Deadline: April 10th, Transforming Health Systems

Deadline: April 10th, Transforming Health Systems
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Plea for damages referred to panel

THIRUVANANTHAPURAM: The State Groundwater Authority has decided to refer the plea for payment of compensation to the people of Plachimada for the damages sustained by them on account of pollution allegedly caused by Hindustan Coca Cola Beverages Private Limited to a high-power committee of the government.
The Authority, which took up the report of a sub-committee constituted by it earlier to look into the question of payment of compensation as demanded by the Plachimada Struggle Solidarity Committee and the Plachimada Adivasi Samrakshana Sanghom, felt that there was need for assessing the exact damages that the people in the locality might have sustained on account of the operations of the company. The meeting concluded that while there was merit in the argument for payment of compensation, the actual assessment of the damages can be undertaken only through a coordinated initiative by different government departments, informed sources said.
The Authority was also of the view that the question as to how and from whom the compensation could be secured would have to be gone into some detail as the company had been remaining closed for the last four years. The two organisations seeking compensation have cited the manner in which compensation was awarded to the victims of the Bhopal gas tragedy as a model that could be looked into.
The Authority also recommended changes in the Kerala Groundwater Act to provide for stiffer penalty for over-exploitation of groundwater resources.
Among the recommendations was one for enhancement of the fine payable by persons found guilty of over-exploitation from the present Rs.500 for the first offence to Rs.2,000. The Authority was of the view that repeat offenders must be met with a fine of Rs.4,000 and three-time offenders must be criminally proceeded against.
The Authority also approved the plans for a campaign to create awareness of registration of draw wells in the State.
Author: C. Gouridasan Nair

Delhi under the weather

New Delhi: Delhi and other parts of NCR is witnessing a sharp increase in viral fever cases, thanks to sudden change in weather. According to doctors , current weather is conducive for transmission of viral infections. They say that 30-40% of the OPD cases are of viral fever and related infections. "There has been a two-fold increase in viral fever cases, especially in children. Nearly 40% of the cases in the OPDs are of viral fever or infections,'' said Dr Sanjeev Bagai, head of the department, paediatrics and director, Rockland Hospital. A majority of people are down with viral fever, which can be treated symptomatically, but doctors say with dengue cases on the rise, fever shouldn't be taken lightly. "Cases like high-grade fever with pain in eyeballs, bodyache etc for more than 24-hours should be taken to doctor, as it could be dengue,'' said Bagai. The weather is said to be conducive for viral infection to spread. There are fluctuations in day and night temperatures too. "Exposure to this change in temperature can be dangerous. But this happens every year and one just needs to take precautions and avoid crowded places. Children should be more careful. With schools re-opened, parents should be careful, as kids move in close groups and chances of getting infected are higher,'' said Dr G C Vaishnava, head of the department, internal medicine, Fortis Healthcare. For asthma patients, this weather can aggravate the medical condition, as there is a lot of pollen movement in the air. "This is a tough season for asthma patients, as mild allergy can aggravate breathing difficulty. Moreover, constant change in temperature and humidity also makes things worse for asthma patients,'' said Dr Mukesh Mehra, head of the department, internal medicine, Fortis Healthcare. Apart from complaints of cough and cold, along with fever, are very common. "We are seeing a lot of cases of upper respiratory track infections. Viruses like rhino virus are responsible for such infections. It is better to cover your face, especially when exposed to dust,'' said Dr Ashutosh Shukla, head of internal medicine, Artemis Healthcare Institute. Doctors say that the coming season is going to be tough for people with compromised immunity, as they are at a greater risk of contracting secondary infections. "People with diabetes and other lifestyle diseases or elderly people can contract secondary infection if their viral infections are not treated on time. We are seeing cases of viral pneumonia in elders as a secondary infection. In such cases, it can get serious. People with compromised immunity should be proactive in seeing a doctor at the initial stages as adequate steps need to be taken to control the problem,'' said Dr Tarun Sahni, senior consultant, internal medicine, Indraprastha Apollo.

People with diabetes lose more than money

"It is not about money. No amount of money will give back my limb" said a 65 years old woman with diabetes (name withheld on request) who underwent limb amputation at the Gandhi Memorial & Associated Hospitals (GM & AH). She couldn't have been right in conveying the message in the lead up to the World Diabetes Day, 14 November 2008, to prevent many diabetes-related complications that are extremely devastating. "Diabetes ups the risk for heart disease and stroke" said Dr Rishi Sethi, who works with Department of Cardiology at CSM Medical University. "This increased risk to stroke and heart diseases can be lowered by keeping blood glucose (also called blood sugar), blood pressure, and blood cholesterol close to the recommended levels. Reaching your targets also can help prevent narrowing or blockage of the blood vessels in your legs, a condition called peripheral arterial disease" advises Dr Sethi. "People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness - loss of feeling - in the hands, arms, feet, and legs" informed Professor (Dr) Rama Kant, who heads the diabetic foot unit at CSM Medical University (formerly King George's Medical College) in Lucknow, India. "Another major diabetes-related complication is related to kidneys. People with diabetes are prone to develop a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease (CKD)" explains Prof Kant. "Will you be surprised to learn that diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases" says Prof Kant. "Even when diabetes is controlled, the disease can lead to CKD and kidney failure" adds Prof Kant. However the diabetes-related complication which had devastated the life of the 65 years old woman in GM & AH (who is quoted above), is diabetic foot. "The foot of the patient with long-standing diabetes is often the site of neuropathic and vascular growth which poses a considerable threat, not only to the lower limb but also to the life of the patient" warns Prof Kant. Relatively diabetic foot is one of the leading causes resulting in long hospital stays for people with diabetes. It demands much care and attention by both the patient and healthcare personnel. Two major problems which predispose the patients with diabetes to amputation are the development of neuropathy due to uncontrolled diabetes over several years while result in damage to the nerves in the feet leading to the loss of sensation. They also develop certain high pressure points under the feet which result in the formation of callus which later turns in to an ulcer. In addition cigarette smoking will lead to nerve damage and reduced blood flow in the feet. With increasing age, people with diabetes may develop diminished sensation and decreased peripheral circulation in the feet, and thus are at a heightened risk of developing foot infections. Prof Kant lists some ways people with diabetes can take care of their feet: 1. Keep feet clean – wash them regularly. 2. Use only lukewarm water – no hot water, heating pads, hot water bottles, iodine or alcohol. 3. Keep the feet dry – especially between toes-use unscented lotion or cream to keep skin soft. 4. Use only medicines recommended by your doctor 5. Cut toe nails straight across, not deep into the corners to help avoid ingrown toe nails. 6. Never use razors, knives or corn caps to remove corns. 7. Wear shoes or slippers at all times -never walk bare foot even at home. 8. Wear good fitting shoes/slippers - not tight or worn-out ones. Boots should be used only for short periods. 9. Check your feet daily and see your doctor immediately about foot problems. "Diabetes costs a lot to the people, much more than money" says Prof Kant. According to Diabetes Atlas published by the International Diabetes Federation (IDF), there were an estimated 40 million people with diabetes in India in 2007 and this number is predicted to rise to almost 70 million people by the year 2025. The countries with the largest number of people with diabetes will be India, China and USA by 2025. It is estimated that every fifth person with diabetes will be an Indian. Due to these sheer numbers, the economic burden due to diabetes in India is amongst the highest in the world. International Diabetes Federation (IDF) is striving to raise awareness about diabetes, and advocate for standard treatment facilities globally. With few weeks to go for this year's World Diabetes Day, 14 November 2008, which in India, is also observed as Children's Day to commemorate the birth anniversary of India's first Prime Minister Jawahar Lal Nehru who was known for his affection towards children, let us hope that the awareness related to diabetes can be upped phenomenally.

Health : Background & Perspective

Health Indicators
India, the second most populous country in the world, is a bewildering collection of contradictions. If the people in some regions live in abysmal conditions, and thousands die from preventable and treatable illnesses, islands of good health such as the southern state of Kerala have health indicators comparable to those of developed countries.
Faced with massive problems of ill-health (the burden of disease), Indians have had to address the question of how to provide a health infrastructure that is accessible to the people. A number of critical health issues have been raised in this context. The question is: what are the solutions, and what is being done to change the health system and the quality of health of the people?
Around June 2000, India turned one. One billion, that is. The Census of India 2001 ( counted 1,027,015,247 Indians as of March 1, 2001: 531,277,078 men and 495,738,169 women.Can this child -- and the many more born the same year -- hope for a good life?
The good news:
Life expectancy at birth and infant mortality are two important indicators of a society's health. And the billionth Indian baby is less likely to die in childhood, more likely to live a long life. She can expect to live beyond her 60th year, twice as long as her great-grandfather did.
If in 1947, 146 of every 1,000 babies born died before their first birthday, the infant mortality rate (IMR) is half that today, at 68/1,000.
National averages of all indicators of health and health care are looking up:
For example, couples are having fewer children. In 1998-99, the total fertility rate was 2.9 per woman, down from 3.4 in 1992-93.
More deliveries take place in health facilities (34 per cent in 1992-93, compared to 26 per cent in 1992-3) or with the help of trained support (42 per cent from 33 per cent), reducing the risk to both mother and child.
More children receive the essential vaccines protecting them from tuberculosis, diphtheria, pertussis, tetanus, measles and polio --- 42 per cent, up from 36 per cent.
However, such averages hide wide variations, from the populous northern state of Uttar Pradesh (with an IMR of 88/1,000) to the southern state of Kerala (16/1,000) whose health indicators rank among those of developed countries.
So, the bad news is:
More than one-third of married Indian women have chronic energy deficiency; more than half of them are anaemic.
Forty-five per cent of children under three are severely and chronically malnourished..
Only 42 per cent of children between the age of 12 and 24 months have completed their immunisation schedule; a massive 14.4 per cent have not received a single vaccine.
Only 31 per cent of the rural population has access to potable water supply and only 0.5 per cent enjoys basic sanitation.
In 2001, people continue to die for the same reasons they did when India became independent in 1947: infectious diseases.
Babies continue to die every day of treatable respiratory infections, diarrhoea and other illnesses either preventable through clean water, nutritious food and cheap vaccines, or treatable with basic drugs.
AIDS is one more infectious disease in the landscape today.
As the entire Indian population ages, many more people are being struck down by non-infectious ailments. Some people believe that cancers, diabetes and heart disease will soon overtake infectious diseases as the number one killer.
(For more information see: 1991 Census of India, National Health Policy, 1983, PRB 2000 World Population Data Sheet,, National Family Health Survey-II, 1998-99,
At present, infectious and parasitic diseases dominate. They killed 2,121,000 people in 1998. The killers include tuberculosis and other infections including sexually transmitted diseases, AIDS, tropical diseases, respiratory infections and maternal conditions. In fact, press reports indicate a resurgence of diseases once believed to be on their way out. Epidemics of deadly cerebral malaria have been reported in many parts of the country. Every year, scores of children in the rural areas die of measles, exacerbated by malnutrition.
Tuberculosis kills 500,000 Indians each year. One in two Indians is infected with the TB bacillus, and 1.5 per cent of the population has radiologically active TB. Between one and two million new cases occur ever year, with a case load of over 11 million patients. India has more TB cases than any other country in the world.
TB affects the poorest sections of society. An estimated 26 per cent of all deaths in the economically most productive section is due to TB.
The TB pandemic is further complicated by the spread of HIV/AIDS. It is estimated that there are 250,000 HIV-related TB cases annually by 2000.
It is estimated that the economic cost of TB to India is more than US $2 billion (Rs 8,000 crore) each year.
Almost 100,000 people died from respiratory infections in 1998.
Some 1,25,000 women died from complications of pregnancy, in 1998.
100,000 deaths in 1998 could be attributed to nutritional deficiencies, more than half of which were simple protein-calorie malnutrition.
HIV affected 3.5 million Indians in 1998, according to UNAIDS estimates, though the overall prevalence of HIV in India is still low. Official surveillance data suggest that the epidemic is progressing rapidly.
One in two new HIV infections takes place in people below the age of 25; one in four HIV infections in India are amongst women, most of whom have no risk factor other than being married.
However, doubts have been expressed on the quality of epidemiological data. It has also been argued that the HIV epidemic should be seen in the context of other conditions such as diarrhoea, respiratory infections and tuberculosis, which have a higher morbidity and mortality
Malaria affects 2.6 million people each year, and killed at least 20,000 people in 1999.
India has the largest burden of leprosy patients in the world, with a caseload of over 4 million patients.
(For more information see: World Health Organisation: World Health Report, 1999,, TB:,,, HIV: National AIDS Control Organisation; UNAIDS; WHO Global burden of disease and disability, 1995)
As Indians live longer, chronic diseases, related to aging, are expected to take a greater toll.
Cancers killed 653,000 people in 1998, the single largest type being mouth and oropharynx cancer. An estimated 1.5 million new cases occur each year.
Cardiovascular diseases, which includes those with an infectious origin, such as rheumatic heart disease, killed 2,820,000 people in 1998
Diabetes: In 1994 there were 20 million diabetics in India; there will be more than 33 million in 2005, according to World Health Organisation estimates. One in four diabetics will be Indian. Diabetes was responsible for 102,000 deaths in 1998. Up to 75 per cent don't even know they're diabetic. Studies over the last three decades show a rising prevalence of non-insulin-dependent diabetes, which affects Indians earlier than in the West. Diabetic retinopathy, the most common cause of blindness in urban, middle-class Indians, is on the rise, though most of it is preventable. Diabetes is also the most significant cause of end-stage kidney disease and of amputations in India. The costs of drugs for diabetes, already high for the average Indian, are expected to go up in the near future..
The 2001 Census for the first time records people with visual, hearing, locomotor and mental disabilities.
A benchmark survey was carried out by the National Sample Survey Organisation in 1991. It estimated that 1.9 per cent of Indians are disabled. Other estimates suggest that between 6 and 10 per cent of the population in any developing country is affected by disability, which means 60-100 million Indians are affected by disability.
According to various estimates, between 4 million and 14 million Indians are blind. The most common causes of blindness is cataract, which is treatable by surgery; the next most important cause was refractive error which is treatable with glasses.
The 1991 NSSO survey estimated 3.2 million people with hearing impairment in India. According to a 1980 WHO report, the underlying causes are low socio-economic status, poor health care and nutrition, which deprives people of immunisation against infections and adequate treatment for infection.
Approximately 1.6 per cent of the Indian population, or over 16 million people, are affected by locomotor disabilities. The two most common causes are poliomyelitis and cerebral palsy.
The 1991 NSSO survey estimated that 3 per cent of India's children have delayed development (mental retardation), of whom one in four is moderately to severely retarded. The problem is more common in rural areas. The problem can be reduced with access to prenatal screening, immunisation, nutrition and health services. Early identification, assessment and intervention will help bring down the burden of disability.
Ten per cent of the child population -- or 30 million children up to the age of 14 -- have special educational needs of various kinds. Unfortunately, in the absence of comprehensive support services, not more than 3-4 per cent of children with disability have access to education.
(For more information see
Indian women often tolerate ill health without complaint. A number of community-based studies are bringing to light the extent of women's health problems.
In a study in rural Maharashtra, researchers found that one in two women interviewed reported an illness in the previous month. They spoke of chronic, non-infectious, long-standing problems, related to their reproductive health, to various aches and pains, or to mental health. Illnesses were often linked to their working and living environment, childbearing and contraception. Almost half tolerated their illnesses without treatment -- either they couldn't afford the treatment, or they felt it couldn't be treated, or health facilities were inaccessible.
A considerable proportion of women suffer silently from a range of gynaecological problems -- reproductive tract infections (RTIs), menstrual problems, cervical erosion, infertility, uterine prolapse, and so on. The most frequent complaint is of vaginal discharge. RTIs are acquired through sexual transmission, medical procedures such as IUDs, tubectomies, abortion and childbirth, or from overgrowth of the body's own bacteria. Numerous studies have demonstrated that gynaecological morbidity is a serious problem in India.
100,000 Indian women die of pregnancy-related causes each year. The maternal mortality ratio (number of deaths for every 100,000 live births) is 50 times higher than developed countries and six times higher than neighbouring Sri Lanka. The six major causes -- haemorrhage, anaemia, eclampsia (pregnancy-related hypertension), infection, abortion and obstructed labour -- account for 85 per cent of pregnancy-related deaths. There are also a number of background factors: nutrition and health status, age, number of children, marital status, gender disparities, lack of information, socio-economic conditions and poor access to health services all influence maternal mortality and morbidity.
Abortion, which has been legal in India since 1971, accounts for at least 12 per cent of maternal deaths. Only ten per cent of the estimated 5 million abortions ('medical termination of pregnancy' or MTP) that take place in India annually, are performed in approved health services.
Authorised MTP centres are concentrated in the urban areas, and in a few states. Many approved centres may not be providing services, many are inadequately equipped, with poorly-trained or insufficient staff. The private sector provides a large proportion of services.
A rural community-based study in the state of Maharashtra found that one out of six women who underwent an abortion did so to abort a female foetus. Two out of three suffer health consequences serious enough to affect their daily lives. Less than one-third of women are counselled about the procedure's risks, but more than half are given contraceptive advice, and many are forced to accept contraception in order to get an abortion.
However, women's health problems extend beyond their reproductive health. While maternal mortality and morbidity have been the focus of women's health efforts, public health specialists have argued that mortality data from the government's model registration scheme indicate that communicable diseases are the most significant cause of death for women
More than one-third of all deaths take place in children under the age of five. In 1999, 98 of every 1,000 children died from an infectious disease before their fifth birthday, placing India 49th out of 187 countries in the under-five mortality rate.
As many as 429,000 children died of diphtheria, pertussis (whooping cough), tetanus, measles or polio, in 1998. One in two polio deaths in the world occurs in India. All of these are preventable.
733,000 children under the age of five died of diarrhoeal diseases in 1990 (250 million cases annually).
777,000 children under the age of five died of respiratory infections in 1990 (nearly 500 million cases annually).
333,000 children died of complications following low birth weight in 1990.
These deaths are preventable through adequate nutrition to mother and child, clean water supply and sanitation, effective immunisation and an accessible health service to provide prompt treatment.
Public health services. India has a vast health care sector, estimated at Rs 126.27 billion in 1998. This health care sector is broadly divided into the public and private sectors. Public health services consist of the following 'step-up referral' network of sub-centres, primary health centres, community health centres and district hospitals:
140,000 sub-centres manned by two multipurpose health workers; 23,000 primary health centres (PHCs) with a medical officer, 14 staff and 4-6 patient beds, with each PHC acting as a referral unit for six sub centres; 3,000 community health centres (CHCs) with four medical specialists, 21 staff, 30 beds and basic surgical and lab facilities, with each CHC a referral unit for four PHCs; 550 district hospitals and 1,012 at the sub-divisional level.
In the urban areas, the network consists of urban family welfare centres for contraceptives, urban health posts and hospitals.(Figures as of June 1999, according to the health ministry:
Doctors, nurses, hospitals and dispensaries: In 1998, about 523,000 allopaths and 115,500 practitioners of other systems of medicine provided health services to the Indian population. Institutional services were provided by 17,000 hospitals and 28,000 dispensaries (mostly privately owned and in the urban areas), with 95,000 beds, and supported by 566,000 nurses. Health providers are trained at 165 medical colleges, which turned out 12,000 graduates and 3,140 postgraduates in 1991. However, more than 80 per cent of out-patient services and a smaller proportion of hospital services were provided in the private sector.
This infrastructure is primarily in the private sector, which provides at least 80 per cent of health services in the country. The role played by non-governmental organisations working in health is also significant.
Indigenous medicine: India has perhaps the world's largest community-based tradition of indigenous systems of medicine.
Every rural community has its own local health tradition, using thousands of plants for medicinal purposes. As many as 700,000 traditional dais (midwives) conduct the majority of rural deliveries, 60,000 bone-setters treat orthopaedic problems, 80,000 herbal healers provide primary health care for various conditions. Millions of people use home-based remedies.
The classical systems include Ayurveda, Siddha (, Tibetan medicine, Unani-Tibb ( and Homoeopathy ( Some of these date back thousands of years, and depend on a codified system of knowledge, some documentation, and institutions of teaching, research and manufacture. Medical practice is largely not institutionalised.
Yet only four per cent of the national health budget is devoted to these systems. There have been very limited efforts to evaluate these systems. Most Ayurvedic colleges do not have the required infrastructure and faculty. The Central Council of Research in Ayurveda and Siddha has 80 research centres, but there is a general lack of perspective on the proper research design to validate the claims of ayurveda based on its own theoretical formulations rather than isolating active principles for allopathic medicine. Overall, there has been no effort to strengthen these systems.
Health policy

The 1983 National Health Policy was meant to arrive at "an integrated, comprehensive approach towards the future development of medical education, research and health services… to serve the actual health needs and priorities of the country." Critical of the curative model of health care, it emphasised a primary health care approach to prevent illness and promote good health. It envisioned an inexpensive but decentralised system of health care, depending on volunteers, paramedics and community participation, with an expanded private curative sector to reduce the government's burden, and a network of epidemiological stations to support health programmes.
The next decade saw the rural health infrastructure develop with a massive expansion of primary health care facilities (described in Infrastructure). However, this effort was sabotaged by a combination of poor quality facilities, inadequate supplies, ineffective managerial skills, poor planning, monitoring and evaluation.
There was no community participation in building up the health services. Various national health programmes function almost independently of each other. Public health experts have suggested that allocation for disease control programmes is driven more by donor organisations than the country's epidemiological realities. Health services concentrated on targetted programmes like family planning and immunisation. Primary health services were never really established in the country.
The private health sector has grown phenomenally, thanks to state subsidies in the form of medical education, soft loans to set up medical practice, etc. accounting for 70-80 per cent of all primary care treatment sought, and over 40 per cent of all hospital care -- in a country where over three-fourths of the population lives at or below subsistence levels.
"Universal, comprehensive, primary health care services" are a distant dream. Public health experts suggest that current trends in health care, and the policies demanded by the structural adjustment programme, have sharpened inequities in health. Selective health interventions have become even more focussed after the World Bank's 1993 World Development Report recommended limiting government health money to the most 'cost-efficient' interventions. "Efficiency scored over the severity of health care problems, as well as equity and social justice."
Problems of access
One in three Indian women did not receive an antenatal check-up during their pregnancy. Fifty-four per cent delivered their babies without the support of trained personnel. Fifty-eight per cent of children have not completed their immunisation schedule and 14 per cent have not received a single vaccine. Only one in two women seeks treatment for illness, usually because the nearest health service is too far away, or it's too expensive. These examples are only meant to illustrate the fact that people's access to health care is limited by their ability to pay, as well the availability of services.
The private-public debate
India is believed to have one of the largest private health sectors in the world. Varying estimates place private expenditure at between 75 and 85 per cent of health care expenditure. One out of two people seeking hospitalisaton go to the private sector, which handles a larger proportion of out-patients than of in-patients.
In 1991, the Indian government's health care expenditure was less than two per cent of its gross domestic product, and just 21.7 per cent of total health expenditure -- one of the lowest proportions in the world. Over the years, it has made further cutbacks in its commitment to public health services. Total expenditure on health is 5.2 per cent of the GDP, but out of this, only 13 per cent is spent by the government. Health accounts for only 3.9 per cent of total public expenditure.
What does this mean in a country where at least 26 per cent of the population are still fighting for subsistence (below the poverty line)? Poverty and ill-health go hand-in-hand, and limited income means a limited capacity for health spending. For the poor, therefore, health care is often the last priority, affordable only if there is money left over after paying for more immediate needs such as food. In such a situation, what is the government's responsibility in providing health services for the people?
Sri Lanka, with health indicators comparable to many developed countries, spends only 3 per cent of its GDP on health, but 45.4 of this is spent by the government. Or take the example of Cuba, with similar health status, which commits as much as 10 per cent of all public expenditure to health.
Private services: not the privilege of the rich
In the absence of accessible government clinics and hospitals, private health care is not the privilege of the rich but often the only option of the poor as well. Studies of household expenditure have shown that health care can use up to 40 per cent of a poor family's budget. Even using public services costs money: fifty per cent of the patients in Mumbai's public hospitals spend more every day than the daily income of their entire household. In private hospitals, average costs for medicines, doctors' and hospital fees can amount to twice a family's monthly income. No wonder health care is becoming the second most common cause of debt in rural areas.
User charges in government hospitals
For some years now, the government has been advocating user charges in public hospitals, arguing that while it is commited to basic health care (family planning, immunisation and selected disease programmes) people should pay for other services. This has been opposed by many health activists on the grounds that user charges actually reduce the poor's access to essential services.
A small fraction of India's population is covered by insurance schemes of any sort, whether private or employees' schemes. The vast majority of Indians must either make out-of-pocket payments for health services in the growing private sector or go to the public sector which is both small and increasingly demanding compensation.
One of the consequences of structural adjustment programmes in the health sector was to open up health insurance to private companies. Will the entry of private insurance companies provide relief to the poor who cannot afford to pay for care? The private sector has an estimated premium potential of over Rs 4,500 crore. But the private sector will target only those who can afford its premiums. Private insurance companies are unlikely to provide coverage to the poorest of the poor in the rural areas, who need it the most.
Quality of care
The quality of health care available in India is extremely variable -- from corporate hospitals with the latest equipment, highly-qualified doctors and patient-friendly services, to small outfits with unqualified staff, lacking even basic equipment or a continuous supply of water and electricity. General practitioners in slums charge for injections of limited efficacy and possible harm. Traditional health practitioners -- many providing allopathic medicines -- serve a large proportion of the population, many of them practising allopathic medicine for which they are not trained.
All these practitioners thrive free of regulation. Unethical practices such as unnecessary investigations and surgeries and kickbacks for referrals are rampant. Many private hospitals over-charge and deny the patient information about diagnosis and treatment. Though medical services were recently brought under the Consumer Protection Act, there are no enforceable standards for private hospitals. Regulatory bodies such as the medical councils are unwilling to fulfil their responsibilities, the legal system is ill-equipped to handle the burden of medical litigation, and aggrieved patients and their relatives cannot afford the costs and long delays of the battle.
The global economy and Indian people's health
In 1991, India began instituting a structural adjustment programme (SAP), as a condition of a loan from the International Monetary Fund to bail it out a financial crisis. The SAPs were supposed to discipline a wasteful planned welfare state, and required that India reduce government spending, privatise state-owned enterprises, and open up its markets to outside investment and a 'global economy'.
In the health sector, this meant cuts in public health spending, the introduction of service charges in public services, and handing over even more responsibility to the private sector which already accounted for three-fourth of health expenditure.
Many senior public health experts feel that the SAPs increased the rich-poor gap, and increased the international debt burden. The result: cuts were forced in an already inadequate public expenditure on health and other social sectors. At the same time, rising unemployment and food prices as a result of liberalised industrial policies makes people even less able to maintain good health. As investment in health services gets more and more driven by profit rather than need, 'five star' hospitals flourish even as tribal children weakened by chronic malnutrition die in measles epidemics every year.
If Indian people face a myriad health problems, hundreds of individuals and organisations are looking for the way forward. Academic academic and research institutions such as the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi (http:// ), and the Centre for Enquiry into Health and Allied Themes (CEHAT), Mumbai ( -- whose publications are the basis for a number of the points made in Section IV -- have provided vital documentation and analysis of the health scene.Voluntary organisations (see Stories of Change in this section) have provided services as well as demonstrated the effectiveness of innovative strategies and inexpensive models of health care. Some have promoted the value of indigenous systems of medicine which are both more accessible and perhaps less harmful. Others have provided support services for disability groups. Networks of health professionals, academics and activists such as the Medico Friends Circle ( have enriched the many ongoing debates. Larger movements such as the National Health Assembly ( have brought together organisations from all over the country to influence the direction of health policy.

Debilitating ailments on rise in South Asia

(10-05) 04:00 PDT Chennai, India -- T. Selvaraj, 29, lay writhing in pain on a hospital bed in an overcrowded ward, a plaster cast draping his left leg where a neuropathic ulcer had broken down the tissue.
"It is excruciatingly painful," he said, while injecting himself with insulin above his belly button.
Every 30 seconds, a person loses a leg to diabetes, a disease of high blood sugar that can result in amputations, blindness and heart failure. The malady is estimated to cause 3.2 million deaths worldwide every year, according to the World Health Organization. That's nearly 1 1/2 times the number of deaths from AIDS.
Once believed to be a disease associated with industrial nations, diabetes is slowly engulfing the developing world as well. Eighty percent of sufferers now live in developing countries, where, WHO predicts, the number of diabetics will increase 1 1/2 times in the next 25 years.
Currently, 1 of every 3 diabetics lives in India and China, with India having the dubious distinction of being the global leader - about 35 million diabetics, or nearly 15 percent of the world's total. WHO says India is now "the diabetes capital of the world."
Indian health experts warn that the brisk spread of diabetes could have a devastating effect on the economy. Diabetes already accounts for $2.2 billion in annual health care costs, according to government estimates. And a recent report by the Indian Council for Research on International Economic Relations estimates India lost $9 billion in national income as a result of heart disease, stroke and diabetes in 2005 and projects that figure will exceed $237 billion over the next 10 years.
Once known for horrific famines, India in recent years has experienced a torrid economic boom that has lifted millions out of poverty. But this newfound prosperity has also sparked numerous health problems, including diabetes, health officials say. Amid rising income from plush call centers and software companies, Western food habits and sedentary lifestyles are taking root among India's burgeoning middle class. According to WHO, nearly 18 percent of Indians say they do no physical exercise.
Fast food chains have tapped into a vast market in cities where the burgeoning middle class is shying away from traditional foods. And for some, a huge belly has become a symbol of success.
"In a land where famines once made people starve, a bulging paunch is mistaken for affluence," said Dr. V. Mohan, director of Dr. Mohan's Diabetes Specialities Center in Chennai. "Indians today suffer from what I call ... too much consumption."
Selvaraj's leg - which doctors say might require amputation - is a consequence of Type 2 diabetes, the most common kind.
"How will I ever work without a leg?" said Selvaraj.
Seven years ago, Selvaraj left his father's arid farm in rural Tamil Nadu state and migrated to the state capital, Chennai, to open a grocery store. As his business grew, he says he ate richer foods and drank excessively.
Selvaraj's condition is indicative of how diabetes is increasingly afflicting the young, and with India urbanizing at blinding speed, how diabetes - believed largely to be an urban malady - is also spreading to vast swaths of rural India. Since many rural migrants send money home to their families, they are causing a marked shift in eating habits, health officials say.
Studies conducted by Mohan's hospital in Chennai - a manufacturing and software hub in southern India, where nearly 20 percent of adults are said to have diabetes - found that awareness of diabetes is poor, especially in rural areas.
Progress is also impeded, experts say, by a health system that places a high priority on communicable diseases such as malaria, while allocating sparse funds for noncommunicable diseases such as diabetes.
Nevertheless, the Ministry of Health in January launched a pilot program in seven states to increase awareness of diabetes, cardiovascular diseases and stroke.
The program couldn't come at a better time, said Mohan, who travels around Tamil Nadu educating residents about diabetes and preventive health care.
"The message I give out is that 'fatness is not wellness,' " he said. "It'll take a while before that mind-set changes."
Key facts about diabetes
-- Diabetes is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
-- There are two basic forms of diabetes.
-- In Type 1, sufferers produce very little or no insulin and require daily injections of insulin. In Type 2, sufferers cannot use insulin effectively. They sometimes manage their condition with lifestyle changes. Oral drugs, however, are often required - and less frequently insulin - to achieve metabolic control. Most people with diabetes have Type 2.
-- At least 171 million people worldwide have diabetes, and the figure is likely to double by 2030.
-- Around 3.2 million deaths every year are attributed to complications of diabetes; that's six deaths every minute.
-- Cardiovascular disease is responsible for between 50 and 80 percent of deaths in people with diabetes.
-- Diabetes is the most common cause of nontraumatic amputation of the lower limb.
-- Direct health care costs of diabetes range from 2.5 to 15 percent of annual health care budgets.
-- The top 10 countries, in numbers of sufferers, are India, China, the United States, Indonesia, Japan, Pakistan, Russia, Brazil, Italy and Bangladesh.
-- In developed countries, most sufferers are above retirement age. In developing countries, most sufferers are between 35 and 64.
Source: World Health Organization

Norms to start medical colleges may be relaxed

CHENNAI: The Centre is considering relaxation of regulations for starting medical colleges, especially in areas under-served by healthcare systems, Union Health Minister Anbumani Ramadoss has said.
The category “under-served areas” will be applicable to the northeast region and backward States, where the National Rural Health Mission is operational, he said. This measure was to handle the huge shortage of doctors in these States.
“A matter of concern”
Dr. Ramadoss said that while the country needed one lakh doctors, only a third of this requirement was being met. Every year, 32,500 graduates passed out of medical schools and not all of them entered the public health sector.
Due to scarcity of doctors in the northeast, the Union Health Ministry had roped in the armed services medical corps to pitch in.
Referring to relaxation of norms, Dr. Ramadoss said that while the focus would continue to be on quality there was no doubt that given the present conditions in those States, some of the existing rules for setting up medical colleges would perforce have to be relaxed.
Changes would have to be made to the Establishment of Medical College Regulations, 1999. The Regulations insist that “a suitable single plot of land measuring not less than 25 acres is owned and possessed by the person or is possessed by the applicant by way of 99 years lease for the construction of the college.”
The government was considering splitting up the 25 acres into two campuses and making such a recommendation to the Medical Council of India. In most hilly terrains, it would sometimes be difficult to accommodate the entire 25-acre campus in a single location, the Health Minister explained.
Also, it had been specified that the applicant “owns and manages a hospital of not less than 300 beds with necessary infrastructural facilities capable of being developed into a teaching institution on the campus of the proposed medical college.”
Dr. Ramadoss said that “since the lack of hospitals itself is a concern in some States, we intend to introduce a public-private partnership model. Private institutions that do not have such a large-capacity hospital too can start a medical college.”
Source: The Hindu -08 may 2008

Absenteeism among health workers highest in India: Report

Absenteeism among health workers is the highest in India, according to World Bank’s Global Monitoring Report-2008 (GMR). Referring to a survey carried out in 2002 -03, the report says that the rate of absenteeism among primary healthcare workers in India is 40%. This has a strong impact on the Millennium Development Goals (MDGs) like reducing child and maternal mortality and sanitation MDGs. The GMR attempts to highlight how healthcare quality is critical to reaching the MDGs. “The quality of healthcare services matters because it reflects the extent to which investments to national healthcare systems are able to raise both human capital and individual welfare,” says the report.

Trained doctors can make a dramatic difference in improving healthcare, but absenteeism is both chronic and pervasive in many developing countries. While India and Indonesia top the list, countries like Bangladesh and Uganda follow with more than 35% absenteeism among primary healthcare workers. The absence rates in five developing countries averaged 35% in 2002-03. The report mentions that it is possible that these figures underestimates the severity of the problem because health care personnel can be present without actually providing medical care. When asked what can be the possible reasons behind such absenteeism, Dr Zia Qureshi, senior advisor with the office of the chief economist of the World Bank and the lead author of the GMR 2008 report said: “The government framework is weak. There are issues of governance which includes incentives, oversight and accountability. The government in developing countries need to expand their programs with effectiveness.” According to Qureshi, the incentives are weak in India and hence people respond to that by taking leaves and being absent from their work station. There is also lack of accountability among health workers due to which they move freely without attending to jobs. Agrees Shrawan Nigam, Senior consultant, Indian Council for Research on International Economic Relations (ICRIER), who feels that the problem is more severe in rural India. “There is a concept of passing on the responsibility to the panchayati raj, whereas the work is not happening at that level as well and there is a need for monitoring,” asserts Nigam. According to Nigam, absenteeism is high among teachers in India too. The report points out that though there is a need for more spending on education and health programs, that is not the sole answer. “The quality and equity of spending are equally important,” says Qureshi. Improved governance, stronger accountability mechanisms and sound expenditure management are essential to raise the quality of health and education. Although, the report predicts that on current trends the human development MDGs are unlikely to be met yet they can be achieved if stronger efforts are made both by the countries and their development partners. “Progress must be accelerated and made more inclusive. Private players along with public ones have a major role to play. It calls for a reform to make sure that resources are spend effectively and reaches poor and undeveloped areas,” suggests Qureshi.
Source: ECONOMIC TIMES -17MAY 2008

Healthcare: India has worst indicator of child malnutrition

New Delhi, May 14 (ANI): Over 1.5 million children in India are at risk of becoming malnourished because of rising global food prices, the Unicef, says.It warns that food inflation could be devastating for vulnerable women and children right across South Asia.According to the BBC, the region already has the largest number of malnourished children in the world and levels could get even worse.Even before the current crisis almost half of all Indian children showed signs of stunted growth, Unicef says."It is a perfect storm, we have increasing malnutrition in an area that already has the majority of malnutrition in the world," Daniel Toole, Unicef's regional director for South Asia, said here on Tuesday."We have huge numbers of people living in poverty and a doubling of food prices. Those factors combined mean that we're going to just create tremendous vulnerability," he added.According to Unicef's latest State of the World's Children's report, India has the worst indicators of child malnutrition in South Asia.It claims that 48 percent of under fives in India are stunted, compared to 43 percent in Bangladesh and 37 percent in Pakistan.The report further goes on to say that 30 percent of babies in India are born underweight, compared to 22 percent in Bangladesh and 19 percent in Pakistan.Unicef calculates that 40 percent of all underweight babies in the world are Indian.Put all that in hard numbers and the figures are stark. Fifty million Indian under fives are affected by malnutrition. Rising food prices, Unicef says mean 1.5 to 1.8 million more children in India alone could end up malnourished.And already Unicef says more expensive food is having an impact.Three hundred million Indians live on less than one dollar a day, according to the UN.Poor families who cannot afford rising food prices are having to save money where they can, and that also means spending less on healthcare and education.Food prices, he believes, will remain high for at least the next two years, and in that time it isFirst the priority must be to feed the hungry across South Asia, Unicef says. India must invest more in agriculture, Unicef says. (ANI)

Source: Yahoo India News

Healthcare In India Unsatisfactory

NEW DELH: Healthcare in India still lags behind countries like Sri Lanka, China and even Bangladesh on several key parameters despite some improvement in the sector, the Economic Survey for 2007-08 said on Thursday. "India's position on health parameters compared to even some of its neighbours continues to be unsatisfactory. While India has improved with respect to some important health indicators over the years, it compares poorly with countries like China and Sri Lanka," the survey said. While India's maternal mortality rate per 100,000 live births remains a high 450, it is 45 in China, 58 in Sri Lanka and 320 in Pakistan. Similarly, infant mortality rate (IMR) in India is 56 per 1,000 live births against 12 in Sri Lanka and 23 in China. Even Bangladesh fares better than India in infant mortality with 54 children dying per 1,000 live births. India shares its IMR with the landlocked country of Nepal and fares better than Pakistan (79). The survey has revealed that 74 Indian children per 1,000 die before attending their fifth birthday as against 14 in Sri Lanka, 27 in China and 73 in Bangladesh. Giving a comparative study of life expectancy in south Asian countries, the survey underlines that the average life expectancy in India is 62.9 years. It is 72 years in China, 63.6 in Pakistan and 70.8 years in Sri Lanka. Only Nepal (61.3 years) and Bangladesh (62 years) are behind India. There has been some improvement in the quality of healthcare but wide inter-state, male-female, and rural urban disparities in outcomes and impacts continue. Reproductive and child health services reach communities and households through the primary healthcare infrastructure in the country. "Inadequacies in the existing health infrastructure have led to gaps in coverage and outreach services in rural areas," the survey noted. However, it praised the National Rural Health Mission (NRHM), a flagship programme of the health ministry, for improving rural health. "NRHM has successfully provided platform for community health action at all levels. Through united and flexible financing, NRHM is trying to drive reforms that empower local communities to make their own decisions."
Source: Times Of India

Indian healthcare success story - Emergency Management and Research Institute

"EMRI (Emergency Management and Research Institute) is a pioneer in Emergency Management Services in India. It is a not - for - profit professional organization founded, funded and nurtured by Mr.B.Ramalinga Raju, founder and Chairman, Satyam Computers and his brothers. Operating in the Private Public Patrnership (PPP) mode, EMRI is the only professional Emergency Service Provider in India today.EMRI handles medical, police and fire emergencies through the ' 108 Emergency service'. This is a free service delivered through state- of -art emergency call response centres and over 610 ambulances accross Andhra Pradesh and Gujarat. With the expansion of fleet and services set to spread accross more states in 2008, EMRI will have more than 2000 ambulances covering a population in excess of 200 million by July 2008."This is one of India's great healthcare success stories ! They provide emergency medical care which is as good as the US 911 care - at one tenth of the cost ! This is a great example of using a clever mix of managerial skills; advanced technology; entrepreneurship and public-private partnership to provide high quality medical care. It's a very inspiring story - and is full of lessons we can all learn from.
Posted by Dr Aniruddha Malpani, MD


State of health care in India

Thursday, May 15, 2008
Indian health care features in the latest issue of TIME magazine. Its tough to read through it without being angry and frustrated.,8599,1736516,00.htmlI live in Kolkata and my sister is a doctor. I keep hearing horror stories from her about our state hospitals. Power cuts are common in the state hospitals rendernig whatever equipment is available, useless. Cleanliness is difficult, true, given the huge rush of patients, but dogs and cats under beds???!!! Whenever something happens to a patient there are doctors being beaten up and blamed. What most dont realise that in the "system" the doctors are also victims.And we compare ourselves with China? The next global superpower? With a population that cant afford basic healthcare, wont we be too sick to work our way up the ladder to that dream?Added to that is the mentality of our population. Women are still denied basic care, here, in the heart of the city. Our house cleaners daughter is approx 5 months pregnant (at 16, so much for our govt policies, she married last year on her own). Her inlaws are yet to get an ultra sound done. They were reluctant to take her to the hospital at all, was forced by people like us. My baby's ayah is 24. Her sons are 7 and 6 yrs old. Recently her brother got married. Age of the bride- 15 yrs. This is Kolkata, not some out of the way village. In anything, any situation, women are always the first and the most to suffer.
Posted by Smelling oranges on winter afternoons at 11:07 AM


Current Healthcare Indicators- INDIA

This report presents the healthcare indicators for India and discusses industry trends.
Despite the improving health status of the Indian population, healthcare infrastructure in India
has a long way to go towards achieving 100% quality, technology and superior healthcare
delivery systems. While the Central (Federal) Government is limited to family welfare and
disease control programs, the state governments are responsible for primary and secondary
medical care with a limited role in specialty care. Looking at the healthcare indicators and the
growing prevalence of non-communicable lifestyle related diseases, both the government and
private sector, realize the need to meet this basic demand. Today, the private sector
provides 80 percent of the healthcare service.
Market Overview
Increasing private sector participation in healthcare services is stimulating change in the
Indian healthcare industry. According to an ICRA industry report on Healthcare, India
spends 5.1 percent of its GDP on health. The health market is estimated at Rs.1, 408 billion
($30 billion) and includes retail pharmaceutical, healthcare services, medical and diagnostic
equipment and supplies. While India’s overall expenditure on health is comparable to most
developing countries, India’s per capita healthcare expenditure is low due its large billion-
plus population and low per capita income. This scenario is not likely to improve because of
rising healthcare costs and India’s growing population (estimated to increase from 1 billion
to 1.2 billion by 2012).
The government’s share in the healthcare delivery market is 20 percent while 80 percent is
with the private sector.
Structure of the government healthcare service:
- Primary Care (in rural areas): 22,271 primary healthcare centers and 137,271 sub-centers.
- Secondary Care (healthcare centers in smaller towns and cities): 1,200 PSU (public sector
units) hospitals, 4,400 district hospitals, and 2,935 community healthcare centers.
- Tertiary Care (hospitals): 117 medical colleges and hospitals.
The private healthcare providers consist of private practitioners, for profit hospitals and
nursing homes, and charitable hospitals. They are numerous and fragmented. In the
absence of a national regulatory body, some private providers practice without minimum
standards and the quality of treatment varies from one provider to another. The average
size of private hospitals/nursing homes is 22 beds, which is low compared to other
Size of hospitals
84 percent of private hospitals
<30>200 beds
Market Trends
Changing demographic profile: Improving overall health status and socio-economic
pressures have resulted in changes in the demographic profile. With the decline in birth
rates, the population aged 0-14 has declined, while on the other hand improvement in life
expectancy has led to an increase in the old age population. On average this has led to
higher per capita demand for health services.
The type of healthcare service requirement has changed due to the rise of lifestyle-related
diseases such as diabetes, cardiovascular diseases, and diseases of the central nervous
system. There are around 700,000 new cases of cancer each year and approximately 2.5
million cases. It is estimated that there are around 40 million people in India with diabetes,
5.1 million HIV/AIDS patients, and 14 million tuberculosis cases. In the past year, the
Indian pharmaceutical industry witnessed a growth of 7 percent, the cardio-vascular
segment recorded a growth of 15 to 17 percent and the anti-diabetes segment 10-12
percent growth.
Compared to a few private institutions primarily in the form of charitable trusts and small
nursing homes, recently a number of large sized Indian companies have ventured into
healthcare delivery. Companies like Max India, Ranbaxy Laboratories, Escorts, Wockhardt
and Birla have established Specialty Hospitals. There is increased interest is diagnostic
service as well, with companies such as SRL-Ranbaxy, Nicholas Piramal, and Dr. Lal’s
laboratory venturing into this field. Emergence of corporate hospitals has led to increased
professionalism in medical practices and use of hospital management tools.
The demand for quality healthcare has increased with patients preferring to use private
healthcare facilities. Private healthcare service varies in terms of quality and caters more to
the needs of the rich, middle class and urban segments of the population. The growth in
affluence of the Indian middle-class is adding to this demand. In the period 1993-94 to
2001-2002, aggregate household expenditure on health services has increased at an
annual rate of 9.3 percent.
According to a 2002 McKinsey & Co. report on Healthcare, only 14 percent of the
population is covered through prepayment because of poor healthcare coverage. Of total
healthcare spending, 64 percent is out of pocket expenditure or direct household spending.
Economic indicators
GDP (in $ billion, 2004)
Per Capita (in $, 2004)
Real Growth (in %, 2004)
Health expenditure (in $ billion, 2003)
Health expenditure as % of GDP
Public expenditure as % total
Private expenditure as % of total
Demographic indicators
Population (in million 2004)
Population growth (in %, during 2004) 1.9
Demographic profile - Age/years
54 and above
Health indicators
Life expectancy (years)
Birth rate (per 1000)
Death rate (per 1000)
Infant mortality rate (per 1000)
Healthcare Infrastructure
Hospitals (numbers)
Hospital beds (numbers)
Medical colleges
New doctors every year
Retail chemist (pharmacy) outlets
Size of medical and pharmaceutical market
Pharmaceutical market (in $ million for 2004)
Estimated growth rate per year (for 2004)
7-8 %
Medical equipment market (in $ million for2004)
Estimated growth rate per year (for 2004)
Source: Ministry of Health, Medistat Outlook Espicom report January 2007, ICRA report
Indian Healthcare sector February 2007, Confederation of Indian industry.
Indicators of health status of the Indian population
Ophthalmology: Annual incidence of cataract, the cause of 80 percent of blindness, is 3.8
million cases. The total potential for surgical cataract removal is 1.75 million cases per
Cancer: The total number of cancer cases in India was estimated at 924,790 in 2001. This
is projected to increase to 1,229,968 by 2011 and to 1,557,800 by 2021.
Cardiovascular diseases: The mortality rate due to cardiac arrest and related causes was
estimated at 2.4 million in 1990. With increasing urbanization the problem is on the rise.
Malaria: Projected to increase from 2.03 million cases in 2001 to 2.62 million cases in
Hypertension, diabetes and renal diseases: These stress and lifestyle related disorders are
on the rise. The diabetic population in India is projected to increase from 40 million of 2001
to 47 million people in 2010. Hypertension is lower in rural areas but on an increase in
urban cities. Prevalence rate in Delhi alone is 17.34 percent. Both hypertension and
diabetes further cause renal disorders.
Neurological and psychiatric disorders and addictions: The current prevalence rate for
neurological disorders is 15 to 20 people per thousand. The most common ailments are
epilepsy, migraine, cerebrovascular disorders, Parkinson’s disease and peripheral
neuropathies. It is estimated that 1 percent of the population is suffering from serious
psychiatric illnesses, 10-15 percent have neuro-disorders, and 2.5 percent are mentally
Source: ICRA report on Indian Healthcare and TIFAC
In view of the growing population and higher incidence of non-communicable diseases, it is
estimated that the demand for quality healthcare in India will increase. The role of the private
sector is likely to further increase with preference for private care and government’s constrains of
limited resources.
For more information or assistance in exploring business opportunities and establishing a
presence in the Indian market, please contact:
Dr. Ruchi Bhatt,Business strategist
Prosource Strategy

90% of `doctors` in slums have no formal deg: Survey

New Delhi, May 12: The poor in the urban areas seem to be facing a health risk with a new survey done in two slum clusters here claiming that over 90 per cent of "doctors" offering medical services have no formal degree. The study, conducted by department of community medicine at AIIMS in collaboration with the university of Aarhus in Denmark, also said that not a single "doctor" surveyed in a slum cluster in Orissa's Bhubaneswar had requisite qualification for offering medical services. Without divulging the locations, the survey claimed that out of the 27 private practitioners covered under the three-year study, only four possessed a formal degree to practice while others dispensed allopathic medicines. "These practitioners have active associations and networks with diagnostic facilities. The majority are "trained" outside Delhi and certificates indicating 'registered medical practitioner' are displayed," Chandrakant S Pandav, head of centre for community medicine, said quoting from the report. According to the study -- health system reform and ethics: private practitioners in poor urban neighbourhood in India, Thailand and Indonesia -- 92 per cent of 207 households surveyed in Delhi cited that they preferred a doctor in the slum cluster as their first preference for treatment. During the two-year field study, the survey said, only in two cases the family took patients to a government dispensary located around four kilometres from the settlement. The situation seemed to be worse in Bhubhaneswar with the study claiming that main providers of primary health care in the settlement were drug vendors and chemists, who often engaged in diagnosis.
Source: Zee News

DELHI Slum dwellers prefer quacks to doctors

A study has found that 93 per cent of slum dwellers in Delhi rely on quacks as their primary healthcare contact due to social, psychological and economic reasons.
The four-year long study was funded by Denmark's Danida Council for Development Research. The study, conducted by doctors from the All India Institute of Medical Sciences (AIIMS) during 2004-08 in a South Delhi slum, found that of the 207 households, only two preferred to visit the government dispensary located four kilometres from the settlement. The others felt that non-qualified medical practitioners are more humane, more communicative and offer more payment options for daily wage workers.
The study also found that non-qualified medical practitioners as well as qualified doctors prescribed similar medicines for illnesses like fever, diarrhoea, dengue, vaginal discharge and tuberculosis on first consultation. The majority of these quacks were former employees with chemists, clinics or hospitals, the researchers said.
"These quacks are the only ones who are physically present in such urban slums. Enacting laws to prohibit their practice will not make any difference, as even today, they are running their clinics without any legal protection," said C S Pandav, lead researcher and head of community medicine, AIIMS.
"Having realised the ground situation, I feel that the central government's proposed National Urban Health Mission (NUHM) should factor in their presence before framing policies. Until there is a credible alternative, they will continue to play a role in the healthcare delivery network in slum areas," he added.
The researchers also quoted Delhi Medical Council estimates to suggest that about 40,000 such non-qualified medical practitioners are functioning as the primary healthcare contact.
According to them, police raids to close down such clinics often prove unsuccessful due to the local support enjoyed by such practitioners.
Besides Delhi, studies were also conducted in Bhubhaneswar to understand the healthcare patterns of the urban poor. Bhubhaneswar however presented a different picture, with a very low presence of non-qualified medical practitioners. Most of the rural households in the area said that their first point of contact is the local chemist and not the doctor.
Reacting to the study, Suyash Prakash, mission director, Delhi State Health Mission said that two-thirds of Delhi's population of over 11 million live in the slums. "If 80 per cent of these 11 million are being attended to by non-qualified medical practitioners, it is a serious matter," he said.
He added that there are no credible figures for the number of quacks in Delhi and put the number at 5,000.
Source: economic times 11 may 2008

Call for amenities in Rural areas

Former President A.P.J. Abdul Kalam today said the country requires a “hassle-free” single-window system of clearing investment proposals.
Foreign institutional investors are finding investing in India “attractive”. “We need to accelerate this process,” he said, while charting a course for transforming India into a developed nation with food, economic and national security at the first convocation of Ravenshaw University here.
He also underlined the need for co-ordinated progress in agriculture and food processing, reliable and quality electric power, surface transport and infrastructure for all parts of the country, education and healthcare, information and communication technology and self-reliance in critical technologies. Kalam also said: “There is a need for provision of urban amenities in rural areas (Pura) through the creation of triple connectivity — physical, electronic and economic — leading to economic connectivity.”
The country today requires 7,000 Puras, Kalam said, while exhorting educational institutions to participate in evolving a road map for developing Puras.
Citing the example of Periyar Pura, Kalam suggested Ravenshaw University to consider establishing a Pura covering a population of about 50,000 in 20 villages around Cuttack. In Periyar Pura at Vallam in Tamil Nadu, students and teachers of Periyar Maniammai College of Engineering and Technology are working in the planning and development of a cluster of 65 villages that involves a population of one lakh, he said.
Kalam further exhorted the teachers to play an active role in nurturing five capacities — research and inquiry, creativity and innovation, use of high technology, entrepreneurial and moral leadership through the educational process to meet the challenges of national development.

Shortage of specialists puts healthcare on life support

When seven-month-pregnant Khiloni of MP’s Gwalior district started haemorrhaging, her family bundled her into a bullock-cart and took her to the nearest primary health centre in Murar block. The PHC had no trained birth attendant and Khiloni died on the kuchcha road that links Duhiya village and Gwalior city. When it comes to healthcare, there are two Indias: one that boasts state-of-the-art hospitals which attract medical tourists from affluent countries, and the other — in which most of the population lives — whose residents have limited or no access to quality care. Every public hospital in any big city has serpentine queues, and overburdened doctors. Not surprising since India has just six doctors for every 10,000 people as compared with the global average of 15, according to a 2007 report by rating agency Crisil. "States like Chhattisgarh and Jharkhand have just two doctors for 100,000 people," says Benaifer Jehani of Crisil. A recent Planning Commission report said that India is facing a shortage of six lakh doctors, ten lakh nurses and two lakh dental surgeons. "The availability of specialist manpower at community health centres is particularly bad. As against the sanctioned posts, about 59.4% surgeons, 45% obstetricians and gynaecologists, 61% physicians and 53% paediatricians were not in position (in March 2006)," the report noted. It also drew attention to the low turnout of doctors with post-graduate degrees. The shortage of surgeons and specialists is also worrying doctors like Devi Shetty, cardiac surgeon and chairman of Narayana Health City, Bangalore. "We have 32,000 students passing out every year with MBBS degrees, but only 10% of them get to do post-graduation. Even in Karnataka, which has more colleges for PG as compared to the northern states, as many as 1,000 applicants vie for a single PG seat." The country urgently needs more institutes of higher medical education, he stresses. The government seems to have woken up to the problem. The Union health ministry is modifying some of the regulations under the Indian Medical Council Act, 1956, that will relax operating, staffing and land norms and make it easier to establish medical colleges in India. In a move to bring back Indian doctors settled abroad, the Indian government has also decided to recognize graduate medical degrees from Britain, the US, Canada, Australia, and New Zealand, provided they are recognized in the respective countries. Until now, doctors with an undergraduate degree from India but a graduate degree from another country were not allowed to practice in India. Indian doctors with graduate degrees from the approved countries will now be allowed to practise in India at any public or private hospital. They can also be recruited to teach under-graduates in any medical college. These steps may alleviate the situation somewhat but the medical fraternity is unanimous in its opinion that more needs to be done, specially in view of the continued exodus of medical talent to the West. With millions afflicted with infectious diseases such as TB and the growing incidence of lifestyle diseases such as diabetes and heart problems, the availability of highly skilled doctors may prove crucial in nursing the country back to health. (Neelam Raaj With inputs from Nirmala N Nagaraj in Bangalore)
Source -Times of India

Tips on buying health insurance

Whether you are making a choice between the health insurance plans offered by your employer, or buying an individual policy for yourself, here are 10 tips to take into consideration. 1 Know thy needsBefore you get down to comparing different plans, it is important to determine your insurance needs. You may not find a policy that will cover every contingency, but you should try to find a plan that at least covers the essentials, and meets your medical needs.Does a family member have special needs? Do you plan on having a baby in the next couple years? Does a dependant need prescription drugs? Do you travel abroad? Thinking this through will enable you to match your next policy with your current and future medical needs, and get the kind of coverage that is right for you.2 Shop aroundAll health insurance policies are not created equal. You or your insurance agent should get quotes from different insurance companies for comparison. You will find that there are broad differences in the cost, benefits and exclusions offered by various policies. By shopping around, you may not only save money on your insurance premium, you may also find a policy with benefits that are better suited to your needs. While shopping, be sure to do an apples-to-apples comparison of the standard benefits that each company has to offer.One of the most convenient ways to get quotes from a number of health insurance companies, is at an insurance comparison website. You will fill out a single questionnaire and get several different quotes. Here are three comparison sites:

India's medical system in poor health

By Neeta Lal
The irony couldn't have been starker. Just as India was cementing its position as a world-class medical tourism destination - with revenues from foreign patients set to touch a whopping US$2 billion by 2012, according to a Confederation of Indian Industries-McKinsey report - comes a government survey which states that the country's public healthcare system is headed for a crisis due to an acute medical manpower crunch. According to the recently released Planning Commission report, India is short of a phenomenal 600,000 doctors, 1 million nurses and 200,000 dental surgeons. With positions for 300,000 dental surgeons, only 73,000 are currently full. Meanwhile, 1.1 million nurses are filling up vacancies for 2.1 million, a shortfall of nearly 50%. To make matters worse, there is also a huge paucity of paramedical staff including radiographers, X-ray technicians, physiotherapists, laboratory technicians, dental hygienist, orthopedists and opticians. The report also highlights a skewed statewide distribution of doctors with states like Karnataka and union territories such as Delhi and Goa having a passable ratio while others, like Haryana, Bihar and Uttar Pradesh, are being under-served. The availability of specialist manpower in local Community Health Centers, compared to the number of sanctioned posts, is also disquieting. About 59.4% surgeons, 45% obstetricians and gynecologists, 61% physicians and 53% pediatricians were not in position at the time of the survey. The number of doctors registered by different state councils during 2006 led to a doctor-to-population ratio of 60:100,000. Nationally, this glaring inequity manifests itself in an abysmal patient-doctor ratio. In other words, for every 10,000 Indians, there is barely one doctor available. These figures compare dismally with countries like Australia which provides 249 doctors for every 10,000 people, Canada which offers 209, Britain 166 and the United States 548. The medical manpower shortfall is all the more ironic because, as the report states, India ranks at the top of nations whose well-qualified healthcare professionals, particularly doctors, radiologists, laboratory technicians, dental hygienists, physiotherapists and medical rehabilitation workers, are working in major developed countries. "The current situation in the public healthcare sector is scary," said Dr Aveek Parekh, a senior oncologist at a New Delhi government hospital. "The government needs to urgently re-assess the country's healthcare needs and address the shortfall if it is to avert an imminent national crisis. It needs to probe the various factors impacting the performances of the health services sector and suggest short and long term policies to enhance and sustain its competitiveness in the future." Experts reiterate that the medical staff crisis is partly triggered by the continuous exodus of Indian doctors to foreign shores in search of better growth opportunities and work environment. According to the Planning Commission, Indian docs who have migrated to developed countries, form nearly five per cent of their medical workforce with nearly 60,000 Indian physicians working in the US, Britain, Canada and Australia alone. "For several decades, Indian medical professionals have been serving not only in the Middle East but also in developed countries, including the US and the UK," said Anwarul Hoda, a member of the Planning Commission who headed the group that drafted the report. "The overriding requirement in India, therefore, is to increase the supply of human resources at all levels from specialists to paramedical personnel and improve their quality." This is easier said than done considering the medical profession in India has itself lost much of its old charm. In fact the number of Indian youth who are now opting for medicine as a career choice has whittled down remarkably. For instance, this year, according to the Central Board of Secondary Education (CBSE), only 1.6 million candidates took the medical entrance exam, a 25% plummet since last year. This is in stark contrast to the over 800,000 candidates who registered for the AIEE, the engineering entrance test conducted by CBSE, and another 300,500 who took the JEE exam for entrance into the blue-chip Indian Institute of Technology. Overall, Indian medical colleges currently churn out about 30,000 doctors a year, apart from 20,000 dentists and 45,000 nurses. About 3,181 undergraduate degrees are awarded annually, while 1,316 postgraduate diplomas are given in the country each year. Experts point out that the need for medical staff is at least double these numbers. Undoubtedly, the massive paucity of medical staff in India underscores an overall disenchantment with the profession. The current crop of Indian youth are rejecting the white coat in favor of more lucrative and less time- and labor-intensive professions like business, law or engineering. "As a profession, medicine is an extremely demanding one," says Aditi Pai, 28, who opted out of a premier Indian medical college to pursue an MBA. "Eighteen-hour workdays, seven days a week are quite the norm while the pay scales don't quite match up." And they don't. In fact, even senior government doctors - after putting in 20-25 years - rarely take home salaries in excess of 50,000 rupees (about US$1,200). Poor pay, ill-equipped hospitals and lack of support staff have driven even the most idealistic doctors to explore greener pastures. Worsening the current scenario is a Medical Council of India stipulation that undergraduate and postgraduate qualifications of foreign institutions, which do not grant recognition to Indian degrees, are currently not recognized. Consequently, hospitals and other clinical establishments cannot tap the pool of non-resident Indian medical professionals who may be willing to work in India. If this bottleneck is removed, say experts, it would augment the supply of quality medical personnel to Indian service providers as well as in the areas of medical tourism, telemedicine and clinical research. To prevent the situation from deteriorating further, the Planning Commission suggests that the medical education sector be opened up completely for private sector participation to help it establish medical, dental and nursing colleges. In addition, it also advises the government to fill vacant posts of teachers in government medical colleges to help them provide good education at subsidized rates to meritorious students. Towards this end, Indian Health Minister Ambumani Ramadoss stated last week that India will soon be setting up new medical colleges and recognize the medical degrees issued by five English-speaking countries, including the US, Britain and Australia. The 11th five-year plan, stated the minister, envisages setting up of six All-India Institute of Medical Sciences-like institutions and upgrading 13 existing medical institutes. It is also planning to establish 60 new medical colleges and 225 new nursing colleges based on the template of the private ones. These steps will be crucial in resuscitating India's ailing healthcare system back to health. Apart from addressing the immediate healthcare needs of a billion-plus population, they will also help the country build on its growing status as a world-class medical tourism hub which is growing at a robust clip of 25% per year.