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Chapter: Sociology of Health : Community Health

Central and state Government Role - Community health problems in India

It was introduced with a view to providing medical and health care facilities to the Central Government employees and expensive reimbursement of medical expenses under Central Services (Medical Attendance) Rules, 1944.

Central and state Government Role:


It was introduced with a view to providing medical and health care facilities to the Central Government employees and expensive reimbursement of medical expenses under Central Services (Medical Attendance) Rules, 1944. This scheme was started in Delhi/New Delhi. Critics say that the national policy lacks specific measures to achieve broad stated goals. Particular problems include the failure to integrate health services with wider economic and social development, the lack of nutritional support and sanitation, and the poor participatory involvement at the local level. Central government efforts at influencing public health have focused on the fiveyear plans, on coordinated planning with the states, and on sponsoring major health programmes.


Government expenditures are jointly shared by the central and state governments. Goals and strategies are set through centralstate government consultations of the Central Council of Health and Family welfare. Central government efforts are administered by the Ministry of Health and Family Welfare, which provides both administrative and technical services and manages medical education. States provide public services and health education. The 1983 National Health Policy is committed to providing health services to all by 2000.


In 1983 health care expenditure varied greatly among the states and union territories, from 13 per capita in Bihar to Rs 60 per capita in Himachal Pradesh, and Indian per capita expenditure was low when compared with other Asian countries outside of South Asia. Although government health care spending progressively grew throughout the 1980s, such spending as a percentage of the gross national product (GNP) remained fairly constant. In the meantime, health care spending as a share of total government spending decreased. During the same period, private sector spending on health care was about 1.5 times as much as government spending.


·             Expenditure:


In the mid1990s, health spending amounted to 6% of GDP, one of the highest levels among developing nations. The established per capita spending is around Rs 320 per year with the major input from private households (75%). State governments contribute 15.2%, the central government 5.2%, thirdparty insurance and employers 3.3%, and municipal government and foreign donors about 1.3, according to a 1995 World Bank study.

Of these proportions, 58.7% goes towards primary health care (curative, preventive, andpromotive) and 38.8% is spent on secondary and tertiary inpatient care. The rest goes for nonservicecosts. The fifth and sixth five year plans (FY 197478 and FY 198084, respectively). Included programmes to assist delivery of preventive medicine and improve the health status of the rural population. Supplemental nutrition programmes and increasing the supply of safe drinking water were high priorities.


The sixth plan aimed at training more community health workers and increasing efforts to control communicable diseases. There were also efforts to improve regional imbalances in the distribution of health care resources. The Seventh Five year plan (FY 198589) budgeted Rs 33.9 billion for health; an amount roughly doubled the outlay of the sixth plan.


Health spending as a portion of total plan outlays, however, had declined over the years since the first plan in 1951, from a high of 3.3% of the total plan spending in FY 195155 to 1.9% of the total for the seventh plan. Midway through the Eighth FiveYear Plan (FY 199296), however, health and family welfare was budgeted at Rs 20 billon, or 4.3% of the total plan spending for FY 1994, with an additional Rs 3.6 billion in the nonplan budget.


·             Primary Services:


Health care facilities and personnel increased substantially between the early 1950s and early 1980s, but because of fast population growth, the number of licensed medical practitioners per 10,000 individuals had fallen by the late 1980s to three per 10,000 from the 1981 level of four per 10,000. In 1991 there were approximately ten hospital beds per 10,000 individuals. Primary health centers are the corner stone of rural health care system. By 1991, India had about 22,400 Primary health centers, 11,200 hospitals, and 27,400 clinics.


These facilities are part of a tiered health care system that funnels more difficult cases into urban hospitals while attempting to provide routine medical care to the vast majority in the countryside. Primary health centers and sub centers rely on trained paramedics to meet most of their needs. The main problem affecting the success of Primary health centers are the predominance of clinical and curative concerns over the indented emphasis on preventive work and the reluctance of staff to work in rural areas.


In addition, the integration of health services with family planning programmes often causes the local population to perceive the Primary health centers as hostile to their traditional preference for large families. Therefore, Primary health centers often play an adversarial role in local efforts to implement national health policies. According to data provided in 1989 by the Ministry of Health and Family welfare, the total number of civilian hospitals for all states and union territories combined was 10,157. However, various studies have shown that in both urban and rural areas people preferred to pay and seek the more sophisticated services provided by private physicians rather than use free treatment at public health centers.

·             Emergency Medical Relief:

Disaster management is the responsibility of State governments, but the Directorate General of Health Service, Ministry of Health and Family Welfare, Government of India provide technical assistance to the states. The responsibility is discharged by the Emergency Relief Division of the Directorate, which requires constant communication with the state governments.


·             Drugs:


The Drugs and Cosmetics Act, 1940, as amended from time to time, regulates import, manufacture, sale and distribution of drugs and cosmetics in the country. Under the Act, import, manufacture and sale of substandard, spurious, adulterated/misbranded drugs are prohibited.


·             Vaccine Production:


India is selfsufficient in the production of all vaccines, including measles required for the National Immunization Programme, except Polio. Polio vaccine which is imported in bulk, is blended at the HaffkineBioPharmaceuticals Corporation Ltd. (Mumbai), Bharat Immunologicals and Biologicals Corporation Ltd. (Bulandshahar, UP), RadicuraPharma (Delhi) and Bromed Pvt. Ltd. (Ghaziabad, UP).


·             Nutrition:


Major nutritional problems in India are Protein Energy Malnutrition (PEM), Iodine Deficiency Disorder (IDD), VitaminA deficiency and anaemia. To combat these problems arising from nutritional deficiencies, Government has initiated various programmes.


·             Medical Education and Research:


The Indian Council of Medical Research (ICMR) was established in 1911, as the apex body in India for the formulation, coordination and promotion of biomedical research.


·             Medical Council of India:


It was established as a statutory body under the provisions of the Indian Medical Council Act, 1933, which was later repealed by the Indian Medical Council Act, 1956, with minor amendments in 1958. A major amendment in the IMC Act, 1956 was made in 1993 to stop the mushroom growth of medical colleges/increase of seats/starting of new courses without prior approval of the Ministry of Health and Family Welfare.


·             Dental Council of India:


It was established under the Dentists Act, 1948 with the prime objective of regulating dental education, profession and its ethics in the country.


·             Pharmacy Council of India:

The Pharmacy council of India is a statutory body constituted under the Pharmacy Act, 1948. It is responsible for regulation and maintenance of uniform standard of training of pharmacists.


·             National Academy of Medical Sciences:


It was established as a registered society with the objective of promoting growth of medical sciences. To keep the medical professionals abreast with new problems and update their knowledge in those fields for the required delivery of health care, a programme of Continuing Medical Education (CME) is being implemented by the Academy since 1982. Nursing Education


·             National Illness Assistance Fund:


It has been set up in the Ministry of Health and Family Welfare with an initial contribution of Rs. 5 crore in 1997. The Fund will provide necessary financial assistance to patients livings below poverty line, suffering from life threatening diseases, to receive medical treatment at any of the super specialty hospitals/institution or other government/private hospitals.




All the States/UTs administration has been advised to set up an Illness Assistance Fund in the respective States/UTs.

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