for a healthier, more resilient state.

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Ahead of the Vidhan Sabha elections 2024, the Maha Vikas Aghadi (MVA) coalition government in Maharashtra has introduced a sweeping set of healthcare initiatives designed to establish healthcare as a fundamental right for every resident. These proposals represent a comprehensive approach to improving health outcomes, targeting diverse healthcare needs across the state. From preventive care to emergency response, the initiatives aim to close healthcare access gaps, particularly for rural and underserved populations. Below is a detailed exploration of these initiatives and why they are essential to building a healthier Maharashtra:

  • Free cervical cancer vaccines for girls aged 9 to 16

Cervical cancer is a major public health challenge in India, ranking as one of the most common cancers among women. It accounts for a significant percentage of female cancer deaths in the country, with the human papillomavirus (HPV) identified as the primary cause. The MVA government’s proposal to provide free HPV vaccines for girls aged 9 to 16 is a proactive approach to addressing this issue. This initiative is not only a public health priority but also a critical step toward achieving health equity, particularly for families with limited financial resources. Cervical cancer disproportionately affects women in low- and middle-income countries, and India bears a large share of this global burden. The lack of access to preventive healthcare, regular screenings, and costly treatments leads to high mortality rates, especially in under-resourced communities. HPV, a sexually transmitted infection, is a significant risk factor, causing nearly all cervical cancer cases. The infection often goes undetected for years, with symptoms only surfacing in advanced stages when treatment is more challenging and outcomes are poor.

  • Expansion of the Mahatma Phule Jan Arogya Scheme

The Mahatma Phule Jan Arogya Scheme (MPJAY), Maharashtra’s flagship health insurance program, has historically provided financial support for select ailments and covered certain treatments in government and empanelled private hospitals. MPJAY primarily focusses on critical and high-cost ailments rather than general health issues, covering around 1,000 types of procedures related to specific heart and kidney diseases, cancer treatments and neurological disorders, amongst others. The goal was to address life-threatening and severe medical conditions that could lead to financial catastrophe if left untreated. The scheme primarily benefited low-income families, giving them access to critical medical treatments they might not otherwise afford. 

Now, the MVA government proposes a significant expansion of MPJAY to cover all diseases, including those resulting from accidents. This transformative change aims to offer a broader safety net, shielding Maharashtra’s economically vulnerable populations from the financial hardships often associated with healthcare expenses. Expanding MPJAY is also an important step toward achieving Universal Health Coverage (UHC) for Maharashtra. In line with the goals of the National Health Mission, which advocates for accessible and affordable healthcare for all, MPJAY’s expansion contributes to creating a more inclusive healthcare system that ensures everyone can access quality medical services.

  • Review and expansion of health insurance schemes

Recognising that the current health insurance schemes have limitations, the MVA manifesto proposes a thorough review to identify gaps and expand coverage accordingly. Many existing policies don’t cover all necessary treatments, and out-of-pocket expenses remain high. Enhanced insurance schemes will give citizens better access to advanced healthcare services, benefiting especially middle-income families who often struggle to cover medical costs. Expanding insurance coverage could also help the government partner with private providers to offer subsidised treatments.

  • Free medicine availability in government hospitals

Access to free essential medicines in government hospitals is a cornerstone of affordable healthcare. This proposed policy would address the problem of patients not completing treatments due to high medication costs. Providing medicines for free ensures that economic barriers do not prevent people from receiving necessary care, especially for chronic conditions requiring lifelong medication. It also aligns with the National Health Policy’s goal to increase the availability of generic drugs in government facilities.

  • Policy for Universal Healthcare Rights

By adopting a Universal Healthcare Rights policy, MVA envisions Maharashtra joining the global efforts to make healthcare accessible and equitable for all. This proposed policy includes a commitment to improving healthcare infrastructure, human resources, and service delivery in rural and urban areas alike. It prioritises inclusive care by ensuring that even the most remote regions of Maharashtra have access to high-quality healthcare.

  • Equipping district hospitals with comprehensive facilities

Upgrading district hospitals to provide full medical services is essential for bridging healthcare disparities between urban and rural areas. District hospitals in Maharashtra lack the infrastructure to offer specialised treatments, forcing patients to travel long distances to larger cities. With comprehensive facilities, these hospitals can address a broader spectrum of health needs locally, reducing delays in critical care and improving health outcomes for rural populations.

  • Lowering population criteria for Primary Health Centres (PHCs)

In Maharashtra, remote, hilly, and tribal regions often have limited access to healthcare facilities due to challenging terrains, dispersed settlements, and low population densities. By reducing the population requirement for establishing Primary Health Centres (PHCs) from 20,000 to 10,000 in these areas, the MVA aims to address these logistical challenges and bring healthcare closer to the people. This initiative is particularly significant for Maharashtra’s tribal communities, which represent around 9% of the state’s population. These communities, often located in the Sahyadri and Satpura ranges, face not only geographic isolation but also economic and educational barriers to healthcare. Increasing the number of PHCs in these regions will allow residents to access basic health services such as maternal and child health, immunisation, and treatment for common diseases within their localities. This approach helps address longstanding healthcare disparities in Maharashtra, particularly in districts like Gadchiroli, Nandurbar, and Palghar, where the need for accessible healthcare is critical.

Reducing the population threshold to 20,000 for setting up PHCs in other rural parts of Maharashtra will also potentially bring healthcare access within reach for rural communities across the state. PHCs play a crucial role in providing first-level medical care, handling outpatient services, preventive health education, and early diagnosis for common illnesses. By making these centres more widely available, the initiative reduces the need for residents to travel long distances to larger hospitals for minor ailments and preventive care. This not only saves time and costs for rural families but also alleviates the burden on district and sub-district hospitals, allowing them to focus on more complex cases. For rural districts like Ahmednagar, Solapur, and Jalgaon, where many residents rely on agriculture and face seasonal challenges with limited income, the increased accessibility of PHCs can make a significant difference in overall community health. With improved proximity to primary healthcare, early detection and prevention of diseases such as diabetes, hypertension, and respiratory illnesses can be achieved, helping reduce the need for hospitalisations and fostering a healthier rural population.

  • Expansion of ambulance services to 2,000

The MVA’s promise to expand Maharashtra’s ambulance fleet to 2,000 vehicles is a commitment to strengthening emergency healthcare access across the state, especially for rural and remote communities where medical facilities can be hours away. In emergencies such as road accidents, natural disasters, childbirth complications, or sudden critical health conditions like heart attacks, timely medical intervention is often a matter of life and death. The increase in well-equipped ambulances, staffed by trained paramedics, will ensure that more people receive rapid, essential care at the scene and on the way to hospitals, significantly reducing response times and potentially lowering mortality rates in critical situations.

This expansion would make a tangible difference for Maharashtra’s rural districts and remote tribal areas, where many communities are located far from the nearest healthcare facility. Regions like Vidarbha, Marathwada, and the tribal areas of the Western Maharashtra, where emergency services are often hard to access, will benefit from the MVA’s focus on bridging these healthcare gaps. By proposing to increase the ambulance fleet, the MVA government aims not only to provide faster emergency responses but also to build a more resilient healthcare infrastructure that can serve all citizens, even in times of large-scale crises. This pledge shows a strong commitment to ensuring that life-saving healthcare is available and accessible across Maharashtra, delivering critical peace of mind to families statewide.

  • Right to healthcare policy development for Maharashtra

Crafting a dedicated healthcare policy that aligns with state and national standards will set clear benchmarks for healthcare services in Maharashtra. This policy will provide a foundation for accountability, ensuring all residents have equal access to healthcare. It will also streamline government operations to ensure that healthcare services reach urban and rural populations effectively.

  • Increasing the healthcare budget

An increase in healthcare spending is essential for supporting such a comprehensive healthcare program. The manifesto suggests incrementally raising the healthcare budget to 8% of the state’s total budget, aligning with recommendations in the National Health Policy. These funds will be directed towards upgrading infrastructure, expanding facilities, and ensuring sufficient medical supplies, enabling sustainable development of Maharashtra’s healthcare system.

  • Construction of a 100-Bed modern hospital in each Taluka

Maharashtra’s 358 talukas represent the administrative backbone of the state, and establishing a 100-bed hospital in each taluka will create a decentralised healthcare system. These hospitals will provide emergency care, specialised services, and in-patient facilities, reducing the burden on tertiary hospitals and ensuring more timely care for residents in their communities.

  • Community-based healthcare oversight

Activating community health committees will foster transparency and accountability in public healthcare. These committees will give local representatives and social organisations a voice in healthcare planning, empowering them to shape services that directly address their community’s needs. This model proposed by the MVA promotes citizen engagement, ensuring that healthcare remains responsive to changing local dynamics.

  • Health workforce policy and regularisation of contractual nurses

Maharashtra faces significant challenges in maintaining a sufficient and well-trained healthcare workforce, particularly in public health facilities. The state’s healthcare system is often stretched thin, especially in rural and remote areas where the availability of medical professionals is limited. The proposal for introduction of a Health Workforce Policy by the MVA government seeks to address this critical issue by prioritising the filling of existing vacancies in both urban and rural healthcare settings. This policy will focus on recruiting doctors, nurses, paramedics, and other healthcare professionals to ensure that public health centres and district hospitals are adequately staffed. A key component of this initiative is the regularisation of contractual nurses, many of whom work in precarious conditions without job security or benefits. By transitioning these nurses into permanent roles, the policy will not only offer them the stability and financial security they need but also improve their long-term commitment and investment in patient care. Nurses play a central role in the healthcare delivery system, and providing them with permanent positions will lead to better continuity of care, reduced staff turnover, and improved morale. This move will also help Maharashtra address regional disparities, ensuring that both urban and rural areas have access to a well-supported and consistent healthcare workforce, which is essential for the quality of care and patient outcomes across the state.

  • Increased remuneration for ASHA and Anganwadi Workers

Accredited Social Health Activists (ASHA) and Anganwadi workers play a critical role in grassroots health services. Maharashtra aims to increase their remuneration, recognising the demanding and often underpaid nature of their work. Despite their critical role, these workers often receive low pay, inadequate benefits, and limited job security, which has resulted in low morale and high turnover rates. Recognising their immense contribution, the MVA government has promised to increase their remuneration. This move will not only provide these workers with a fairer income but also acknowledge the demanding nature of their roles, especially in rural Maharashtra where access to healthcare facilities is limited. By improving the financial recognition of ASHA and Anganwadi workers, Maharashtra aims to ensure that these workers remain motivated and able to continue their vital work in improving community health, thereby reducing health inequalities in rural and underserved areas. Improved pay aligns with practices in states like Kerala, where higher compensation has boosted job satisfaction and led to better health outcomes in rural communities. As of March 2024, the monthly honorarium for an Accredited Social Health Activist (ASHA) worker in Maharashtra is ₹13,000, which is a ₹5,000 increase from the previous amount, bringing it to one of the highest paying states.

  • Expanded generic medicine centres and free essential medicines

Offering free essential medicines and expanding generic medicine centers will make treatments more affordable, especially for marginalised communities. Generic centres reduce dependency on costlier branded medicines, encouraging patients to adhere to prescribed treatments and preventing diseases from worsening.

  • ‘Stree Shakti’ initiative for women’s health

With over half of India’s women facing anemia, the ‘Stree Shakti’ initiative addresses a critical health issue that affects women’s productivity, pregnancy outcomes, and quality of life. This proposed initiative by the MVA will provide supplements and healthcare support, targeting anemia reduction and improving maternal and child health, leading to a healthier future generation.

  • Malnutrition control and Tribal Health and Nutrition Missions

Malnutrition remains a challenge in India, especially in tribal regions. A dedicated Malnutrition Control Board and Tribal Health and Nutrition Mission will coordinate resources and interventions to tackle this problem. The Tribal Health and Nutrition Mission proposed by the MVA in particular, will focus on unique health challenges faced by tribal populations, such as sickle cell anemia and other genetic disorders, improving health equity across Maharashtra.

  • Free medication for chronic diseases and preventive health initiatives

Chronic conditions such as diabetes and hypertension are rising in India. According to the manifesto of MVA, they will be providing free medication and encourage early screening so that complications can be prevented, hospitalisations can be reduced, and patients’ quality of life can be removed. Initiatives to control malaria, dengue, TB, and chikungunya reflect a proactive stance on public health.

  • Expanded mental health services

Today, mental health issues like depression, anxiety, and digital addiction are being openly discussed and have also become a priority. Establishing counselling centres across the state will make mental health services more accessible, promoting mental well-being and helping residents manage life’s pressures more effectively.

  • Transparency and accountability in healthcare services

By implementing a Patient Rights Charter and setting up grievance cells, MVA envisions Maharashtra to make healthcare services more accountable. This transparency will improve trust in public healthcare, giving patients the security of knowing their rights are protected and they have recourse if standards are not met.

  • Telemedicine helpline and clean drinking water initiatives

As proposed by the MVA, the telemedicine helpline will provide a valuable resource for remote communities who face challenges accessing healthcare facilities. Clean drinking water campaigns, like ‘Nirmal Jal,’ will combat waterborne illnesses, improving health outcomes in regions such as Marathwada and Vidarbha.

  • Addressing the safety of healthcare workers in Maharashtra

The safety of doctors and healthcare professionals is a growing concern in Maharashtra, as across the country, the rise in assaults on medical staff has become a significant issue. These incidents not only jeopardise the physical safety of doctors and staff but also undermine the overall healthcare system, creating an environment of fear and discouragement among medical professionals. To address this, the MVA government has recognised the need for robust measures to protect healthcare workers, emphasising the importance of maintaining a safe working environment for medical staff. The government is committed to taking necessary precautions, such as implementing stricter laws and enforcement against those who resort to violence, introducing better security systems in hospitals, and training healthcare workers in conflict resolution techniques. In addition, the creation of a more supportive environment, including the establishment of dedicated grievance redressal mechanisms for healthcare workers, can help prevent such incidents and ensure that healthcare providers can focus on delivering quality care without the fear of physical harm.

The MVA’s approach to tackling violence against healthcare workers is not just about improving security measures but also about changing the broader culture of healthcare in Maharashtra. The government’s focus on preventing assaults on doctors and medical staff involves not only legislative action but also enhancing public awareness about the importance of treating healthcare workers with dignity and respect. Public campaigns and outreach programs will educate the public on the challenges faced by doctors, especially in high-stress environments like government hospitals where the patient load is often high, and resources are limited. Moreover, strengthening hospital security through the installation of CCTV cameras, increasing the presence of trained security personnel, and enforcing protocols for handling volatile situations will create a safer space for healthcare providers. In the long run, these efforts will encourage more healthcare professionals to work in public hospitals, knowing that their safety and well-being are a priority, thereby improving the overall healthcare system in Maharashtra.

  • Target to raise life expectancy to 77 years

Aiming to increase life expectancy reflects Maharashtra’s commitment to a holistic approach to health. Improved public health, accessible healthcare services, and initiatives focused on clean water, sanitation, and preventive care will contribute to a healthier, longer-living population, ultimately enhancing the state’s social and economic development.

Building an inclusive and comprehensive healthcare system for all

The MVA’s healthcare manifesto sets the stage for a transformative shift in Maharashtra’s healthcare landscape, focusing on inclusivity and equity in access to medical care. By implementing a universal healthcare policy, the government aims to ensure that no one, regardless of their economic background, geographic location, or social status, is left behind. The promise to expand primary healthcare services in rural, remote, and tribal areas—by reducing the population threshold for establishing Primary Health Centres (PHCs)—will bring essential healthcare services closer to communities that have historically faced challenges in accessing quality care. The increase in ambulance services to 2,000 vehicles ensures faster and more reliable emergency medical response, reducing delays that can be the difference between life and death in critical situations. This approach will help alleviate the burden on overextended urban hospitals, offering decentralised healthcare options that empower local communities.

Moreover, the commitment to free medicines, vaccination programs, and cancer treatment for women highlights the government’s drive to make healthcare affordable and accessible for all. The MVA’s initiatives will improve health outcomes in marginalised communities, such as the tribal regions of Vidarbha, Marathwada, and the Western Ghats, by addressing health disparities that have persisted for years. This focus on preventive healthcare, including expanding the availability of HPV vaccines, malnutrition control programs, and maternal and child health initiatives, will help reduce the long-term disease burden, improving overall population health and reducing the pressure on expensive hospital treatments. These measures form the foundation of a healthcare system where quality care is guaranteed as a right, not a privilege, contributing to the overall well-being of every citizen across the state.

Sustainable healthcare infrastructure and empowerment of medical workers

The MVA manifesto’s vision extends beyond just expanding access; it aims to build a sustainable healthcare infrastructure that is robust, resilient, and future-ready. With initiatives like equipping every sub-district hospital, building 100-bed modern hospitals in each taluka, and enhancing district hospital facilities, the MVA government is ensuring that Maharashtra’s healthcare infrastructure will be able to handle both present and future challenges. The inclusion of Mohalla clinics in urban areas will make healthcare services more accessible on a local level, while the creation of a Health Workforce Policy and the regularisation of contractual nurses will ensure that the state is equipped with a skilled and motivated healthcare workforce. By addressing the remuneration and job security of crucial grassroots workers like ASHA and Anganwadi workers, the MVA government is directly improving the quality of healthcare at the community level, empowering those who are often the first point of contact for rural and underprivileged populations.

These initiatives, which focus on both infrastructure and workforce development, are designed to create a healthcare system that can withstand future pressures, such as a growing population or emerging health crises. The promise to improve security measures for doctors and prevent assaults further strengthens the healthcare ecosystem by ensuring that medical professionals can work in a safe, supportive environment. Together, these transformative changes will not only increase the state’s healthcare coverage but also foster an environment where medical professionals, from frontline health workers to doctors, can thrive. By prioritising healthcare as a fundamental right and building a system that supports both patients and providers, MVA envisions Maharashtra to be on the path to becoming a model state for healthcare, one that sets new standards for accessibility, quality, and sustainability.

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UP’s healthcare hub facade built by regime’s friends in the news media? https://sabrangindia.in/ups-healthcare-hub-facade-built-regimes-friends-news-media/ Mon, 13 Dec 2021 12:07:00 +0000 http://localhost/sabrangv4/2021/12/13/ups-healthcare-hub-facade-built-regimes-friends-news-media/ Media outlets perceived to be close to the regime appear to be working overtime to create positive image despite official data pointing to very different ground realities

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UP Healthcare
Representational Image

A section of the news media, that either has strong right-wing leanings, or is perceived to be close to the regime, appears to have taken it upon itself to push Uttar Pradesh Chief Minister Yogi Adityanath’s claims of turning the state into a “healthcare hub”. Following the state government’s boasts in late-November, media-houses sites like Zee News, e-Health, the Hindustan Times have repeatedly endorsed the idea that ‘UP is becoming a medical hub with the Centre’s assistance’.

“Committed to provide better medical facilities to the people of Uttar Pradesh, the Yogi government is rapidly enhancing the health facilities in the state,” said Zee News while talking about the administration’s “one district one medical college” policy.

According to the article, the state government by December 12, 2021 opened two All India Institute of Medical Sciences (AIIMS) in Gorakhpur and Rae Bareli that have already started out patient services. The publication further highlighted that the BJP had established private or government medical colleges in 16 districts that previously did not have this facility during the tenure of “other governments”.

UP Healthcare

Yet, despite pointing out the shortcomings of previous governments, the article did not comment on the sudden influx of viral fever cases around September. Approximately 200 people were diagnosed with dengue-like symptoms of which 100-150 were young children. Between September 10 and September 25, as many as 84 children suffered encephalitis in the Purvanchal region. Parents grieved their children’s death outside hospitals because they were unable to find vacant beds in nearby hospitals.

Still the Hindustan Times on November 21 did not challenge Adityanath’s claim that all 75 districts “are well equipped with ICU beds, 1.80 lakh emergency beds, and [that] 518 oxygen plants have also become operational.”

It is worth asking the government whether these plants became operational following the second-wave of Covid-19, when people were resorting to social media to avail oxygen cylinders. At the time, the Yogi-government had threatened citizens with arrests and FIRs if they “spread panic” regarding the pandemic by enquiring about oxygen supplies or storage capacity via the internet.

A CAG report on 2019 state functioning in particular condemned the government for their “lackadaisical approach [that] resulted in unfruitful expenditure of Rs. 1.88 crore on procurement of Central Oxygen System (COS), which could not be made operational even after a lapse of more than 8-10 years.”

The report said that the release of full payment to suppliers without getting the COS operational, the failure to ensure preventive maintenance of supplied equipment and no training to hospital staff for use of the system and failure to have timely conversations with the suppliers led to the huge fiscal waste. It also pointed out how the concerned District Hospital in Agra continued to depend on small cylinders because the COS was lying non-functional until 2020, despite government assurances as far back as December 2017.

During the Lok Bhavan speech, the Chief Minister said that the government built 33 medical colleges in the last four-and-a-half years, out of which nine medical colleges have become operational. Even so, these claims fall flat on recollecting that citizens found no vacant beds in their area despite contrary information on government portal.

The recent CAG report also showed how the Medical Health and Family Welfare Department failed to impose a penalty of Rs. 6.17 crore on non-supply of medicines/drugs resulting in undue benefit to suppliers coupled with the risk of inadequate patient treatment.

Unfazed by all this, the e-Health website on November 26 spoke about how “sustained efforts” of the BJP government led to less malnourished children as per the National Family Health Survey 5 (NFHS-5).

“Due to the relentless efforts of the state government, UP has shown considerable progress in the National Family Health Survey-5,” said the report.

UP Healthcare

In fact, the data showed that 7.3 percent of children under 5 years are severely wasted while 3.1 percent of children of the same age-group are overweight. In the NFHS-4 report, 6 percent children from the same age-group were severely wasted and 1.5 percent were obese. In general, obesity among adult women increased from 16.5 percent in 2015-16 to 21.3 percent in 2019-21. Similarly, obesity among men increased from 12.5 percent in 2015-16 to 18.5 percent in 2019-21.

The report also went on to note how 66.4 percent children between 6-59 months are anaemic as compared to 63.2 percent in the previous report.

Regarding health-related information, the NFHS-5 reported that 13.1 percent women and 22.1 percent men have comprehensive knowledge about HIV/AIDS – less than the 17.5 percent women and 26.2 percent men who were informed about the same in 2015-16.

As UP elections 2022 draw closer, the state government, and their stooges in the news media, have jumped into action singing praises about the administrative work in the state so far. However, data and on-ground reports indicate otherwise.

Anganwadi workers and ASHAs, who acted as the backbone of the entire healthcare system during the global pandemic are yet to receive their dues. As the second wave of coronavirus subsided, ASHAs observed a nationwide campaign to demand their dues. However, like the workers in other states, their demands remain unnoticed. Instead, the state nowadays witnesses more protests by farmers and teachers, indicating that after the health sector, workers from other social sectors have begun voicing their apprehension about the state government functioning.

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Make Right to Health a fundamental right: Oxfam India’s report on unequal healthcare https://sabrangindia.in/make-right-health-fundamental-right-oxfam-indias-report-unequal-healthcare/ Tue, 20 Jul 2021 08:48:46 +0000 http://localhost/sabrangv4/2021/07/20/make-right-health-fundamental-right-oxfam-indias-report-unequal-healthcare/ A detailed and comprehensive analysis, uses data since 2015-16 to understand the persisting issues of health inequalities in India

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Oxfam IndiaImage Courtesy:mediaindia.eu

The right to health should be enacted as a fundamental right, demands Oxfam India in its Inequality Report 2021. The report analyses the country’s weak public healthcare system, health inequalities and the ongoing pandemic.

Titled India’s Unequal Healthcare Story, the report provides a comprehensive analysis of the health status across different socioeconomic groups such as marginalised communities that suffer from ill-health the most.

“The general category performs better than SCs and STs, Hindus perform better than Muslims, the rich perform better than the poor, men are better off than women, and the urban population is better off than the rural population on various health indicators,” said the report in its introduction.

Further in the report there is a closer look at health inequalities during the recent health emergency.

India’s healthcare and Covid 19

While analysing state performance in terms of the global pandemic, the report found that states that attempt to reduce social inequalities and spend more on health reported lower confirmed cases. However, states attempting to reduce inequalities showed lower recovery rate as well. 

According to contributor Apoorva Mahendru, this may be because the ‘Reduced Inequality Index’ used by the report does not take into account factors like social distancing, access to improved water and sanitation. Such access contributes greatly to recovery from Covid-19. These same factors are not easily available for marginalised communities.

Similarly, higher-income groups could easily arrange for transport to hospitals. Among the lowest income bracket, comprising households with a monthly income of Rs. 15,000, the report found that 30 percent had to arrange for transport themselves. In households with income of Rs. 30,000 or less, 14.8 percent and 22.2 percent faced issues of slow response and quality of food served, respectively.

“Percentage of respondents in low-income brackets facing discrimination in the community due to being Covid positive was five times than those in high-income brackets,” said the report.

Further, over 50 percent of people hailing from Scheduled Castes (SC) and Scheduled Tribes (ST) faced difficulties in accessing non-Covid medical facilities compared to 18.2 percent in the general category. In the same way, only 3.9 percent of general category respondents depended on springs or streams for water consumption. The figure for Scheduled Castes was four times that of the open category. This means that more SCs were forced to use unsafe sources of water.

In terms of gender disparity, 33.9 percent of female respondents experienced anxiety, irritation and anger, and sleep-deprivation during the lockdown compared to 18.2 percent males.

“This is because of an increase in women’s unpaid care work burden at home, increase in cases of domestic violence, and probability of re-employment of women lesser than that of men post-lockdown,” said the report.

Experts also pointed out that current vaccination drives are blind to the digital divide in India. At the beginning of the pandemic, only 15 percent rural households had internet connection, smartphone users in rural India were almost half of urban India. More than 60 percent of women across 12 states said they had never used the internet. SCs and STs with smartphones stood at 25 and 23 percent respectively, while 43 percent open category individuals had access to smartphones.

“The number of Covid cases doubled in the second wave. The second wave hit the middle class more with 90 percent of all cases in Mumbai concentrated in high-rise buildings, while 10 percent were in slums,” said the report.

Considering infrastructure, India ranks 155 out of 167 countries on bed availability. It has five beds and 8.6 doctors per 10,000 of its population. However, only 40 percent of beds are concentrated in rural India that houses 70 percent of the population.

Social inequalities and its impact on healthcare

Using National Family Health Survey (NFHS) 3 and 4 data, the report stated that literacy rate for general category women is 18.6 percent higher than SC women and 27.9 percent higher than ST women.

“Education, specifically of women, has a direct effect on improving the health outcome at the level of the household as educated women are known to take informed healthcare decisions,” said contributor Khalid Khan.

Thus, the health inequality is evident in the attainment of female literacy with a gap of 55.1 percent between the top and bottom 20 percent of population in 2015-16.

In case of water and sanitation, two out of three households have access to improved, non-shared sanitation facilities in the general category. Meanwhile, SC households are 28.5 percent behind the open category and ST are 39.8 percent behind them. It is worth noting that poor water, sanitation and hygiene conditions were responsible for 1,00,000 deaths from diarrhoeal diseases in under-five children in 2015 in India.

Moreover, while 93.4 percent of households in the top 20 percent have access to improved sanitation, only 6 percent have access in the bottom 20 percent, a difference of 87.4 percent.

Regarding household expenditure on health, one in every six rupees spent on hospitalization by households is financed through borrowings. Less than one-third of households were covered by a government insurance scheme in 2015-16.

Another indicator of health inequality are institutional and home births. Though the gap in the institutional delivery of rural-urban, caste, religion and income groups has been declining over the decade, inequality prevails across these categories.

Institutional births in ST households were 15 percent below general category births in 2015- 16. There is a 35 percent gap in institutional births between the lowest and highest 20 percent wealth quintile groups in 2015-16.

Further, despite improvement in child immunisation, female-child immunisation rate continues to be below that of the male child. Similarly, more children in urban areas are immunised compared to rural children. Immunisation of SCs and STs is behind that of other caste groups. The child immunisation of the high wealth quintile group is much higher than of low wealth quintile.

Even in terms of nutrition, the difference between stunted children in SC and ST households and those in general category households is 12.6 and 13.6 percent, respectively. One in every two children are anaemic, wherein 60 percent of anaemic children are from SC and ST households.

Efficacy of government intervention

In the last 10 years, around 18 percent Indians have begun seeking some form of healthcare when they report being sick. Still, the current health status is a testament to the unfulfilled dream of ‘Health for All’ said contributor Mayurakshi Datta.

“The right to the highest attainable health is far from being realized. This holds especially true for the socially and economically marginalised,” said Datta.

In the 2021-22 budget, the health ministry has been allocated Rs. 76,901 crore, 9.8 percent less than Rs. 85,250 crore reported from revised estimates of 2020-21. Moreover, public funds for health have also been invested specifically on secondary and tertiary care rather than primary healthcare. Meanwhile, private healthcare providers are thriving, widening inequalities along caste, class, gender and geography.

“Health insurance schemes are being promoted as a way to achieve UHC [Universal Health Coverage] and to reduce OOPE [Out-of-Pocket Expenditure]. But evidence shows that the limited scope and coverage of the insurance schemes cannot address the all-encompassing requirements of UHC,” said the report.

So what next?

Aside from a call for right to health and free vaccine policy, the report called for an increase in health spending to 2.5 percent of GDP at the union and state level.

They also called upon the government to ensure that union budgetary allocation in health for SCs and STs is proportionate to their population while dedicating two-thirds of the concerned budget to primary healthcare. The centre should provide financial support to states with low per capita health expenditure to reduce inter-state inequality in health.

Regions with higher concentration of marginalised population should be identified and public health facilities should be established, equipped and made fully functional as per Indian Public Health Standards (IPHS).

While the report does not endorse Government-financed Health Insurance Schemes (GFHIS) as a way to achieve UHC, it is imperative that GFHIS widens its ambit to include outpatient costs as a way to reduce out-of-pocket expenditure (OOPE).

Experts also called for a centrally-sponsored scheme that earmarks funds for free essential drugs and diagnostics at all public health facilities. Further, rights under the Patients’ Rights Charter should be made enforceable by law.

The private health sector must be regulated by ensuring that all state governments adopt and effectively implement Clinical Establishments Act. They also called for regularisation of women frontline health workers services especially Accredited Social Health Activists (ASHAs), establishing government medical colleges with district hospitals prioritising their establishment in hilly, tribal, rural and other hard-to-reach areas, enhancing medical infrastructure and establishing contingency plans for scenarios such as the second wave of the pandemic.

Report can be read here:

Related:

Is the right to health a forgotten constitutional mandate?
Protect people’s health and life: JSA to gov’ts
Great Number Game of Vaccine Funding: Zero Allotment = Rs. 35000 Crores !!!
Using digital portal for vaccination will impede universal immunisation: SC

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Protect people’s health and life: JSA to gov’ts https://sabrangindia.in/protect-peoples-health-and-life-jsa-govts/ Wed, 23 Jun 2021 04:22:53 +0000 http://localhost/sabrangv4/2021/06/23/protect-peoples-health-and-life-jsa-govts/ Public health campaigner demands healthcare, vaccination for all

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Image Courtesy:phmovement.org

Jan Swathya Abhiyan (JSA), India’s national network of civil society groups and people’s movements working for health rights, condemns the central government’s failure and demands that both central and state administration fulfill their duties in protecting people’s lives. It has demanded a slew of policy measures aimed at improving public access to healthcare and vaccination amidst the Covid-19 pandemic. JSA has shared their observations and a list of obligations of central and state governments in a statement. 

As many as four lakh new Covid-cases and over 3,500 deaths were officially recorded on May 1, 2021 marking yet another grim milestone for India’s Covid-crisis. Major cities, districts continue to struggle to provide basic healthcare to people. JSA also took note of how cremation grounds overflowed, how Maha-kumbh, election rallies and ignorance of social distancing ran rampant in the country despite explicit warnings by the Parliamentary Standing Committee on Health and the Family Welfare Committee about an impending second wave. 

JSA called for a proper plan of action against the third wave and warned from repeating the previous mistake of laxity. The government erred greatly in scaling back measures for health systems strengthening. This left the whole nation vulnerable to the second wave catastrophe that followed. The organisation said that all democratic institutions, scientists, health movements and people must remain vigilant to keep this from happening again.

Accordingly, it reminded governments of their obligation to: 

  • provide free treatment, transport and healthcare for all
  • beds with oxygen for critical Covid care 
  • access to quality testing 
  • effective contact tracing, quarantine and isolation facilities 
  • universal vaccination with priority to the vulnerable
  • prevent violation of civil rights and liberties, etc.

The complete list of government obligations along with a detailed list of urgently required policy measures are listed below:

Related:

Almost, but not quite…
An Indian’s right to vaccination amidst a global pandemic
Covid-19: Which states fared worst and why?
Factsheet on the Rights of the Dead in India

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Covid-19: Which Indian states tackled it effectively and how? https://sabrangindia.in/covid-19-which-indian-states-tackled-it-effectively-and-how/ Fri, 28 May 2021 09:21:24 +0000 http://localhost/sabrangv4/2021/05/28/covid-19-which-indian-states-tackled-it-effectively-and-how/ We analyse how some states have fared better than other in managing the Covid crisis in the past year, and what sets them apart. In this deep dive into healthcare systems, we find out whether higher spending on healthcare by government has enabled some states to be more prepared in tackling this on-going crisis

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The pandemic while bringing on a sea of tragedies for Indians, has exposed the unpreparedness of callous governments which left people to the mercy of an over-burdened and a structurally weak health system.

While the enormity of the second wave of Covid in India caught the central as well as state governments off guard, the myopic, even authoritarian attitude of the Central government in 2020, taking decisions unilaterally without consulting state governments has made matters worse.

Under the Constitution, health is a state subject and it is for states to build their own capacities and health care systems as they deem fit. However, at times of crises, in the true spirit of federalism, under the National Disaster Management Act (NDMA), 2005, consultation and coordination are key. This has been woefully lacking.

A healthy cooperative spirit honouring the Federal principles of the Indian Constitution would have been in order; setting up an Inter-State Coordination mechanism that was consultative and inclusive. Instead, we had a series of diktats and flip-flops from the Centre. This combined with weakened state health infrastructures left populations reeling.

Some states fared better: How and Why?

  • Nos of persons/ Primary Health Centres
  • Nos of Govt Doctors/Persons, Population

While putting the onus entirely upon the states in terms of handling the Covid-19 Pandemic is not entirely correct legally speaking, it remains crucial to examine the role played by state governments and how some states have fared better in managing the Covid-19 fallout better than some other states. There are certainly many factors involved here including building of a robust public health care system over the years, building capacity, augmenting and retaining human resources especially medical professionals, maintaining optimum levels of bed to population and doctor to population ratio as also real time management of crisis by administration under the leadership of an able government. More than anything else, making good, efficient and affordable healthcare accessible to the maximum number of Indians, in the most remote areas, is fundamental to democratising the right to health.

Role of state governments

The International Monetary Fund in its latest World Economic Outlook October 2020 has advocated all major economies to allocate adequate resources for healthcare as the near-term policy priority. While availability of hospital beds and health care workers is essential, elaborate and sustained administrative support and additional healthcare expenditure has gained importance in managing a crisis like Covid. Therefore, a simplistic analysis of public health expenditure will not reflect upon a state’s performance in handling Covid.

The second wave/surge of Covid in 2021 caught the Centre as well as States completely not just unawares but showed up Indian authorities for an absence of scientific and rational understanding of a worldwide Pandemic. Worldwide countries and societies experienced a second wave while India carelessly gloated on coming out of the Pandemic. This attitude showed up the unpreparedness of governments and the callous complacency that set in due to a brief dip in cases which was not in tandem with increasing administration of vaccination doses to the maximum population.

Money spent by the state government on health infrastructure, mainly public health care system, may give the government a solid foundation to work on but it is not a sure shot way of handling the crisis. Having a robust public health care system includes infrastructure, a strong referral system as well as adequate human resources, adequate coverage proportionate to the population and so on.

One of the most important strategies to reduce the out-of-pocket expenditure is to strengthen the primary health care system in the state. Health care systems build on a strong comprehensive primary care service acts as a platform which can reduce the health expenditure considerably.

Public Health Activist, Ravi Duggal, wrote in June 2020 in The Hindu Businessline that states that spend more on health care were less affected by the Covid impact.[1] Larger states like Bihar, Uttar Pradesh, Jharkhand, Madhya Pradesh, Odisha, West Bengal, Karnataka, Gujarat, Maharashtra and Punjab turned out to have the weakest primary healthcare system owing to low spending on health care. Says Duggal, two indicators of availability of public health services is the number of government doctors per lakh population and number of persons per Primary Health Centre (PHC). Again, states like Bihar, Uttar Pradesh, Maharashtra, Karnataka, and West Bengal have more than 30,000 persons per PHC and less than the national average of nine government doctors per lakh population. It is not a coincidence that Maharashtra, Karnataka and UP have also allowed privatisation of the health infrastructure.

The data derived from Health Ministry’s National Health Profile, 2019 showed that Kerala had 15 government doctors per lakh population and 42,403 persons per PHC. On another scale, where WHO recommends a doctor patient ratio of 10:10,000 in Kerala it is 16.5 doctors per 10,000.

The data on public health expenditures across states is reflected in a table as below:

Privatisation of public health care

The NITI Aayog has recommended  handing over of district hospitals to the private sector under PPP arrangements as a solution for improving health care system. However, data increasingly suggests that states which have reasonably robust primary healthcare have been able to deal with the Covid first wave, better than the states that did not have a good public health system. Naturally, the same is analogous to higher spending of states on health care out of its GDP and its annual budget. The 2017 National Health Policy recommends 2.5 per cent of GDP or ₹3,800 per capita (at 2017 prices) as the appropriate spending for delivering reasonably good health care predominantly through public health facilities. This translates into ₹5 lakh crore public health spending for the country or 2.5 per cent of GDP or 8.3 per cent of total government budgets.

Privatisation of public health care will only increase out of pocket expenses for people, making health care more and more expensive in the country and out of reach of millions. The example is playing out in reality as governments and courts are having a hard time capping rates charged by private hospitals for Covid treatment. Even in times of such a national health emergency, the private sector sticks to it primary objective – making money. On the other hand, a public health care system has been over burdened and taking on patients unable to afford the sky rocketing private hospital charges.

Almost  62.4% of expenditure on health is borne by households and rest by government. It is well-known that such a high share of out-of-pocket expenses imposes a financial hardship on household budgets and more than often pushes vulnerable households into debt and poverty.

Kerala tops the charts

Kerala has seen the third highest cases in the country following Maharashtra and Karnataka with more than 24.2 lakh cases and over 7,000 deaths – –as per the official count– as of May 24. Mathematicians and data management experts worldwide have projected that India’s deaths could well be three-five times higher than officially admitted figures.

Primary Healthcare Performance Initiative analysed Kerala’s health care reform over the years whereby the state gave local governments control of 35 to 40% of the state budget for improving care and access, regardless of income level, caste, tribe, or gender, reflecting a goal of not just effective but also equitable coverage. The current Public Health Centre (PHC) system consists of sub-centers, primary health centers that support five to six sub-centers and serve a village, and community health centers. Overall, Kerala has maintained low infant and maternal mortality rates, and higher literacy rates, when compared to the national average.[2]

Kerala’s Expert Committee for health submitted a report in 2014 whereby it identified Kerala to have one of the highest ‘out of pocket’ expenditures on health in the country. As per National Health Accounts (2004-05) Kerala had the highest per capita public expenditure as well as highest private expenditure in the country. In its 2020-21 budget, Kerala has allocated 5.5% of its total expenditure on health.

An article in the Huffington Post stated that for over 60 years, Kerala’s health indicators—infant and child mortality rates, birth rates, life expectancy, sex ratio and maternal mortality ratios—have consistently topped the country, despite its middling economic achievements and high unemployment rates.

On May 10, Kerala government fixed a cap on prices that may be charged by private hospitals for Covid treatments. General wards would now cost Rs. 2,645 per day including registration charges, bed charges, nursing and boarding charges, surgeons, anaesthetists, medical practitioner, consultant charges, blood transfusions, oxygen, medicines, pathology and radiology tests and others.With the same facilities, an ICU bed will cost Rs. 7,800 and an ICU bed with a ventilator is capped at Rs.13,800. This move was lauded by the Kerala High Court as well.

Kerala is often described as a state without the urban-rural divide, with civic infrastructure in rural areas being comparable to those in cities. It is also a state with the highest elderly population in the country, with about a fifth of its population over 60.

A report in Al Jazeera from May 11 states that in Kerala and Tamil Nadu, medical oxygen production was augmented and hospital capacities were increased expecting cyclical spikes and troughs of Covid-19 infections. Until late March, Kerala’s case fatality rate (CFR), which is the percentage of deaths to positive coronavirus cases, hovered at 0.32 percent, while in Tamil Nadu, it was 0.52.[3]

However, the state Assembly elections became the hindrance in the continued efforts of the administration to keep Covid spread in check and compelled the newly elected government to enforce a lockdown. Yet, Kerala is one of the few states, which has not faced oxygen shortage until now. In the past year, Petroleum and Explosive Safety Organisation has made concerted efforts to set up oxygen plants and maintain the existing ASU (Air Separation Unit) plants and manufacturing plants both in public and private sectors.[4]

Tamil Nadu

Tamil Nadu has seen 19.4 lakh cases with over 21,000 deaths –as per the official count– as of May 24. Mathematicians and date management experts worldwide have projected that India’s deaths could well be three-five times higher than officially admitted figures.

The State has separate Directorate of Public Health with its own budget. It is staffed by a professional cadre of trained public health managers who are promoted to the Directorate after long years of experience of planning and oversight of public health services in both rural and urban areas.

A study by Swaniti Initiative on Tamil Nadu Public Health System states that apart from having a separate budget for public health in Tamil Nadu, the size of the public health budget is large relative to spending on secondary/tertiary medical care and medical education. The Directorate of Public Health has consistently had larger budgets than the two other Directorates in the Health Department. The state (a) separates the medical officers into the public health and medical tracks, (b) requires those in the public health track to obtain a public health qualification in addition to their medical degree, and (c) orients their work towards managing population-wide health services and primary health care ─ while those in the medical track obtain additional clinical qualifications and are oriented towards providing hospital care.[5]

Tamil Nadu has a Public Health Act, which specifies the legal and administrative structures under which a public health system functions, assigns responsibilities and power to different levels of government and agencies.

A research conducted in 2019 indicated that OOPE per episode of hospitalization in public health centers was lowest in Tamil Nadu (₹2395) and highest in Punjab (₹10540).[6]The Chief Minister Comprehensive Health Insurance Schemes (CMCHIS)cover costs up to ₹5 lacs including quality medical and surgical treatment in public and private health centers. Studies also suggest that good public health care infrastructure, distribution of free medicines, and health insurance for formal sector employees may be the other reasons for low OOPE in Tamil Nadu.[7] While WHO recommends a doctor patient ratio of 10:10,000 in Tamil Nadu it is 19.1 doctors per 10,000.

Tamil Nadu implemented free medicine distribution scheme for all who are utilising public health facilities for treatment since 1995

In its 2020-21 budget, the state has allocated 5.7% of its total expenditure on health. A report in Al Jazeera from May 11 states that in Kerala and Tamil Nadu, medical oxygen production was augmented and hospital capacities were increased expecting cyclical spikes and troughs of Covid-19 infections. Until late March, Kerala’s case fatality rate (CFR), which is the percentage of deaths to positive coronavirus cases, hovered at 0.32 percent, while in Tamil Nadu, it was 0.52.[8]

However, the state Assembly Elections became the hindrance in the continued efforts of the administration to keep Covid spread in check and compelled the newly elected government to enforce a lockdown. Worse, mass election rallies, negative and irresponsible messaging by leaders (giving speeches without wearing masks) caused a rapid spread of the virus. Until April 23, there was sufficient oxygen supply in the state but merely 2 weeks later, the state was facing a shortage of 50 MT of oxygen and the Sterlite plant which was set to open in a week was the faint hope for the state. Chennai has been operating an oxygen war room which functions 24×7 since May 6 with the aim to create a smooth access chain for oxygen for hospitals treating Covid patients in the state.

Odisha

The state has had 7.1 lakh cases as of May 24 and has had about 2,500 deaths – as per the official count—so far. Mathematicians and date management experts worldwide have projected that India’s deaths could well be three-five times higher than officially admitted figures.

Odisha is the second most poor state in India (estimated poverty rate of 32.6%[9]) in the country with a population of over 42 million and a large concentration of scheduled caste and schedule tribe population. Despite high levels of poverty in the state, there have been notable improvements in health outcomes. The state has combated issues like child mortality, maternal mortality over the years.

Political stability in the state has been attributed to political attention towards socio economic development. The per capita spending on health by Odisha government has increased over the years. In 2018 it was Rs.1,143 which increased to Rs.1,413 in 2019 and marginally increased to Rs.1,557 in 2020. It’s not among the highest per capita spends compared to other states where you have north eastern states with way higher expenditure like Arunachal Pradesh (Rs.10,869), Sikkim (Rs.5,971), Mizoram (Rs.5,145) to name a few but it’s definitely more than a few larger states like Maharashtra (Rs.1,266), Uttar Pradesh (Rs.1,032) and Karnataka (Rs.1,505).

Owing to its high poverty levels, the state’s health policy was more focused on an equity based health policy. The Health Equity Strategy (2009–12) aimed to improve the health of the most disadvantaged people in the State, and recognizes the particularly poor health status of Scheduled Tribes and Scheduled Castes and the comparatively poorer districts. The Nutrition Operational Plan (2009–15) aimed to achieve maximum nutritional health of all children below six years of age, especially for the poorest and the most disadvantaged, through effective inter-sectoral coordination.

In Odisha a strong focus of the Health Equity Strategy and the Nutrition Operational Plan was closing the health and nutrition gap between state level outcomes and those of Scheduled Tribes and Scheduled Castes and the underserved KBK+ districts.[10]The Southern belt of 11 districts in the state is known as KBK+ and is made up of the districts of Bolangir, Boudh, Gajapati, Kalahandi, Khandamal, Koraput, Malkangiri, Nabarangpur, Nuapada, Rayagada, and Sonepur.

In Odisha, the underserved and poorer districts in KBK+ have been given special attention including mobile health units which have become the major source of health care in the remote and inaccessible villages. The other efforts include control of malaria related deaths, increasing access of women to health care, posting newly appointed doctors in KBK+ areas and paying them more, increasing institutional deliveries, carrying out surveys to identity out of pocket expenses and so on. This has resulted in reduced gap in ST women and children and others in utilising health care, increased institutional deliveries, progress in reducing number of underweight and stunted children, reducing nutrition disparities in ST children and other social groups and so on.[11]

Odisha was the first state that took proactive steps to ramp up its health care system particularly having a Covid-19 hospital with intensive care units (ICUs) on public–private partnership mode and was among few states to have created a Covid-19 hospital at each district in record time. It also took measures like and setting up a taskforce to oversee the Covid-19 response daily press briefings. These proactive efforts suffered a slight blow when migrants started returning to the various districts across the state in May 2020. Overall, though, it has managed to keep its fatality rate to very low i.e., 0.4%. At present, Odisha has 50 Covid hospitals with maximum number of seven such hospitals in the most affected Ganjam district. Besides, it has built-up 178 Covid care centres and 17,647 temporary medical centres (TMCs). Bulk of these facilities was created as early as May 2020 when number of Covid cases was not so high and by end of May, 2020 it had dedicated Covid health centres in all districts. The government used panchayats and community-based organisations like well-entrenched self-help groups for managing the movement of migrant workers, arranging shelter and running quarantine centres to providing other critical support.

While many states were found struggling in the initial phase of pandemic, Odisha’s long experience of running relief operations during natural disasters has come critical in terms of swiftly organising shelters for migrants and stranded persons during the lockdown. in April, the state empowered sarpanches to ensure quarantine of returnees and their families and all Gram Panchayats (GPs) were allowed to exercise their jurisdictions at the ground level to aid monitoring efforts of the facilities. [12] Odisha has allocated 5.5% of its expenditure for health in 2020-21.

Low public spending = poverty

While public spending on health is an indicator of good human development index, it is also an indicator of poverty. It is largely observed that people get pushed into poverty due to higher out of pocket expenses (OOPE) on health, since that expense is unavoidable and with a weak public health system, people are compelled to shell out money from their pockets for untoward or unforeseen medical emergencies which pushes them further towards poverty.

Evidence shows that medical poverty owing to high OOPE increased from 32.5 million in 1999–2000 to 50.6 million in 2011–12.[13] A research conducted in 2019 examined whether poor people in poorer states end up spending more on health expenses. As per 2014 figures, Assam had the highest percentage of people using public health centre (87%) followed by Odisha (80%), West Bengal (70%), Rajasthan (64%). It showed that states that were economically better-off used more of the private health centers, while poorer states used more of the public health centers. Further it also found that the poor in State with higher poverty level used public health services for hospitalisation.

Oxygen shortage

The current stage of the Covid crisis in the country is where people are dying of lack of beds and shortage in oxygen supply. Thus, it is important to look at these parameters before declaring any that any state has performed better than others. Until May 12, Kerala, Tamil Nadu had not raised an SOS for oxygen but on May 13, these states, in addition to Andhra Pradesh raised an alarm to the Centre demanding more oxygen. Kerala which had been sending surplus medical oxygen to neighbouring state Tamil Nadu and Andhra Pradesh, has now halted the supply citing demand in its own state. Officials in Kerala said they had to stop supply to ensure the state is able to meet its own demand, with its Covid caseload expected to rise to 6 lakh by 15 May.[14]

In Conclusion

While these states have fared relatively better than the rest of the states in managing the crisis, it is certainly too soon to laud their efforts. With experts predicting a third wave of Covid to be on its way in India, it is necessary that all states remain on their toes and are consistently keeping up the work they have been doing until and also take lessons from the better performing states such as Kerala, Tamil Nadu and West Bengal so that concerted efforts conclude in a successful stint at combating Covid.

*Feature image by Javed Anees (District Hospital, Tirur) via Wikimedia Commons.

Also read:

Right to Health: The forgotten Constitutional Mandate

 


 

[6]Dash, A., Mohanty, S.K. Do poor people in the poorer states pay more for healthcare in India?. BMC Public Health 19, 1020 (2019). https://doi.org/10.1186/s12889-019-7342-8

[7]Mukhopadhyay I, Madras T, Madras T. Tamil Nadu state health account 2013–14. 2017. [https://www.researchgate.net/publication/317493240_TAMIL_NADU_STATE_HEALTH_ACCOUNTS_2013-14]. 

[9] As per NITI Aayog India Index Baseline Report 2018

[10] Closing the health and nutrition gap in Odisha, India: A case study of how transforming the health system is achieving greater equity, Social Science & Medicine, Volume 145, 2015

[11] Closing the health and nutrition gap in Odisha, India: A case study of how transforming the health system is achieving greater equity, Social Science & Medicine, Volume 145, 2015

[12]Sahoo, Niranjan, and Manas Ranjan Kar. “Evaluating Odisha’s COVID-19 response: from quiet confidence to a slippery road.” Journal of Social and Economic Development, 1–15. 25 Nov. 2020

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Free universal healthcare for all in India https://sabrangindia.in/free-universal-healthcare-all-india-0/ Mon, 29 Jun 2020 05:00:10 +0000 http://localhost/sabrangv4/2020/06/29/free-universal-healthcare-all-india-0/ “Swasthya seva hamara adhikar Ise degi hamari Sarkar”

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CoronavirusImage Courtesy:devex.com

The spread of Coronavirus in India and the subsequent misery of the migrant population has exposed the underbelly of dismal healthcare in our country. There is a daily outcry of shortage of hospital beds, doctors, nurses, ICUs, absence of functioning rural healthcare centres, etc.

It is a great pity that while our neighbouring small nations like Bhutan and Sri Lanka provide free universal healthcare for all their citizens, India is still struggling with healthcare schemes that cover only partially a small section of our population that have to struggle meaninglessly for a gold/red/blue, etc. card to become eligible for partial healthcare facility. Almost all advanced nations like the U.K, France, Switzerland, Canada and a host of others provide free universal healthcare for all of their citizens irrespective of income status. Other countries like Cuba, Hong Kong, Singapore, New Zealand, etc. also cover all their citizens with universal healthcare. Why India does not think in this direction and consider providing free healthcare for its citizens a top priority is a mystery unsolved.

The argument that we do not have money for providing free healthcare for all is a fictitious argument because if defense requires double the budget, the money somehow is made available. Defense is top priority but citizens’ health is at the bottom of the list. If citizens are not healthy, whom are we trying to protect with the piling of armaments?

What is the present scenario? India’s Annual budget is Rs. 27,84,200 crores (2019-2020). Out of this allocation for health sector is a mere 2%, i.e. Rs. 63,538 crores whereas the defense budget is 11%, i.e. 2,82,733 crores. Thus India’s Defense budget is five and a half times the Health budget.

Let us see how other nations, who provide free universal healthcare to all its citizens, do their allocation for healthcare from their budget.

Country                                        Health Budget as a % of total Budget   

Switzerland                                                         34.7
Cuba                                                                    28
U.K.                                                                     19.7
Sri Lanka                                                             11
Bhutan                                                                   9
India                                                                      2                             

India’s current population is 136 crores and average annual expenditure incurred by its citizens on their healthcare is Rs. 2,465. This means that to cover all its citizens with free universal healthcare, an annual fund of Rs. 3,35,240 crores is required to be allocated to the health sector, i.e. 12% of Budget. Is that impossible? If the health of its citizens is top priority for a nation, can we give an excuse that due to non-allocation of required resources the health sector will continue to suffer?

Indian Government’s apathy towards healthcare delivery to its citizens is borne out by the following facts as stated by Saif Kamal in Health and Life – 

“There is only one Government allopathic doctor per 10,189 people, only one Government hospital bed per 2,046 people, and one state run Hospital per 90,343 people. Out of 1 million doctors in the country, only 10% of them work in public health sector. They lack good infrastructure, proper management, dedicated staff and many other things which are required to provide reasonable and appropriate healthcare.”

Malnutrition is a serious problem in India. According to Unicef at least 3,000 children die due to malnutrition every day in this country and every year 10,00,000 children die below the age of five.

In Global Health ranking India’s position is 145th out of 195 countries, even below Nepal. Bhutan and Sri Lanka.

Medical costs are one of the primary causes of poverty in India. Around 63 million Indians fall into poverty each year because of health care bills, and 70 percent of all charges are paid directly by patients.

Due to lack of proper and adequate healthcare delivery from the state run hospitals, patients are forced to seek relief from private hospitals where the charges are abnormally high. This results in the poor patient being forced to incur very high out-of-pocket expenditure and this forces him to sell his assets, property or land and drives him ultimately below the poverty line.

When we compare Per capita expenditure on Health for various countries, we find India at the bottom of the list as shown below –

 

Country                                        Per capita expenditure on Health (US $)

Switzerland                                                            6,944
Norway                                                                  4,802
U.K.                                                                        3,500
Sri Lanka                                                                     71
India                                                                            35

Comparing Healthcare Expenditure as a % of GDP –

Country                                                               Percentage of GDP         

France                                                                         8.7
Switzerland                                                                8.5
U.K.                                                                             7.9
India                                                                           1.02

A large country like India, where 70% of total population resides in rural areas, continues to be biased in its healthcare delivery in favour of the urban population. Instead of relying on preventive care and well equipped Primary Health Centres in semi-urban and rural areas, the emphasis has been on city hospitals which become overcrowded and suffer from population pressure.  

The Constitution incorporates provisions guaranteeing everyone’s right to the highest attainable standard of physical and mental health. Article 21 of the Constitution guarantees protection of life and personal liberty to every citizen. The Supreme Court has held that the right to live with human dignity, enshrined in Article 21, derives from the directive principles of state policy and therefore includes protection of health. Further, it has also been held that the right to health is integral to the right to life and the government has a constitutional obligation to provide health facilities.

Failure of a government hospital to provide a patient timely medical treatment results in violation of the patient’s right to life.  Similarly, the Court has upheld the state’s obligation to maintain health services.

It is therefore imperative that we make free universal healthcare for all our citizens a goal to be achieved in the nearest future. A healthy nation is a happy nation and the exorbitant amount that the rural population has to shell out today for healthcare from their meager personal earnings leading to extreme poverty can be totally avoided.

*The author is the convener of Jharkhand Nagrik Prayas.    

Related:

Covid-19: Jharkhand Nagrik Prayas condemns the Centre’s inefficiency in implementing the lockdown
Fight against commercial mining of Coal in Jharkhand
Why should India’s migrant labour pay for their return home

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Staff Shortages, Fund Crunch/Delays Imperil India’s Healthcare Delivery System https://sabrangindia.in/staff-shortages-fund-crunchdelays-imperil-indias-healthcare-delivery-system/ Fri, 31 May 2019 04:48:03 +0000 http://localhost/sabrangv4/2019/05/31/staff-shortages-fund-crunchdelays-imperil-indias-healthcare-delivery-system/ New Delhi: Public spending on healthcare has not crossed 1.28% of India’s gross domestic product (GDP) in the last decade. With disease transition–where more Indians are afflicted by lifestyle diseases than communicable diseases–under way, human resource shortages and a continuing fund crunch affect India’s health goals. This is the concluding part of a four-part IndiaSpend-Observer […]

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New Delhi: Public spending on healthcare has not crossed 1.28% of India’s gross domestic product (GDP) in the last decade. With disease transition–where more Indians are afflicted by lifestyle diseases than communicable diseases–under way, human resource shortages and a continuing fund crunch affect India’s health goals.

This is the concluding part of a four-part IndiaSpend-Observer Research Foundation series on data, healthcare and public policy. As the Narendra Modi government returns to power, we look at the resource constraints that the new dispensation has to address in India’s healthcare.
Given its continent-like diversity, India is undergoing epidemiological, nutritional and demographic transitions in a staggered fashion, with very large state-level variances, recent research by the Observer Research Foundation shows. New challenges posed by non-communicable diseases, as we said, are posing an additional burden on the healthcare delivery system, which is still geared more towards the communicable, maternal, neonatal and nutritional health conditions. Adapting to the fast-changing disease transition requires significant additional financial resources within the health sector.

Despite the Bharatiya Janata Party’s (BJP) titling the health section of their election manifesto as “Health for All”, and the Indian National Congress (INC) starting their manifesto’s health chapter with the declaration that “Healthcare is a public good”, neither party has come close to the promised spending of 2.5% of GDP in the past decade.


The impact of inadequate funding on the health system manifests itself most visibly in terms of insufficient human resources. Given that two-thirds of the public spending on health in India is from the state and local governments, sub-national players are important stakeholders.

The Niti Aayog, the government’s policy think-tank, developed a Health Index in 2018 to instil a spirit of co-operative and competitive federalism between the Centre and states. Along with outcomes and governance issues that were discussed in previous articles in the series (here, here and here), key inputs and processes was the third sub-domain the index explored. Among other things, this sub-domain explored issues of staff shortages and delays in funds transfer.

The proportion of vacant healthcare provider positions in public health facilities is an important indicator explored under this theme. Vacancies of key health staff are linked with both access to healthcare services as well as their quality, according to the Niti Aayog report.

The vacancy status vis-a-vis the total sanctioned positions for both regular and contractual healthcare providers for key positions in public health facilities including auxiliary nurse/midwives (ANMs) at sub-centres (SCs), staff nurses at primary health centres (PHCs) and community health centres (CHCs), medical officers (MOs) at PHCs, and specialists at district hospitals (DHs) was explored as part of the index.

The five best performers with the least percentage of vacancies of staff nurses–among states and union territories with an assembly–are Puducherry (where INC and others are in power), Uttar Pradesh (BJP and others), Tripura (BJP and others), Odisha (Biju Janata Dal) and Nagaland (BJP and others).

The vacancy of staff nurses in PHCs and CHCs was highest in Jharkhand (75%), followed by Sikkim (62%) Bihar (50%), Rajasthan (47%) and Haryana (43%)–all but one (Rajasthan) currently ruled by the BJP and its allies. National Capital Territory of Delhi (NCT Delhi), currently ruled by the Aam Aadmi Party, was the sixth worst with 41% vacancy.

The gaps at the primary-level healthcare delivery system put pressure on the tertiary hospitals, and often force patients to seek help in the private sector, being compelled to “vote with their feet” against government facilities, this May 2015 paper by Oxfam India said.


Source: Niti Aayog
Note: Data as of March 31, 2016

Similarly, among the states and UTs with assemblies, the vacancy of medical officers at PHCs was highest in Bihar (64%), followed by Madhya Pradesh (58%), Jharkhand (49%), Chhattisgarh (45%) and Manipur (43%). There were no vacancies in Sikkim, while Tripura had 2% vacancies–both currently ruled by the BJP and its allies. This was followed by Kerala (6%), Tamil Nadu (8%) and Punjab (8%).


Source: Niti Aayog
Note: Data as of March 31, 2016

Many states showed a very high proportion of vacant specialist positions in district hospitals: Arunachal Pradesh (89%) had the highest, followed by Chhattisgarh (78%), Bihar (61%), Uttarakhand (60%) and Gujarat (56%).

Thirteen states and UTs with an assembly had overall vacancy of specialist positions at over 40%. Of these, seven are currently ruled by the BJP and its allies, four by the INC and its allies, and one each by the AAP and the Telangana Rashtra Samithi.  


Source: Niti Aayog
Note: Data as of March 31, 2016

Healthcare staff shortages at the primary level and for specialty care make the private sector the de facto service provider for a vast majority of the population, with adverse financial implications.

Out-of-pocket (OOP) health expenses drove 55 million Indians–more than the population of South Korea, Spain or Kenya–into poverty in 2011-12, as IndiaSpend reported on July 19, 2018.

Funds unspent in states that need them most

In addition to inadequacy of funds, the inconsistency in the timing of funds released by the Centre to state governments has contributed to inequity in terms of service delivery across the country, analysis from the Observer Research Foundation showed. 

On average, there were more unutilised funds at the end of the year in the states that needed them the most. Studies have shown that a file with a request for release of funds has to cross a minimum of 32 desks while going up the administrative hierarchy, and 25 desks on the way down.

The Niti Health Index analysed the average time taken for transfer of Central National Health Mission (NHM) funds from the state treasury to the implementation agency (department/society) based on all tranches of the financial year 2015-16, and found huge variance between states.

Time taken for funds to reach implementing agencies varied from zero days in Daman & Diu and Lakshadweep to and 287 days in Telangana. Almost all Indian states have reported lengthy delays–more than 100 days in many cases–in transfer of funds from the state treasury to state health societies, thereby adversely affecting timely implementation of various health sector initiatives.


Source: Niti Aayog
Note: Data for the financial year 2015-16

Unlike the governance and information sub-index–which deals with the status of the governance structures and information systems within states–the overall performance of the states was mostly consistent with the domain-specific performance within the “key inputs and processes” theme–which deals with human resources, and the level and quality of healthcare and processes.

However, Odisha and Rajasthan performed better on the “key inputs and processes” sub-domain compared to the overall index, according to the Niti Index Rankings.  At the same time, all smaller states showed better performance on health outcomes–such as Goa and Manipur–compared to “key inputs and processes”. This aspect needs further study.


Source: Niti Aayog

If India is to get to a reasonable level of healthcare for all Indians, all mainstream parties in India must agree on a common minimum programme on health down to the state level, to help stop losing time during transition years such as between schemes such as the Rashtriya Swasthya Bima Yojana–started in 2008 by the then United Progressive Alliance government–and the Pradhan Mantri Jan Arogya Yojana launched in 2018 by the previous National Democratic Alliance government, in which Centre-state coordination is key.

As health remains a state subject, and the National Health Policy 2017 has made a logical case for regulation of healthcare, explicitly supporting “the need for moving in the direction of a rights-based approach”, India needs to take urgent steps to reduce bureaucratic delay in fund disbursement in particular, and to improve Centre-state relations within the multi-party federal democratic setup.

This story was first published here on HealthCheck.

(Kurian is Fellow at Observer Research Foundation’s Health Initiative.)

Courtesy: India Spend

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Is Modicare an eyewash meant to blind the public? https://sabrangindia.in/modicare-eyewash-meant-blind-public/ Tue, 07 Aug 2018 11:05:40 +0000 http://localhost/sabrangv4/2018/08/07/modicare-eyewash-meant-blind-public/ Many states are unwilling to merge existing state healthcare models with the national one and international economists are calling it a hoax.   Many states are unwilling to merge existing state healthcare models with the national one and international economists are calling it a hoax.  New Delhi: With great pomp and fanfare, Arun Jaitley, Union […]

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Many states are unwilling to merge existing state healthcare models with the national one and international economists are calling it a hoax.

Health Care
 
Many states are unwilling to merge existing state healthcare models with the national one and international economists are calling it a hoax. 
New Delhi: With great pomp and fanfare, Arun Jaitley, Union Finance Minister and the Minister of Corporate Affairs in the Cabinet of India, announced the Ayushman Bharat or ‘Modicare’ health care scheme in February. With PM Modi set to launch the scheme on August 15, many issues have cropped up ranging from many states unwilling to merge existing state healthcare models with the national one and international economists calling it a hoax.
 
What is Ayushman Bharat or ‘Modicare’?
Ayushman Bharat is a national health protection scheme covering primary, secondary and tertiary healthcare to be launched on August 15.
 
The programme aims to provide free essential drugs and diagnostic services for illnesses that do not necessitate hospitalisation (outpatient care) through 150,000 health & wellness centres, as well as an insurance cover of up to Rs 5 lakh per year per beneficiary family for hospitalisation (inpatient care), both secondary and tertiary care. A PTI report said that the govt claimed that it will provide employment to 10,000 jobs will be created and over one lakh people will be skilled to become ‘Ayushman Mitras’ who will assist people to get the most out of this scheme at both private and government hospitals.
 
Ayushman Bharat is expected to take India towards universal health coverage, the situation when “all people obtain the health services they need without suffering financial hardship when paying for them”, to quote the World Health Organization.
 
To cover more than 107 million poor and vulnerable families or about 40 per cent of India’s population, the government claims that Ayushman Bharat will be the world’s largest government-funded health protection programme, and will have “a major impact on reducing out-of-pocket expenditure on health”.
 
It also claimed that it will provide employment to 10,000 jobs will be created and over one lakh people will be skilled to become ‘Ayushman Mitras’ who will assist people to get the most out of this scheme at both private and government hospitals.
 
States unwilling to merge with Modicare
Many states ruled by non-BJP governments are wary of the political implications of launching a scheme so closely associated with the prime minister’s name, they also already provide health coverage to a much larger universe of beneficiaries than what the centre is willing to provide under Ayushman Bharat. “So the states are obviously hesitant, as merging existing schemes with Ayushman Bharat will raise costs while also being a political dud,” reported CNBCTV18.
 
“Maharashtra has been reluctant since it already runs the ‘Mahatma Jyotiba Phule Jan Arogya Yojana’ covering 2.2 crore families when Ayushman Bharat is offering a cover for only 83 lakh families. The Kerala government is faced with a similar dilemma. The state already offers a cover to 35 lakh families when the Ayushman Bharat cover will apply to only 19 lakh families. In repeated conversations between the centre and the officials of the state on the enrollment for Ayushman Bharat, the government has been reluctant to abandon the universe currently covered,” the report added.
 
Economist who designed MGNREGA calls ‘Modicare’ a hoax
Development economist and activist Jean Dreze termed the soon-to-be-launched Ayushman Bharat health scheme a “hoax” as it was actually not big as it was being claimed to be. “The budget (for the scheme) for this year is Rs. 2,000 crore. Even if it is spent, it’s less than Rs. 20 per person,” he said at the launch of the book “Bharat Aur Uske Virodhabhas’, the Hindi edition of his book ‘An Uncertain Glory: India and its Contradiction’ that he co-wrote with Nobel laureate and economist Amartya Sen.
 
“It is projected as health insurance for 50 crore people, but it is virtually nothing, said Dreze. The Belgian-born Indian economist helped the UPA government in the first draft of Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA). Jean Dreze became an Indian citizen in 2002 and is an honorary Professor at the Delhi School of Economics.
 
The reality of Healthcare in India under Modi rule
India spends only Rs.3 for the health of every Indian every day.
 
“Since the BJP-led National Democratic Alliance (NDA) government came to power, there has been a 20% cut in the budget for the National Health Mission and a 10% cut in the allocation for the Integrated Child Development Services (ICDS) programme. The worst affected is the National AIDS Control Programme, now in its fourth phase of implementation. The AIDS programme will receive Rs. 300 crore less funds next year. The government has “not just belied its promises, it has done precisely the opposite”, wrote Jayati Ghosh, professor of economics at the Centre for Economic Studies and Planning, Jawaharlal Nehru University, in the latest issue of the British Medical Journal.
 
Out-of-pocket (OOP) health expenses drove 55 million Indians–more than the population of South Korea, Spain or Kenya–into poverty in 2017, and of these, 38 million (69%) were impoverished by expenditure on medicines alone, according to a new study released in June by the Public Health Foundation of India (PHFI), an advocacy group.
 
The amount India spends on public health per capita every year is Rs 1,112, less than the cost of a single consultation at the country’s top private hospitals–or roughly the cost of a pizza at many hotels. That comes to Rs. 93 per month or Rs. 3 per day.
 
At 1.02% of its gross domestic product (GDP)–a figure which remained almost unchanged in nine years since 2009–India’s public health expenditure is amongst the lowest in the world, lower than most low-income countries which spend 1.4% of their GDP on health, according to the National Health Profile, 2018, released by union minister for health and family welfare, J P Nadda, on June 19, 2018.
 
Existing schemes from UPAs rule
In 2004, when UPA came to power, expenditure on public health was around Rs 7,500 crore. It quadrupled to Rs 27,000 crore before Modi came to power in 2014. “In the beginning of UPA’s regime, the National Rural Health Mission (NRHM), known to be “the most ambitious rural health initiative ever”, was initiated. The NRHM was formed to provide effective healthcare delivery to our rural population, especially women and children. Data from 2014 showed that in the last 10 years, infant mortality rate (IMR) has come down from 58 per 1,000 to 44. This is further set to decline sharply. During the National Democratic Alliance’s regime, the IMR declined at a snail’s pace of 1.3% annually, whereas now this deceleration is happening at 6.4% per annum,” reported Economic Times in 2014.
 
The Universal Health Care Scheme that UPA II partially rolled out towards the end of 2013 had at its core 50 essentials medicines, some devices and diagnostics to be given free. The Modi Government stopped that in 2014 and then started the PMBJP (low-cost pharmacy scheme) with ambitious plans to scale upto 6 lakhs outlets. It was a resounding failure with just 3000 of them at the end of 2017. So, they have gone back to the free scheme without contours being drawn under the new dispensation.
 
The government should rope in all stakeholders and even if the pharma, devices and diagnostic companies are told to contribute the 2% CSR into the government scheme, it could go a long way. Even in AIIMS, the patients have to buy even sutures themselves.
 
There is actually no shortage of resources. Both in primary health and primary education. There is limitless demand, backed by money, albeit at low price points. There is enough private sector capital, only some of it from philanthropic funds, willing to invest in a scalable hub and spoke models using AI techniques. It will not just change the lives of citizens, but will provide employment chiefly to women.
 
It is not the scheme itself which is faulty or ill-advised, lack of implementation and monitoring could very well make it another healthcare nightmare and scam of gargantuan proportions. It is possible that another fundamental human right could become a political commodity in the wrong hands.

 

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Muslims Have Highest Fertility Rate, Lack Access To Healthcare https://sabrangindia.in/muslims-have-highest-fertility-rate-lack-access-healthcare/ Mon, 30 Apr 2018 09:59:10 +0000 http://localhost/sabrangv4/2018/04/30/muslims-have-highest-fertility-rate-lack-access-healthcare/   Mumbai: Hindus have India’s highest infant mortality rate with 41.6 deaths per 1,000 live births and the third highest fertility rate–the average number of children a woman would have by the end of her childbearing years–of 2.13, the latest health data show.   Hindus also have the third-lowest access to healthcare facilities, with only 79.3% […]

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Mumbai: Hindus have India’s highest infant mortality rate with 41.6 deaths per 1,000 live births and the third highest fertility rate–the average number of children a woman would have by the end of her childbearing years–of 2.13, the latest health data show.
 
Hindus also have the third-lowest access to healthcare facilities, with only 79.3% women receiving antenatal care (including at least one tetanus toxoid injection and iron folic acid tablets or syrup taken for 100 or more days) visits from skilled professionals, lower than Sikhs, Christians, Buddhist and Jains, national family health survey data show.
 
Muslims have India’s highest fertility rate, 2.61 per woman, and the second lowest access to antenatal care provided by skilled professionals (77%).

A “child survival hypothesis” states that if child mortality is reduced, fertility reduction follows, with the net effect of lower growth of population, according to this 1990 study by Finnish Medical Society.
 
Adding a maternity clinic to a village decreases the odds of infant mortality by almost 15% in comparison to the risk before the clinic was added, evidence from a 1995 study in Indonesia show. An additional doctor reduces the odds by about 1.7%.

Though the fertility rate for Hindus is lower than the national average, it is high compared to communities like Christians, Jains, Sikhs and Buddhists.
 
While the national average is 2.2 children per woman, Muslims have the highest fertility rate (2.6) followed by others (Jews, Parsis and tribes that do not identify themselves as Hindus like Khasi, Jaintia & Garo in the North east) (2.5) and Hindus (2.1). Meanwhile, Christians (1.9), Sikhs (1.5), Jains (1.2) and Buddhists (1.7) have lower fertility rates.
 
Access to healthcare plays key role
 
As many as 79% of women delivered babies at a health facility; the lowest proportion was among “other religious communities”–which include Jews, Parsis  and tribes that do not identify themselves as Hindus like Khasi, Jaintia & Garo in the North east–(51%) followed by Muslims (69.2%).
 
The national average for receiving antenatal care from skilled providers is 79.3%, while it is the lowest for “other religious communities” (68.5%), followed by Muslims (77%).
 
The lack of access to healthcare facilities also inhibits the usage of modern methods of family planning. For example, the national average for the usage of any modern method of contraception among women is 47.8% while the lowest is among “other religious communities” (36.5%) followed by Muslims (37.9%).
 
Sanitation access and child mortality
 
Access to sanitation is another factor that is known yo have an impact on reducing child mortality rates.
 
“We found  that Muslim neighbourhood are less likely to have piped waters, and less likely to have other state services than Hindu neighbourhoods,” Dean Spears of the Research Institute for Compassionate Economics, told IndiaSpend in an interview on August 13,2017.
 
“But, on average, there is less open defecation in Muslim neighbourhoods because they are more likely to have and use latrines than Hindu households.”
 
Indirect factors that impact fertility rate includes higher education of women to employment status among women, research show.
 
Women from “other smaller religious groups” and Muslims have the highest percentage of women with no schooling at 34.4% and 31.4%, respectively.
 
The two communities also have the lowest percentage of women who have completed schooling of more than 12 years at 10.9% and 14.8%, respectively.


 
Note: Others includes Jews, Parsis and tribes that do not identify themselves as Hindus, such as Khasi, Jaintia & Garo in the North east.
 
Only 73% Muslim women participate in decision-making pertaining to one’s own health while the all-India average is 74.5%.
 
Muslim women in rural and urban areas had the lowest labour force participation rate at 15.9% and 10.9%, respectively, while the national average was 25.3% and 15.5%, respectively.
 

This article was first published on indiaspend.com.

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CAG report demolishes claim of Chouhan government, exposes major lapses in healthcare, Vyapam https://sabrangindia.in/cag-report-demolishes-claim-chouhan-government-exposes-major-lapses-healthcare-vyapam/ Mon, 27 Mar 2017 08:00:36 +0000 http://localhost/sabrangv4/2017/03/27/cag-report-demolishes-claim-chouhan-government-exposes-major-lapses-healthcare-vyapam/ The report has ignited a political storm in Madhya Pradesh where the Vyapam scam is still a raw wound for the government and a soft target for the opposition. Image: Indian Express On the last day of the budget session of the Madhya Pradesh Vidhan Sabha on March 24, Comptroller and Auditor General of India […]

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The report has ignited a political storm in Madhya Pradesh where the Vyapam scam is still a raw wound for the government and a soft target for the opposition.

Shivraj Singh Chauhan
Image: Indian Express

On the last day of the budget session of the Madhya Pradesh Vidhan Sabha on March 24, Comptroller and Auditor General of India demolished the claim of the BJP ruled state government that Madhya Pradesh has ceased to be a "Bimaru Rajya".
 
The report which was tabled in the house pulled up the state government on two major counts. The two issues relate to health care, particularly in rural areas and various factors pertaining to the Vyapam scam. 
 
In a major embarrassment to the Madhya Pradesh government, CAG has punched holes in the implementation of National Rural Health Mission (NRHM). 
 
A newspaper reporting CAG's comment about health care said that it has caused a major embarrassment to the state government. Normally CAG reports are only tabled in the Vidhan Sabha but this time CAG report was released at a press conference. 
 
The report found state government's claim about health care in rural areas hollow and baseless.
 
The central audit revealed financial irregularities and misappropriation of central funds for the project. The Centre gave Rs 5,269.70 crore to the state in the last fiscal year to revamp rural healthcare but the state failed on a host of key parameters.
 
Infant mortality rate (IMR) in the state was 51 per 1,000, live births and maternal mortality rate (MMR) stood at a shocking 221 per 1,00,000, way higher than the national average (40 and 167 respectively). The report said the shortfall in providing maternal, child and reproductive healthcare services resulted in the failure in achieving targets.
 
Out of 93.72 lakh pregnant women registered for ante-natal care during 2011-16, only 52.51 lakh (56 per cent) were registered within first trimester of pregnancies and 19.44 lakh (21 per cent) pregnant women did not undergo three check-ups. As a result, well-being and the progress of fetal growth could not be ascertained in such cases.
 
HIV testing of 47.27 lakh and VDRL testing of 60.34 lakh pregnant women were not conducted.
 
As many as 28 per cent women were discharged within 48 hours of delivery in public institutions, says the report, and only 35.21 lakh (55 per cent) mothers received post-partum check-up between 48 hours and 14 days after delivery due to the "apathetic attitude of service providers", it adds.
 
Against 93.72 lakh registered pregnancies during 2011-16, there were only 69.83 lakh deliveries. The case of missing deliveries may have an impact on the skewed sex ratio of 52:48 at birth in the state.
 
There was shortfall of 16-21 per cent in targets set for child immunisation against seven vaccine-preventable diseases due to lack of awareness among parents and failure to mobilise women/ children by the administration, the report points out. Out of 69.25 lakh live births, only 39.30 lakh (57 per cent) infants were provided hepatitis B vaccine due to lack of storage facilities.
 
The State did not achieve the targeted total fertility rate (TFR) due to under-performance in family planning programme, says CAG. Against 3.03 lakh male sterilisations planned during 2011-16, only 0.83 lakh (27 per cent) were performed. Female sterilization was a shade better at 43 per cent and 22 per cent of target (minilap and post-partum). There was a 42 per cent shortfall in distribution of contraceptive pills and 49 per cent in condoms.
 
The CAG has also severely criticised the Shivraj Singh Chouhan government on a string of "irregularities" concerning Vyapam — from the government's alleged "dual stand" and how central auditors were stopped from accessing its records to "arbitrary appointments" and alleged lack of financial accountability. 
 
The report has ignited a political storm in Madhya Pradesh where the Vyapam scam is still a raw wound for the government and a soft target for the opposition.
 
"While the MP government disowned and distanced itself from Vyapam, on the other hand it was in full control of the examination board for all practical purposes… The shadowy control (on Vyapam) has led to a situation where there was severe erosion in the credibility of exams conducted by board," CAG observed in its latest report for 2015-16.
 
In a scathing remark, the report points out that the state government" did not take any remedial measures" by framing rules/regulations to prevent irregularities even after the Vyapam scam.
 
While the government seemed numbed by the report — no one was willing to give a comment — Congress seized the opportunity. Leader of Opposition Ajay Singh said, "This is a very damning report. The Shivraj Singh Chouhan BJP government now stands fully exposed."
 
The CAG has recommended that the state government investigate cases of irregularities in appointment of officers to the board and hike in pay of officers. It also suggests Vyapam be brought to the level of a public service commission/staff selection commission.
 
The appointments of director and controller were made by "systemic subversion of rules", resulting in undue favour to certain individuals, it says. Dr Yogesh Uprit and Dr Pankaj Trivedi were appointed to these posts directly on orders of the then minister "in contravention of the rules".
 
The delay in establishment of statutory Board, "defeated the purpose of providing greater authority and credibility" to the Professional Examination Board in Madhya Pradesh. The state legislature passed the Vyapam Act in August 2007 but the government established the statutory board under this Act only in March 2016 — after a delay of more than eight years.
 
Recruitment examinations for state-level posts were transferred to Vyapam in April 2003 in an "unprecedented manner", the CAG report says. There was no augmentation of manpower/established system to handle the new function. This hampered conduct of examination by the board.
 
Conduct of recruitment examination — a primary function of the government to ensure free and fair recruitment to its own services, which was till now being conducted by PSC/government departments — was "jettisoned in favour of an institution that was neither statutory nor independent, nor functioned under well laid out regulations", it points out. This went against well established judicial and constitutional pronouncements, it says.
 
The state government did not take any remedial measures by framing rules/regulations to prevent irregularities even after Vyapam reported some cases of irregularities in conduct of examination.
 
There was no evidence that the government ensured the integrity of IT-based system used in the examination conducted by the board. Early on, the government decided that the audit would not be entrusted to CAG as it was presumed that the 'AG was very busy'. AG was not consulted in the matter.
 
The fund of the board was kept outside government account and it was not subjected to budgetary control of the legislature. The board, however, had no hesitation in transferring Rs 13.75 crore fund to other organisations for activities not connected with Vyapam. (IPA Service)
 
 

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