India’s health sector is challenged by
- Overall low levels of public financing
- India has long been a low spender on health care (4.1% of GDP in 2008-09)
- Share of GDP, and as a share of total health expenditure, public health spending in India is not only well below the world average, but also nearly half that of the sub-Saharan Africa, Middle East and North Africa.
- Entrenched accountability issues in the public delivery system.
- Public subsidies for health have historically favored the better off the society.
- Persistent dominance of out-of pocket spending
- WHO estimates put the share of the government expenditure at 30% and that of the out-of pocket payments at about 60% (2011)
- Nearly all this spending is directed to fee-for service private providers. This method of finance places considerable financial burden on the poor households, and is one of the important reasons for impoverishment in India
- 80% of outpatient and 60% of inpatient care is provided by private practitioners.
- Tax-financed, direct public delivery which is available for all of India’s population, operated mainly by the states, the public delivery system accounts for about 20 and 40% of outpatient and inpatient utilization in the country.
- India’s performance on health, especially maternal and child health remains dismal
- India has recorded one of the worst performances on undernourishment and child health.
- India’s failure to delink maternal health from that of her children that results in transmission of ill health from the mother to the child.
- Inequalities in health
- Is not only the unequal distribution of health but also the unfair distribution of health due to unfair or inadequate social arrangement.
Some other issues:
- Economic Status and Health financing:
- Lower an individual’s socioeconomic position, the worse their health.
- Poverty has been linked to higher prevalence of many health conditions
- Regional and Rural/Urban differences in health based economic status
- Utilization of health services better in urban population than in slum and rural population
- Same with health status indicators.
- Socioeconomic inequality is often cited as the fundamental cause for differential health among men and women.
- Children of uneducated mothers are more likely to be malnourished.
- Social class
- Socially backward groups like SCs, STs and OBCs are usually associated with lower use of health services and poorer health outcomes
- Poor employment conditions expose individuals to health-hazards.
- Inadequate water and sanitation, indoor air pollution, overcrowding, poor housing conditions and exposure to vectors of diseases.
Issues in utilization and management of health care services:
ü Economic barriers like user fees, hidden costs of utilizing services like travel cost, wage loss, consumable and bribes, opportunity cost of long waiting period, inconvenient timings.
ü Absence of female doctors, referrals to higher services
ü Behavior of staff like lack of regard for privacy and dignity particularly of women and adolescents, verbal abuse, bribe
ü Lack of accountability, flexibility in public sector and its over bureaucratic nature
ü Lack of continued surveillance of health and health care utilization and management.