Healthcare is a major concern for the Governments around the world. Globalization brings with it increasing threats to health including SARS, Avian Flu, HIV/ AIDS, Humanitarian Emergencies and Bio-terrorism. These and other threats to health know no boundaries as in an age of wide spread global trade and travel, new and existing diseases can cross national borders and threaten our collective security.At a more basic level the promotion of health is a fundamental value by itself, a vital public good and a basic human right. Instruments such as the Human Development Index have forced governments to redefine development. The importance of Universal access to health including water, sanitation and nutrition are essential to a balanced development.
India has both substantial achievements as well as a daunting unfinished agenda in the health sector. Longevity in the country has more than doubled since Independence in 1947, Infant Mortality Rate has fallen by 70% points, Malaria has been contained, Small pox and Guinea worm have been completely eradicated and Leprosy and Polio are nearing elimination. In the preceding 5 years over 500, 000 deaths have been averted due to the up scaling of the Directly Observed Treatment Short Course (DOTS).
However, these achievements do not mask India’s failures. Malnutrition and rates of infant and maternal deaths have stagnated during the last decade. Although India accounts for 16.5% of the global population, it contributes to a fifth of the world’s share of diseases; a third of the diarrhoeal diseases, TB, Respiratory and other infections and parasitic infestations as well as perinatal conditions; a quarter of maternal conditions, a fifth of nutritional deficiencies, diabetes and the second largest number of HIV/ AIDS cases after South Africa.
The public health system is overwhelmed by the co-existence of communicable and infectious diseases along side an emerging upsurge of non-communicable diseases. It is estimated that by 2015 the number of HIV/AIDS cases would be 3 times more than the current level as would be the prevalence level of TB cases. Perinatal and child hood conditions are not expected to decline significantly. What is also of concern is the expected increase in India’s disease burden due to non-communicable diseases. Cardiovascular diseases and diabetes will more than double, cancers will rise by 25% and mental health incidences will affect about 6.5% of the populace.
These and other non-communicable diseases are expensive to treat and India’s focus will be on adopting preventive strategies. Access to clean water and sanitation services and better hygienic practices like hand-washing will reduce diarrhaoea. Likewise, increasing advocacy and awareness efforts against tobacco use will reduce CVD, lung and oral cancers drastically. Promotion of exercise and yoga is increasingly acknowledged to reduce stress and obesity, diabetes and other lifestyle diseases.
The National Rural Health Mission is an attempt at building a sustainable health system for the country. It attempts to address long standing ailments of the health system.
It is about decentralization and empowering local communities beginning at the village level to plan for their own health care needs. The Mission also attempts to fill critical gaps in the system, systemic as well as those relating to human resources, finances, materials and supplies and above all accountability.
At a macro level the NRHM through enhanced political priority has energized the health sector across the country. It has through institutional reforms and flexible financing led to convergent action on the part of local communities as well as pubic institutions resulting in significantly enhanced number of functional health facilities, increase in out patient cases, higher number of institutional birth deliveries and improved immunization coverage.
Close to 350,000 Accredited Social Health Activists (ASHAs) have been positioned at the village level. The ASHAs are literally beacons of hope, they are all women, a part of the local community, trained in preventive health care, community mobilizers and activists all rolled into a single persona. They promote sanitation and hygiene amongst the local communities, disseminate information on basic preventive health care and facilitate access to public health facilities particularly for women and children.
The village health outposts have been provided with untied funds to tackle contingencies.
In terms of outcomes this has meant an intensification of India’s determination to eliminate polio, vaccination of over 9 million children against Japanese encephalitis, elimination of neonatal tetanus from 7 states, full immunization coverage at 54% at the national level and 2 million institutional deliveries – all in the course of last one year. Over 1.3 million monthly health and nutrition days have been organized in the rural areas, 1 million Village Health and Sanitation Committees have been constituted and school health programmes initiated across large part of the country. During 2007 all states are expected to prepare Integrated District Health Actions Plan reflecting convergent action on health and determinants of health such as drinking water, sanitation, nutrition etc.