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Health Infrastructure in India: Need for Reallocation and Regulation

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It is not the hidden fact that India’s health care needs serious attention. In almost all the key health indicators given by World Health Organization (WHO) we lag behind. According to World Health Statistics of 2018 India ranks 145 out of 194 countries. According to NITI Aayog India has a scarcity of 6 lakh doctors, 20 lakh nurses and 2 lakh dental surgeons. Though WHO recommends 1:1000 doctor to patient ratio but in rural India it is 1:11082 and in some states like Bihar It is as low as 1:28391 and UP It is 1:19962 (NHP 2018). Around 80% of India’s1.14 million registered doctors of modern medicine(allopathy) work in cities which is home to just 31% of the country’s population. same is the case with availability of physical infrastructure i.e. primary health centres (PHCs), community health centres (CHCs), district health centre and hospitals. This study highlights these disparities in health care infrastructure available both in rural and urban India by providing actual status of their availability in the country and need for their reallocation. The main theme of the paper is not only to give actual picture of this infrastructure and find out disparities but also tell measures how to correct these and find out solutions to achieve total health care of 1.3 billion people of the country.
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Volume-04 ISSN: 2455-3085 (Online)
Issue-03 RESEARCH REVIEW International Journal of Multidisciplinary
March-2019 www.rrjournals.com[UGC Listed Journal]
RRIJM 2015, All Rights Reserved 289 | P a g e
Health Care Infrastructure in India: Need for Reallocation and Regulation
Dr. Dimpal Vij
Associate professor, Department of Economics, MMH College, Ghaziabad (UP)(India)
ARTICLE DETAILS
ABSTRACT
Article History
Published Online: 13 March2019
It is not the hidden fact that India‟s health care needs serious attention. In almost all the key
health indicators given by World Health Organization (WHO) we lag behind. According to
World Health Statistics of 2018 India ranks 145 out of 194 countries. According to NITI
Aayog India has a scarcity of 6 lakh doctors, 20 lakh nurses and 2 lakh dental surgeons.
Though WHO recommends 1:1000 doctor to patient ratio but in rural India it is 1:11082 and
in some states like Bihar It is as low as 1:28391 and UP It is 1:19962 (NHP 2018). Around
80% of India‟s1.14 million registered doctors of modern medicine(allopathy) work in cities
which is home to just 31% of the country‟s population. same is the case with availability of
physical infrastructure i.e. primary health centres (PHCs), community health centres
(CHCs), district health centres and hospitals. This study highlights these disparities in health
care infrastructure available both in rural and urban India by providing actual status of their
availability in the country and need for their reallocation. The main theme of the paper is not
only to give actual picture of this infrastructure and find out disparities but also tell measures
how to correct these and find out solutions to achieve total health care of 1.3 billion people
of the country.
Keywords
Health, Health Care, Health Care
Infrastructure, India, Doctor-Patient
Ratio, WHO
*Corresponding Author
Email:dimpal.vij@rediffmail.com
1. Introduction
Health is wealth. Even our Vedas said “PehlaSukhNirogi
Kaya”. No nation can progress until its people are happy and
healthy. Happy and healthy citizens are real wealth of a nation
to progress upon. Needless to say, that poor, sick, ill, addict
and unhealthy people are a liability to a nation and they
swallow a good portion of its GDP in the form of health care.
According to World Development Report 1993 (WB, 1993)
“Improved health contributes to economic growth in four ways.
It reduces production losses caused by worker illness, it
permits the use of natural resources that had been totally or
nearly inaccessible because of diseases, it increases the
enrolment of children in schools and makes them better able to
learn and it frees alternative uses resources that would
otherwise have to be spent on treating illness.”
The economic gains are relatively greater for poor people,
who spend and suffer a lot due to their ill-health and loose
productive days as well as spend a lot to treat illness. For e.g.
It has been estimated that 62.6% (HT, India's Health Spending,
2017) of expenses on healthcare in India are out of pocket
expenditure but government expenditure is only 1.4% (Sharma
N. C., 2019) of GDP which is much lower than the global
average of 6%. The government is spending just Rs. 1,112 per
capita for health care which means only Rs. 3 per day is spent
for the health care of an average Indian. (NHP, 2018) This puts
India even lower than nations like Bhutan, Sri Lanka and Nepal
who spend 2.5 1.6, and 1.1 of their GDP on health care. Due to
lack of health care services approximately 10 lakh people lose
their life before time (DJ, 2018). Approximately 7% of
population annually plunges below poverty line due to health
care costs. (Khandheria, 2018) But before coming to health
care infrastructure of India let us come to the basics first. What
do we mean by health or health care etc.
Health is not only lack of illness or absence of disease but
according to WHO (Callahan, 1973) - “Health is a state of
complete physical, mental and social well-being and not merely
the absence of disease.” According to Oxford dictionary “It is
soundness of body and mind that condition in which its
functions are duly and efficiently discharged.”
Health is considered to be a stock of capital that yields
return in the form of healthy days just as wealth is a stock of
capital that yields a stream of income. Efficiency of any
person/worker depends considerably on his/her health.
Workers whose health is not good or who fall sick quite often
cannot do their job efficiently and their productivity as well as
income declines.
Health care means provision of services to improve health
status of individuals. Anything that contributes to producing
better health such as nutritious food, clean air, exercise,
medical intervention etc. is considered to be health care.
Health care infrastructure means an optimum mix of physical
structure (building etc.) and human resources as both are
required to deliver the desired health services.
2. Literature Review
Shailendra Kumar (Kumar S. , 2016) in his working paper
clearly explained How public health care services failed to
provide health for all and private sector was promoted and
even facilitated to provide health care services to people but
failed due to base on profitability, hence created merely
inequality and misallocation in spreading of infrastructure
facilities in all areas.
Kumar and Gupta (Gupta, 2012) discussed the present
scenario of health care facilities and personnel. They
suggested a model health care plan which devolves around
preparing a long-term strategy for qualitative as well as
Volume-04, Issue-03,March-2019 RESEARCH REVIEW International Journal of Multidisciplinary
RRIJM 2015, All Rights Reserved 290 | Page
quantitative improvements in India‟s health care infrastructure
by focusing on workforce capacity and competency,
information and data systems and organizational capacity.
They suggest government to take an integrated approach with
a decentralized structure based on district level with the help of
local people and local level institutions like Panchayats.
Isabelle Joumard and Ankit Kumar (Kumar I. J., 2015)
found in their study that health care system in India is a mix of
private and public providers and there is a great shortage of
health care staff in populous and rural states of north. They
suggest that longest gains in health status will come from
preventive measures. Improving living conditions and lifestyle
habits would have greatest impact as total sanitation campaign
(Swachh Bharat Mission) has high effect on reducing young
deaths and development disorders in later stage of life.
Likewise, better use of drugs would improve quality of health
care and reduce out of pocket expenditure.
Chandrakant Lahariya(Lahariya, 2018) discussed health
service infrastructure, health education infrastructure and
human resources available for health in India and the
challenges in this area. It comes out with conclusion that
India‟s vast rural health infrastructure has the capacity and
potential to deliver more services than currently it providing.
The need is to strengthen them and enable with input mix of
facilities, supplies and human resources based upon real time
information system.
Pradeep Kr. Chaudhary (choudhury, 2018) in his paper
raises questions on the issue of private sector involvement in
medical education, the regional variations in the health care
services and availability of doctors. It analyses role of private
sector in providing medical education, unequal distribution of
medical colleges and quality of medical graduates produced
from private institutions and suggests the government to
correct the geographical imbalances by setting up medical
institutions in underserved regions.
Objectives of the Study
1. To find out the current status of health and health
care infrastructure of India
2. To find the misallocation in the current health care
infrastructure of India
3. To give suggestions to improve this misallocation
Research Methodology
This study is based on secondary data. It uses analytical
and descriptive technique to find misallocation in health care
infrastructure of India through different research papers,
articles, different health reports published by Indian
government and world agencies as WHO, World Bank etc.
Data from different sources have been culled, analyzed and
conclusions drawn.
3. Health Care Infrastructure in India
Ever since India got independence it has worked to check
epidemics and enhance general well-being of its people and no
doubt it has improved on various health indicators but the rates
are still much above the world average and need immediate
action. See Table 1
Infrastructure is a prerequisite for delivering any services.
Health care system in India is a mix of many sectors public,
private, indigenous system of medicine and voluntary agencies.
Health care Infrastructure division of India is given in Figure 1
Table-1
Selected Health Indicators of India
S. No.
Parameter
1.
Crude Birth Rate (per 1000)
20.4
2.
Crude Death Rate (per 1000)
6.4
3.
Total Fertility Rate (per women)
2.2
4.
Maternal Mortality Rate (per 1,00,000 live births)
130
5.
Infant Mortality Rate (per 1000 live births)
34*
6.
Under 5 Mortality Rate (per 1000 children)
50
7.
Percentage of Deliveries attended by Trained Personnel
79
8.
Immunization covered among children aged 12-23 months
62
9.
Life Expectancy at Birth
68.3
Source- NFHS survey 4, *NHP 2018, Economic Survey 2017-18
Volume-04, Issue-03,March-2019 RESEARCH REVIEW International Journal of Multidisciplinary
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Figure 1Health Care Infrastructure in India
3.1 Public Health Sector Infrastructure
India took a long time almost three and half decades after
independence to announce its first National Health Policy (NHP)
in 1983 (G.Sen, 2012) in which a holistic (Primary health care)
approach was adopted to ensure health for all (HEA) through
provisioning of Sub Centres (SCs), Primary Health Centres
(PHCs), Community Health Centres (CHCs), district/civil
hospitals and medical institutions. The SC is the first and the
most peripheral point of contact between the primary health
care system and community. One SC covers a population of
3000 in hilly/tribal/difficult area and 5000 in plains. Each SC is
required to have at least one female health workers/auxiliary
nurse midwife (ANM) and one male health worker. (see Figure
2) SCs have been assigned the task of conducting
interpersonal communication in order to bring about behavioural
change and provide services in relation to maternal and child
health, family welfare, nutrition, immunisation and control of
communicable diseases programmes. Above SC are PHC that
is the first contact point between village community and the
medical officer. One PHC covers 30000 population in plain area
while 20000 in hilly/tribal/difficult area. The PHCs are envisaged
to provide an integrated curative and preventive health care to
the rural population with emphasis on preventive and promotive
aspects of healthcare. At present, a PHC is manned by a
medical officer supported by 14 paramedical and other staff. It
acts as a referral unit for 6 sub centres. It has 4-6 beds for
patients.
Figure 2.Public Health Sector Hierarchy in India
*Health Worker, **Auxiliary nurse midwife, ^Female, ^^Male
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The activities of PHC include curative, preventive,
promotive and family welfare services. Above PHC are CHC.
they are being established and maintained by state
government under MNP/BMS programme. One CHC has to
cover 1,20,000 population in plain area while 80,000 in
hilly/tribal/difficult area. One CHC has 4 medical specialists
surgeon, physician, gynaecologist and paediatrician supported
by 21 paramedical and other staff. It has 30 in-door beds with
one OT, X-ray, Labour Room and Laboratory facilities. It
serves as a referral centre for 4 PHCs and also provide
facilities for obstetric care and specialist consultations. Above
CHCs comes sub-divisional hospitals (SDH), District hospitals,
super-specialist hospitals. Table 2 gives actual number of
these centres in India till March 2017.
Table 2Health Care Infrastructure in India on March 31, 2017
Health centres
Sub Centres
Primary Health Centres
Community Health Centres
Sub-divisional Hospitals (SDHs)
District Hospitals
Mobile Medical Units
Medical Colleges and associated Hospitals
Dental Colleges
General Nursing Midwives Institutions
Pharmacy Colleges
Total Hospitals
Rural Areas
Urban Areas
Total Beds
Total beds in Rural Hospitals
Total beds in Urban Hospitals
Licensed Blood Banks
Allopathic Doctors
Dental Surgeons
AYUSH Doctors
Pharmacists
Nurses
Source- National Health profile 2018
3.1.1 Health Insurance Schemes:
Employee State Insurance Scheme: The ESI
Scheme introduced in 1948 is based on the principle
of contribution by employer and employee. It provides
medical care in cash and kind, benefits in the
contingency of sickness, maternity and employment
injury.
Central Government Health Scheme (CGHS):
CGHS was first introduced in 1954 to provide
comprehensive medical care to central Government
employees, pensioners and their dependents residing
in CGHS covered cities. At present CGHS has health
facilities in 37 cities having 287 allopathic
dispensaries and 85 AYUSH dispensaries in the
country with 10,82,913 registered cards/families.
(NHP, 2018)
3.1.2 Other Agencies:
Besides these defence services have their own
organization for medical care under the banner “Armed Forces
Medical Services”. Likewise, the railways provide
comprehensive Health care services to its employees.
3.2 Private sector Infrastructure
India has a large and unregulated private sector, both in
formal and informal sectors which provide health services to
people on payment basis. Private sector health care
infrastructure can be divided in two parts
a. Private Hospitals, Polyclinics, Nursing Homes and
Dispensaries
b. General Practitioners and Clinics
Authentic data about private informal sector is not
available while the majority of super specialist hospitals and
doctors‟ practise in urban areas.
3.2.1 Private Non-profit Sector
The private non-profit sector includes health care services
provided by voluntary organisations, Non-Profit organizations
(NGOs), Charitable institutions, missions and charitable trusts.
These organizations provide health care services on voluntary
basis without any cost or with minimal costs. General public
especially poor people are great beneficiaries of these low-cost
service providers.
3.3 Indigenous System of Medicine
In addition to these India has its own indigenous system of
medicine. Ayurveda, Siddha, Unani, Homeopathy, Naturopathy
are some examples of it. The government of India and many
state governments have taken steps to formalize and initiate
standardization of these systems. Even a new ministry AYUSH
ministry has been opened to promote and develop these
indigenous systems of medicine. In India AYUSH infrastructure
is given in Table 3
Table 3
Registered AYUSH Practitioners in India
AYUSH Dispensaries
27,698
AYUSH hospitals
3,943
Ayurveda
428,884
Unani
49,566
Siddha
8,505
Naturopathy
2,242
Homoeopathy
284,471
Total AYUSH Doctors
773,668
Source- National Health profile 2018
AYUSH has maximum number of registered Ayurvedic
doctors (55.44%), followed by registered homeopathy doctors
(36.77%) in India.
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3.4 Voluntary Health Agencies
Voluntary health agencies play an important role in
community health programmes. They collect fund and spend
according to the need of the society. India has vast number of
voluntary health agencies as Indian Red Cross Society, Bharat
SevakSamaj, All India Blind Relief Society, Professional bodies
like Indian Medical Association (IMA), All India Dental
Association etc., International Agencies like Ford Foundation,
Bill and Milinda Gates Foundation etc.
Besides these Auxiliary Nurse Midwife plays a very crucial
role in providing health care services. They have wider
linkages with ASHA workers, Anganwadi workers of ICDS and
other development sectors like education, water supply and
sanitation. Table 4 gives Registered number of ANM, GNM
and LHV.
Table- 4Nurses Registered in India
ANM (Auxiliary Nurse Midwives)
841,279*
GNM (General Nurse Midwives)
1,980,536*
LHV (Lady Health Visitors)
56,367*
Nursing Institutions
3,215**
Production capacity of Nursing Institutions
1,29,926**
Source- National Health profile 2018
*Till 31-12-16, **Till 31st October, 2017
4. Problems with Health Care Infrastructure of India
Despite so many hospitals, clinics, dispensaries and
health centres both in public and private sectors and even
NGOs and charitable institutions in health care, India‟s health
care services failed to provide a satisfactory level of health
care to its 1.3 billion population. Every year in India new public
health challenges are emerging due to demographic and
epidemiological transitions, environment degradation,
emerging infectious diseases and anti-microbial resistance.
India‟s health care infrastructure however, is unable to respond
these new challenges as the delivery system is not functioning
optimally and it is not based on the current needs of the
community. The main problems of Indian Healthcare
infrastructure are -
Shortage of Staff and Equipment’s
Though Indian Government both central and state have
created a vast network of health care infrastructure in India but
it is insufficient to provide proper health care to common
people in a cost-effective manner. The government Rural
Health Survey reveal that only 55.6% of CHCs have functional
X-ray machine while only 18% of specialists required (surgeon,
physician, gynaecologist and paediatrician) are in place.
(Alexender, 2018) Northern States of India are not only poorly
equipped but have shortage of staffs also. At least 4 specialists
are expected to be available at each CHC in India. However,
against a requirement of 22,496 specialist doctors only 4,156
were available at 5,624 CHCs across in India at the end of
March 2017 (Lahariya, 2018). Overall there was a shortfall of
86.5% surgeons; 74.1% obstetricians &gynaecologists; 84.6%
general physicians and 81% paediatricians at CHCs in the
country. According to rural Health Statistics in March 2018 only
8% subcentres, 12% PHCs and 13% CHCs met Indian Public
Health Standards (Alexender, 2018). In addition to doctors and
specialists there is shortage of other category of health staff.
There was shortfall of nearly 10,000 ANM and Health worker
(F) at SCs and PHCs. Of total 31,274 PHCs and CHCs, there
was a shortfall of 12,511 laboratory technicians; 7052
pharmacists, 13,194 nursing staff and 3629 radiographers.
Health care infrastructure is heavily skewed in favour of
urban areas
The evidence show that private health care market
occupies a large share of hospitals (75%), hospital beds
(50.7%) and medical institutions (54.3%) largely located in
urban areas. The growth of private sector has been urban and
metro centric. (S.K.Hooda, Private sector in Health Care
Delivery Market in India: Structure, Growth and Implications,
2015) With regards to the spread of organised hospital care,
the IMS Health survey conducted in 62 Indian cities in the year
2012 covering 14121 hospitals reflects that out of the total
hospitals surveyed, almost half (48%) of the large private
hospitals and two-thirds of corporate hospitals are located in
five million plus cities in India. Mumbai alone has 16% of all
hospitals in organised healthcare. (Mukhopadhyay, 2015)
Of the total 1.14 million allopathic doctors registered with
medical council of India by December 2017, around 80% work
in urban areas while 69% of rural India is heavily dependent on
public health system where allopathic doctor population ratio is
1:11,082 while World Health Organization recommends a ratio
of 1:1000. (Sharma S. , 2018) Delhi is best served with one
government doctor per 2,203 people while Bihar is the worst
with one doctor for 28,391. Figure 3 gives state-wise allocation
of doctor population ratio.
Six states Delhi, Karnataka, Kerala, Tamil Nadu, Punjab
and Goa have more doctors (Nagrajan, 2018) than WHO norm
of 1:1000 but most of these doctors are located in urban areas
and may be rural areas of these states see dearth of qualified
doctors. Besides, most doctors from these states are unwilling
to move states like Bihar or UP that suffer from acute shortage.
This again raises question whether producing more doctors
can address the crunch in rural areas.
Moreover, due to concentration in urban and in posh areas
these doctors have started malpractices to woo the patients.
According to Dr. Prabhakar president of Karnataka Branch of
IMA “40% of doctors in Karnataka are in Bangalore. In rural
areas there is still a shortage. Bangalore issaturated, even for
specialists. So, they don‟t get jobs. Doctors salaries are
coming down… we need to focus on producing doctors for the
periphery. Just producing more doctors won‟t not work.”
(Nagrajan, 2018)Around 90% of dentists and 80% of
practitioners of Ayurveda, yoga and naturopathy, unani, siddha
and homeopathy (AYUSH) are also in private sector. Nurse are
more evenly distributed, with half the number of nurse and
midwives in public sector.
Volume-04, Issue-03,March-2019 RESEARCH REVIEW International Journal of Multidisciplinary
RRIJM 2015, All Rights Reserved 294 | Page
Figure 3
Statewise Allopathic doctor- population Ratio in India
Source- National Health profile 2018
Inter-State and Intra-state variations
There is high variation in the availability of health care
facilities across the states and within the state. In a few states
such as Kerala, Tamil Nadu and Delhi public health facilities
play their intended role of being the first point of care and
proactively delivering essential services while in some states
like Uttar Pradesh, Bihar, Jharkhand primary health care is not
available to masses and they are highly dependent on private
sector with their own expenditure. These states also suffer
from lack of doctors and nurses.
Not only among the states but within a state there is a
wide variation in availability of health care facilities. In his study
Hooda found (S.K.Hooda, 2017) public health facilities
(estimated covering availability of SCs, PHCs, CHCs, sub-
divisional and district hospitals per 1,00,000 population) also
shows high inequality in the provision of public Health Facilities
across Districts. He found while the private facility is highly
urban centric covering a few districts of India, there is dearth of
both public and private health care facilities in many of the
districts and there are many parts/areas/districts where no one
is to serve people.
No proper regulatory mechanism and monitoring-
Not only there is shortage of doctors but there are many
practitioners in the private sector who are actually not qualified
doctors or Jholachapp in local language. According to WHO
report published in 2016 Only one in five doctors in rural India
is qualified to practice medicine. The report said that 31.4% of
those calling themselves allopathic doctors were educated only
up to class 12 and 57.3% doctors did not have a medical
qualification. (HT, 2017)
Due to poor regulatory mechanism and monitoring, private
health care services and doctors are following unethical,
greedy practices treating medical services as a business and
hospitalisation as a source of profit, writing unnecessary
diagnostic tests, high rate medicines instead of generic one,
organ theft (kidney racket) etc. even denying treatment to poor
people though getting land from government on a subsidised
rate. In addition, Shailaja Chandra in her study (Chandra,
2017) noticed that Indian citizens (rich or poor) have no
protection against medical exploitation or malpractice.
Regulators like Medical Council of India and state Medical
Council rarely react to medical malpractices. This is why there
is no check on greed and malpractices of doctors and
hospitals.
5. Recommendations
Based on this study following recommendations can be
given
1. Primary health Centres needs to be strengthened as
80-90% health needs of a person in a life time can be
provided by primary health care centres that ranges
from maternity to child care, disease prevention
through immunisation, management of seasonal and
life style diseases like flu, cold, fever, hypertension,
diabetes etc., supporting care to aging people who
have multiple diseases. For this in urban areas
Mohalla clinics can be a good alternative while in
villages SCs and PHCs should be strengthened.
2. Increase the expenditure on health from current 1.4%
to 2.5% as envisaged NHP 2017 to improve
infrastructure in health centres. as in health there is a
problem of underfunding and not inefficiency. If
government can ensure a perfect combination of
physical and human infrastructure by spending
adequate amount of money on health, the results will
be different. It is proved that public health care sector
has never been given a chance to do better, the
sector has always been lacking from flow of meagre
funds. Wherever it has been provided with funds it
has done much better for e.g. in case of AIIMS, PGI
Chandigarh or JIPMER
3. To meet shortage and availability of trained staff at
PHCs and CHCs preference should be given to local
people. To solve problem of abstaining from leaves or
resistance to live in rural areas local people should be
trained and posted in SCs, PHCs and CHCs of
Volume-04, Issue-03,March-2019 RESEARCH REVIEW International Journal of Multidisciplinary
RRIJM 2015, All Rights Reserved 295 | Page
difficult/ tribal and hilly areas. Skills of good
performing ASHA, ANM workers and nurses should
be upgraded and they should be posted in their own
rural and remote areas of PHCs and CHCs.
4. To remove misallocation of medical colleges
maximum in urban areas new medical colleges
whether it is private or public should be opened
strictly only in rural and remote areas. Special focus
should be on large populous northern states or
backward states.
5. There should be proper regulation and monitoring
against all the malpractices prevalent in health area.
Stringent laws and punishment should be there for all
those who do unethical practices in this field as health
is a service not business to fulfil the greed of the
people.
6. Use of technology can help a lot to reduce the cost as
well as improving facilities in health area. On line
monitoring of all the facilities of a health centre as well
as use of tele-conferencing, tele-medicine and tele-
radiology, mobile hospital and mobile ambulance in
remote, rural, hilly and tribal areas can help a lot to
bring down the cost of establishing health centres
over there.
7. Overall help of community people should be sought
for providing health care to all because no programme
can be successful without active involvement of
community. Kerala is a good example for it that took
help of educated youth and Panchayati Raj
Institutions for implementing her health programmes.
6. Conclusion
Though government has done a lot in last few years and
many steps have been taken to improve infrastructure in health
sector. New AIIMS and medical colleges have been opened.
To remove regional differences and bring equitability
government has made a policy to open a medical college
covering 3 parliament constituency. Tablets are being provided
to ANM and ASHA workers. After the launch of Ayushman
Bharat SCs and PHCs are being converted into health and
wellness centres. As one of the components of this program is
to upgrade 1,50,000 SCs and PHCs into health and Wellness
Centres (HWCs) by 2022. This should be taken as an
opportunity and the attention should be ensuring of providing
the right mix of facilities, supplies and human resources to
enable them to deliver servicers. This should be linked with
real time information system as is being done by National
Health Resource Repository (NHRR) Programme that aims to
collect information on existing health facilities, providers and
services available at the facilities in the urban area. The area
of this programme should be extended to all health and
wellness centres to do real time monitoring of the services
provided by these centres. Thus, lot is to be done as health is
the right of every individual and to ensure that government has
to adopt an integrated approach in which help of all stake
holders public, private, NGOs, voluntary organisation etc.
should be taken to provide health care to all. As no health
programme can be successful without active involvement of
the community so Active involvement of community and
educated youth should be ensured to achieve goal of Health
for all and like „Swachh Bharat Mission‟ „Swasth Bharat'
should be our new slogan.
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... He also stated that the BPL population in urban slum areas is facing health issues due to lack of essential amenities like hygiene, garbage disposal and potable water. The problem is further worsening due existence of an unhealthy competition between private healthcare service providers, medical malpractices inflation and concealed referral of patients to private hospitals by a doctor or paramedic in return for monetary incentive, leading to increased OOP treatment cost (Jindal, 1998;Vij, 2019;Kumar, 2020). In Indian subcontinent, private healthcare providers are more inclined towards offering services to the masses with higher paying capacity with an aim of profit maximization, ultimately ignoring healthcare needs of BPL and low-income population (Baru, 2003). ...
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