india's overall health care system performance has helped the country to the 112th position among World Health Organisation members, according to the World Health Report 2000 released in the latter part of June. India stands 133rd on the basis of per capita expenditure in the field of health. With these inputs, India is 121st in the field of overall goal attainment.
Among the other interesting information in the report: Guatemala, which stands 130th in terms of expenditure, is placed higher at 78th position on the basis performance. Japan is the 13th biggest spender in this field but shows great results in the field of goal attainment and stands at the top. On the other hand, the us, which is the biggest spender on health care system, is way down on performance. This is likely to be due to its inability to reach the required goal achievement.
A landmark in the field of health care, the report provides an important tool for measuring performance of health care systems across the world along with providing an insight into the areas needing improvement. It emphasises that health care systems can be bettered not only by increasing the amount of funds but also by utilising the funds appropriately and fully. The report is the result of extensive discussions carried out at the May-end 53rd World Health Assembly in Geneva. The report provides a framework for assessing the performance of hospitals and indexing the national health systems performance. Assessing the Indian scenario further it observes that 'Health for all by 2000' predicted by the government did not materialise and the latest Red Cross report shows that 400 million Indians are still not able to use the services of the health system. Three-fourths of the nation's health care is in private hands where the western system of medicine is followed. This makes medical care extremely expensive. At present, Indians are prone to a variety of infections like tb and aids, childhood and congenital diseases like polio, respiratory disorders, maternal diseases, cancer, heart problems, and digestive diseases, which increase the load on the health care system. Recently, the minister of health, C P Thakur announced that "Health for All" will become a reality in 2010.
This load is likely to be increased further as the growth plans being undertaken by the government are leaning heavily on industrialisation. According to a United Nations Development Programme report, India has moved up four places in the Human Development Index 2000. This is likely to bring about a further increase in the level of pollutants, which would have a negative impact on health. With a higher gdp, the government might be able to divert more funds towards the field of health care, but more is obviously going to be needed.
Policies formulated on disjointed bits of information tend to fail. The ban on old vehicles, thought to be one of the major polluter in Delhi has not been able to reduce the level of suspended particulate matter in the air. The World Disaster Report released by the International Federation of Red Cross and Crescent Societies have indicted India for the lack of proper health care and the cost of medical care as the major reason behind rural debt. Lack of preventive health care systems and problems of urbanisation, climate change and environmental degradation would further worsen the situation.
The report links the efficiency of health systems with its "goodness" which is providing the best available health care and its 'fairness' that advocates the difference between how people are treated should be as small as possible. A health system can be improved only if the policy-makers know why the changes are being made and who the target people are. In this endeavour, the policy-maker is constrained by the fact that if health services are provided to all, then all services cannot be provided.
The report makes clear that low and middle income countries account for 11 per cent of global health spending, yet 84 per cent of the world population lives in these countries and bears 93 per cent of the world's disease burden. The rural population has to bear a larger share of the burden as the urban hospitals receive nearly two-thirds of the health budget but cater only to around 10-20 per cent of the population.
The need to protect the poor from the monetary loss of falling ill has been raised by the report. Pre-payment has been advocated as the most suitable way to deal with this. Unfortunately, at times this can increase the load on an individual as some money will have to be paid even when the facility is not being used.An additional sum may have to be paid from personal expenses when actually falling ill. Having an income-based and risk-based insurance scheme can be one solution.
The failure of a health system becomes evident when there is an increase in the number of deaths, disabilities that reduce productivity, poverty, humiliation and despair. A good health care system is a prerequisite of a developing country like India. Problems of ever-increasing population, excessive poverty, pollution, lack of basic amenities such as clean water and sewage disposal make it essential that the government policy is user-friendly. The impact of industrialisation, globalisation of trade and environmental damage and an increased awareness about aspects such as diet, child bearing and sexual behaviour have increased the importance of an effective health care system.
However, all may not be lost. The report states that revival of the village health care system with meaningful involvement of local bodies, including proper training of village health workers, activating rural hospitals, expanding both general and specialty hospitals would be helpful. Viable financial management with emphasis on providing more for less, fairness and equality in the system, which should be gentle on the underprivileged, and clearly thought out National Programmes may save the situation. A good system of accreditation, licensing, monitoring health statistics, reporting, linkages to other national health programmes and promotion of health insurance are also important. The government has decided to bring out a new health policy reviving the Licensed Medical Practitioner scheme, which would make the health care system in the rural areas better.
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