|Year : 2018 | Volume
| Issue : 1 | Page : 1-3
Tracking India’s Progress in Health Sector after 70 Years of Independence
Sanjay P Zodpey1, Preeti H Negandhi2
1 Chief editor, n Journal of Public Health, Vice President-Academics, Public Health Foundation of , New Delhi, India
2 Associate Professor, n Institute of Public Health Delhi, Public Health Foundation of , Gurgaon, Haryana, India
|Date of Web Publication||6-Mar-2018|
Sanjay P Zodpey
Chief editor, Indian Journal of Public Health, Vice President-Academics, Public Health Foundation of India, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Zodpey SP, Negandhi PH. Tracking India’s Progress in Health Sector after 70 Years of Independence. Indian J Public Health 2018;62:1-3
|How to cite this URL:|
Zodpey SP, Negandhi PH. Tracking India’s Progress in Health Sector after 70 Years of Independence. Indian J Public Health [serial online] 2018 [cited 2018 Aug 15];62:1-3. Available from: http://www.ijph.in/text.asp?2018/62/1/1/226625
It has been 70 long years since India attained independence. We have come a long way since 1947 – in more ways than one. Nonetheless, in some sectors, progress has been inadequate. This article examines India’s progress across health versus other sectors between 1947 and 2017.
Situation in 1947 – According to the 1951 Census, India’s population was 36.1 crores. Only 18.33% of the total population was literate then, of which female literacy was 8.86%; only one out of every 11 women were able to read and write. The overall life expectancy was 32 years. The infant mortality rate (IMR) was 145.6/1000 live births. Maternal mortality ratio (MMR) in the 1940s was 2000/100,000 live births, which apparently came down to 1000 in the 1950s. There were only 50,000 doctors across the country. The number of primary health-care centers in the country was only 725.
We are now in 2017 – India has progressed immensely across several sectors in the past 70 years. However, this development has been uneven. Paradoxically, some sectors have shown tremendous progress while important others are yet to show substantial development. Today, India is the world’s largest democracy, with a population of over 1.32 billion (2016 estimate). Given this trend, we are expected to overtake China by 2022. Our literacy rates have risen to a total of 74%, with male and female literacy being 82% and 66%, respectively.
India’s progress as a country can be measured through our world rankings in several sectors. Our Gross Domestic Product (GDP) (2.45 trillion [nominal]) is the 6th largest in the world. Our economic growth rate is 7.2%, and we are the 3rd largest world economy in terms of purchasing power parity. We have the 2nd largest workforce available for military services. We are ranked 6th in the space sector (2010). At 61 million, India is the 6th largest internet user across the world and the 2nd largest users of mobile phones. Until the 1980s, telephones (fixed line) were a rarity in India, but today almost everyone uses mobile phone/s and the tariffs for calls are also much cheaper. India even has more TV news channels today than any other country in the world.
Despite all the progress in India, it cannot add up to making the country a global leader unless there is parallel progress in health, social, and development sectors. India’s current performance in these sectors needs a closer relook. Today, India accounts for a third of the world’s poor; at least 32% of India’s population lives below the international poverty line (spending <1.2 USD per day). According to the United Nations Development Program report of the Human Development Index, India was ranked 131st out of 188 countries (2016). In addition, our life expectancy has doubled to 68 years (2015) – 67 years for males and 70 years for females.
In the education scenario, we find that while three-fourth of India’s population is reported to be literate today, a 2013 survey of 500 districts found that 50% of 7 year olds could not read letters, 20% of 10 year olds could not read sentences, while 50% of 14 year olds were unable to divide numbers. Another glaring observation was that fewer than 10% of MBA graduates were employable. Moreover, the state of education infrastructure is also not very good. Unfortunately, our water and sanitation indicators also cut a sorry figure. The Swachhta Status Report of 2015 reports over half of the rural population (52.1%) of India still defecating in the open.
Let us now look at the health status of our country. Our major health indicators are disheartening. With regards our maternal mortality, India contributes to 15% of the global maternal deaths. Our MMR steeply declined from 2000 (1940s) to 174 (2015) for every 100,000 live births, but has failed to cross the targets of the Millennium Development Goals. Neighboring countries such as Thailand, Sri Lanka, and China have reported MMRs of 20, 30, and 27, respectively, in 2015. Similarly, although our IMR has dropped down from 145.6–38/1000 live births over 70 years, we are yet to beat our neighboring countries such as Sri Lanka (8), Nepal (29), Bangladesh (31), and Thailand (11), who are doing better than us! Our world ranking for IMR is 50 out of 222 countries, Afghanistan being number one with the worst IMR. With regards our nutritional status, we realize that around 43% of Indian children are underweight today, in comparison to Pakistan (32%), China (4%), and Brazil (2%). According to the NFHS-4 data, only 62% of our children are fully immunized. Furthermore, since decades, we have been grappling with the unfinished agenda of infectious diseases. India is the global rank 1 for tuberculosis (TB), having witnessed 2.8 million new cases of TB in 2015 alone. In 2014, India contributed to 27% of the global notification of TB cases. As if this was not enough, we now also have the added rapidly rising burden of noncommunicable diseases. There are over 69 million people with diabetes in India currently. There are more than 1 million smoking-related deaths. The average age of the first heart attack among Indians is 53 years, at least 5–10 years earlier than in other populations globally. That air pollution is also on the rise in no longer news in India, with significant morbidity and mortality.
Even within India, there are widespread inequalities in health outcomes. For instance, under-5 mortality in Chhattisgarh or Uttar Pradesh is 6–7 times more than in Kerala, where the proportion of educated mothers is almost double. Within the State of Assam, the IMR is 37 per 1000 live births in one district but 74 in another district. In addition, between the urban and rural areas, the rates differ by 28 points (59 urban vs. 31 rural) (2013). Children born in families of Scheduled Tribes are at 19% higher risk of dying in the neonatal period and 45% more risk of dying in post-neonatal period than the other social classes. As far as the sex ratio in India is concerned, we are at 192nd position (out of 201 countries) with 934.7 females for every 1000 males.
India’s share in the global burden of diseases is quite significant – 20%. It is interesting to note that contrary to this burden, our contribution to the global health-care infrastructure is highly inadequate – we have a meager 9% of the global community health workers, 8% of the doctors globally (from 50,000 in 1947 to 7.7 lacs in 2017), 8% nurses, 6% of the beds for patient care (from 725 Primary Health Centres [PHCs] in 1947 to 28,863 in 2017), and only 1% laboratory technicians – scarce human resource to tackle the mountain of diseases. Our health-care access and quality index was 44.8 in 2015, lower than our neighboring countries (Sri Lanka – 72.8, Bangladesh – 51.7, Bhutan – 52.7, and Nepal – 50.8 and ranks above Pakistan – 43.1 and Afghanistan – 32.5).
In addition, our public health financing is low, varying from 1.2% to 1% of the GDP, which is among the lowest in the world; neighboring South Asian countries are faring much better (public health expenditure as a proportion of the total health expenditure was 2.6 times in Thailand, 1.9 times in Sri Lanka, 1.9 times in China, and 1.3 times in Nepal as compared to India in 2014). Whether India’s growth rate is 3% or 9%, there has been no change in the health sector– so where is all the extra money going? 62.4% of our health expenditure was out-of-pocket in 2014 (ranked 10th worst out of 185 countries). This essentially means that we are among the worst for our out-of-pocket expenses as well as with regards our public health financing. Most of our out-of-pocket expenditures are on outpatient care and medicines.
India has come far in the past 7 decades, but we still have a long way to go. We have seen growth in many other sectors, but health, education, and social sectors are still lagging behind. If we truly want to make India a superpower globally, it is time to undertake some conscious efforts in that direction. As Amartya Sen once said “India cannot become a global economic power with an uneducated and unhealthy workforce.” India is a 70-year young nation, with 65% of our population being below 35 years of age and 50% being <25 years of age. By 2020, the average age of an Indian citizen would be 29 years as against the rest of the world (projections for 2020: Japan – 48 years, China – 37 years, UK – 40, and USA – 40). Our demographic dividend will become a demographic disaster if we do nothing about it now. We need to ensure that our country is healthy to make India a true super-power, and it is our responsibility as Indian citizens to keep this young nation healthy and educated.
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