India has both substantial achievements as well as a daunting unfinished agenda in the health sector. The National Rural Health Mission is an attempt at building a sustainable health system for the country. It attempts to address long standing ailments of the health system.
Healthcare is a major concern for the Governments around the world. Globalization brings with it increasing threats to health including SARS, Avian Flu, HIV/ AIDS, Humanitarian Emergencies and Bio-terrorism. These and other threats to health know no boundaries as in an age of wide spread global trade and travel, new and existing diseases can cross national borders and threaten our collective security.
India has both substantial achievements as well as a daunting unfinished agenda in the health sector. Longevity in the country has more than doubled since Independence in 1947, Infant Mortality Rate has fallen by 70% points, Malaria has been contained, Small pox and Guinea worm have been completely eradicated and Leprosy and Polio are nearing elimination. In the preceding 5 years over 500, 000 deaths have been averted due to the up scaling of the Directly Observed Treatment Short Course (DOTS).
However, these achievements do not mask India’s failures. Malnutrition and rates of infant and maternal deaths have stagnated during the last decade. Although, India accounts for 16.5% of the global population, it contributes to a fifth of the world’s share of diseases. A third of the diarrhoeal diseases, TB, Respiratory and other infections and parasitic infestations as well as perinatal conditions and a quarter of maternal conditions, a fifth of nutritional deficiencies, diabetes. It is the second largest number of HIV/ AIDS cases after South Africa.
The public health system is overwhelmed by the co-existence of communicable and infectious diseases along side an emerging upsurge of non-communicable diseases. It is estimated that by 2015 the number of HIV/AIDS cases would be 3 times more than the current level as would be the prevalence level of TB cases. Perinatal and child hood conditions are not expected to decline significantly. What is also of concern is the expected increase in India’s disease burden due to non-communicable diseases. Cardiovascular diseases and diabetes will more than double, cancers will rise by 25% and mental health incidences will affect about 6.5% of the populace.
These and other non-communicable diseases are expensive to treat and India’s focus will be on adopting preventive strategies. Access to clean water and sanitation services and better hygienic practices like hand-washing will reduce diarrhaoea. Likewise, increasing advocacy and awareness efforts against tobacco use will reduce CVD, lung and oral cancers drastically. Promotion of exercise and yoga is increasingly acknowledged to reduce stress and obesity, diabetes and other lifestyle diseases.
The National Rural Health Mission is an attempt at building a sustainable health system for the country. It attempts to address long standing ailments of the health system.
It is about decentralization and empowering local communities beginning at the village level to plan for their own health care needs. The Mission also attempts to fill critical gaps in the system, systemic as well as those relating to human resources, finances, materials and supplies and above all accountability.
At a macro level, the NRHM through enhanced political priority has energized the health sector across the country. It has through institutional reforms and flexible financing led to convergent action on the part of local communities as well as pubic institutions resulting in significantly enhanced number of functional health facilities, increases in out patient cases, and higher number of institutional birth deliveries and improved immunization coverage.