Economic prosperity and healthy India

The coming decades are vital for the country. It has to make a movement in the right direction and make the future as much its’ as the present has been due to the advances in information technology. Bio-sciences and technology will be needing our whole hearted attention if we have to match the health of our citizens with their economic prosperity.

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). The Indian doctors are comparable to the best in the world and the country provides world class facilities for performing sophisticated procedures at a fraction of the cost of similar procedures in much of the developed world.

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.

There have been insufficient investments in public health in the past and the absence of social insurance coupled with the unpredictability of illnesses requiring substantial amounts of money at short notice is reportedly impoverishing an estimated 3.3% of India’s population every year.

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. Cardio vascular 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 including poor management of resources, centralized decision making, inadequate financing, irregular supplies of drugs and equipments, unacceptable level of absenteeism, corruption, absence of performance based monitoring, inadequate accountability, wanting HRD policies, fragmented and overlapping policies and programmes and inadequate participation of the private sector.

At its most simple and fundamental level the National Rural Health Mission 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. It is believed that this is one innovation under the NRHM which will have a transformational impact on health care in rural India.

The village health outposts, i.e. the 1,41,000 sub-centers have been provided with untied funds to tackle contingencies; 2045 of the 3220 Community Health Centers have been identified for upgradation to Indian Public Health Standards and over 10,000 health facilities have established patient welfare committees (Rogi Kalyan Samities). Over 200,000 doctors, 12000 midwives, 7500 staff nurses and 1200 paramedics have been appointed on contract basis to fill critical manpower gaps in the public health care facilities. To improve planning and monitoring as well as fund usage over 1300 professional Chartered Accountants and MBAs have been laterally inducted into the health sector in support of the NRHM.

India’s bio diversity, human resources, infrastructure facilities and a supportive government hold the promise of making it a potential star in the biomedical field in the coming years which would include the pharma, bioinformatics, health care and the R&D sectors. India’s advantage in IT will enable the growth of its bioscience industry. India is also poised to take the global leadership in genome analysis, as it is in a unique position in terms of genetic resources having several ethnic populations that are valuable in providing information about disease predisposition and susceptibility, which in turn will help in drug discovery.

The recent regulatory and much awaited patent law changes have led the Indian Pharmaceutical Industry towards exploring newer avenues of drug development, thus, promising higher capital investment in the pharmaceutical industry in the near future. The Indian Pharmaceutical Research is backed by strong Government support and availability of surplus skilled technical workers at lower costs.

The key to the success of Indian pharmaceutical companies is their ability to retain their cost advantage while matching the quality standards of the west. But lower costs alone cannot be enough. Availability of skilled manpower and a favorable regulatory environment that assures compliance with global norms are the other two legs underpinning success.

Another area in which India has a competitive advantage is health tourism. In the last five years, the number of patients visiting India for medical treatment rose from 10,000 to about 150,000. With an annual growth rate of 30 percent, India is already inching closer to Singapore, an established medical care hub that attracts 150,000 medical tourists a year. Hospitals in India can conduct the latest medical procedures at very low costs. An estimated 100,000 “Medical Tourists” visited India last year, representing a 20 per cent jump over the previous year. More and more people have started traveling to India for Medical Treatment and Medical Tourism is finally coming of age.

India boasts of several good private owned hospitals with facilities second to none. They have some of the best doctors, with most top end being educated in USA and UK. When it comes to becoming a doctor, India also has some of the stringest criteria. Language is another plus factor - English, which is widely spoken throughout the country and in all good hospitals. Furthermore, the costs are much lower than most countries and most importantly, there are no waiting lists. With all the media hype about medical tourism, most hospitals have geared themselves up for medical tourists from abroad.

*Adaptation from the text of the Union Minister of Health & Family Welfare, Dr. Anbumani Ramadoss Speech at the Association of Academic Health Centres (AAHC)’s International Forum’s Programme – “2007 Spring Dialogues”. Organized by AAHC, Washington, USA on March 27, 2007.

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