Health of Indians improving

New Delhi: Data showing that the health conditions of Indians are by and large improving was shared with Parliament last week. The Infant Mortality Rate (IMR), within which figures the Under-5 Mortality Rate, and Maternal Mortality Ratio (MMR) have both shown improvement.

Mortality due to various diseases has reduced too. For instance, the Global Burden of Disease (2015) reports a decrease in mortality (between the years 2005 and 2015) on account of lower respiratory infections (by 22.6%), diarrhoeal diseases (by 31.7%), tuberculosis (by 30.7%), neonatal preterm birth (by 39.5%), neonatal encephalopathy (by 31%) and road injuries (by 2.7%).

As per the report for India, the deaths due to self-harm for the period 2005 to 2015 have declined by 3.9%.

Whether this decade will finally see an improved sex ratio will be clear only on the release of the next Census, scheduled for 2021. As per the Census of 2011, child sex ratio was down from 927 females per 1,000 males in 2001 to 918 females per 1,000 males in 2011.

The implementation and progress of the National Health Mission (NHM) is reviewed at the national level through Annual Common Review Missions, external surveys such as Sample Registration Survey (SRS), the District Level Household Survey (DLHS) and NFHS besides regular monitoring visits from National Program Management Units to States & districts and from States to districts & blocks. The Rogi Kalyan Samiti (RKS)/Hospital Management Committee set up at all the Public Health Facilities from Primary Health Centre (PHC) level and upwards are envisaged to ensure proper functioning and management of the public health facility.

As of 31 March 2015, there were 1,53,655 Sub-Centres, 25,308 Primary Health Centres, 5,396 Community Health Centres,  1,022 Sub-District or Sub-Divisional Hospitals and 763 District Hospitals functioning in the country that provided healthcare services including family planning.

As per Economic Survey 2015-16, the expenditure by Government (Central and State Governments combined) on health as percentage of Gross Domestic Product (GDP) for 2015-16 (BE) was 1.3 per cent.

As per 12^th Five Year Plan document, total public funding by the Centre and States, plan and non-plan, on core health is envisaged to increase to 1.87% of GDP by the end of the 12^th Plan. The Draft National Health Policy 2015 envisages raising public health expenditure progressively to 2.5% of the GDP.

The allocation to States and Union Territories under the NHM by the Centre government for the last 3 years were Rs 19,989.01 crore in 2013-14, Rs 19,132.72 crore in 2014-15 and Rs 16,213.09 crore in 2015-16.

Government programmes

Under the National Health Mission (NHM), where support is provided to the States and Union Territories to strengthen their healthcare system based on the requirements posed by them under programme implementation plans, the funds allocated,  released and expenditure incurred are as under:

National Health Mission

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To meet the shortfall of human resource in health, the government is implementing a centrally sponsored scheme for “establishment of new medical colleges by upgrading district and referral hospitals” with fund sharing between the Union and States in the ratio of 90:10 for the Northeast and special category States and 60:40 for other States. This scheme was approved in January 2014. To be eligible for the scheme, a district must have hospitals with bed strength of 200 or more, but no medical college. Under-served areas will be preferred for this special treatment. Funds released to the State governments for the approved districts under the scheme are given below:

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(Rs. in crore)

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The NDA government is also upgrading existing State and Central government medical colleges to increase MBBS seats in the country. This scheme was approved in January 2014. The funding pattern is 90:10 by Central and State governments respectively for the North-Eastern States and special category States and 60:40 for other States with the upper ceiling cost pegged at Rs 1.20 crore per seat.

Twenty-two medical colleges have been approved under the scheme to increase the number of seats for undergraduates. Funds released under this scheme are given below:

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(Rs in crore)

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A scheme to strengthen and upgrade State government medical colleges with the introduction of postgraduate disciplines and increase of PG seats was launched in the 11^th Plan period. The funding pattern between Centre and States is in the ratio of 60:40. A total of 72 government medical colleges is covered under the scheme for increasing PG seats. Funds released under the scheme are given below:

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The Rashtriya Swasthya Bima Yojana (RSBY), a centrally sponsored health insurance scheme, is being implemented by this ministry, which covers BPL families (a unit of five) and other categories namely building and other construction workers, licensed railway porters, street vendors, MGNREGA workers (who have worked for more than fifteen days during preceding financial year), Beedi workers, Domestic workers, Sanitation Workers, Mine Workers, Rickshaw pullers, Rag pickers and Auto/Taxi drivers, who are enrolled under RSBY. They are entitled for health insurance coverage of Rs.30,000/- cashless  per annum per family. Under RSBY there is no state/UT-wise allocation of funds. Central Government releases its share of premium to State Governments on the receipt of their proposals. The State and Union Territory-wise details of the funds released to State Governments during last 3 years appear in the table below.

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The details of further government initiatives under the NHM to meet the Millennium Development Goals appear in this PDF.

CGHS malfunctioning

Minister of State for Health and Family Welfare Faggan Singh Kulaste stated the above through a written reply in the Lok Sabha on 25 November. The government, however, conceded that the Central Government Health Scheme (CGHS) has under-performed. “Some grievances have been received from CGHS beneficiaries through grievance portals and other channels regarding (the) functioning of CGHS,” a PIB release read, adding, “These are mainly regarding non-issue of medicines, plastic cards, shortage of doctors/ specialists and long queue(s) of patients in wellness centres.”

States’ responsibility

Finally, it’s the individual States that have to be held accountable for public healthcare, as it is a State subject. The Centre does allocate sums to the States to facilitate better healthcare delivery to the citizens. The exact allocations by the Centre to the States appear in the table below, which shows the State and Union Territory-wise approvals, including kind grants, provided for drugs and supplies under the NHM for financial years 2013-14 to 2015-16.

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