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MH0051 – Health Administration -Q.1 Explain healthcare delivery system in India and its functions in detail.

Answer:
In India Healthcare Delivery system is represented by five major sectors or agencies that differ from each other by the health technology applied and by the source of funds for operation.
• Public sector
• Primary Healthcare
• Primary health centers
• Sub-centers
• Hospital/health centers

• Community health centers
• Rural Hospitals
• District hospitals/health centers
• Specialist hospitals
• Teaching hospitals
• Health Insurance Scheme
• Employees state insurance
• Central government health scheme
• Other agencies
• Defence services
• Railways
Private sector
• Private hospitals, polyclinics, nursing homes, dispensaries
• General practitioners
Indigenous systems of medicine
• Ayurveda & Siddha
• Unani
• Homeopathy
• Unregistered Practitioners
Voluntary health agencies
• Jan Aakansha
• Shiksha
• Give India
• The Art of Living Foundation
• Vision Age India
• People Institute for Development and Training (PIDT)
• Child Line India Foundation
• Provision for Recognition, Education, Rejuvenation, and Awareness
Generation for Needy Anonymous (PRERANA)
• Action for Development of Human and Rural Neglected Areas (ADHARANA)
• Seva Bharti Mandal
• Voluntary Health Association of India (VHAI)
• Savera Samaj Kalyan Sansthan, etc.
National health programs
• Major Programs
• National AIDS Control Program
• National Cancer Control Program
• National Diarrheal Disease Control Program
• National Filaria Control Program*
• National Family Welfare Program
• National Iodine Deficiency Disorders Control Program
• National Leprosy Eradication Program
• National Malaria Eradication Program*
• National Program for Control of Blindness & Visual Impairment
• National Reproductive and Child Health Program
• National Program for Surveillance Program for Communicable Diseases
• National Tuberculosis Control Program
• Minor Programs
• National Mental Health Program
• National Japanese Encephalitis Control Program
• National Diabetes Control Program
• National Kala-azar Control Program
• National Water Supply and Sanitation Program
(*Programs are merged into National Vector Borne Control Program since 2003-04)
Core functions of healthcare delivery system in India are as follows:
• Monitoring health situation
• Disease surveillance
• Health promotion
• Regulations
• Partnerships
• Planning & Policies
• Human Resource Development
• Reducing impact of emergencies on health
1 Growing population and economy
One driver of growth in the healthcare sector is India’s booming population, currently 1.1 billion and increasing at a rate of 2 percent per annum. By 2030, India is expected to surpass China as the world’s most populous nation. By 2050, the population is projected to reach 1.6 billion. This population increase is due in part to a decline in infant mortality, the result of improved healthcare facilities and the government’s emphasis on eradicating diseases such as hepatitis and polio among infants. In addition, life expectancy is rapidly approaching the levels of the western world. By 2025, an estimated 189 million Indians will be at least 60 years of age – triple the number in 2004, thanks to greater affluence and better hygiene.
The growing elderly population will place an enormous burden on India’s healthcare infrastructure.
The Indian economy, estimated at roughly $1 trillion, is growing in tandem with the population. Goldman Sachs predicts that the Indian economy will expand by at least 5 percent annually for the next 45 years, and that it will be the only emerging economy to maintain such a robust pace of growth. Population growth and its relation to economic growth has been a matter of debate for over a century. The early Malthusian view was that population growth is likely to impede economic growth because it will put pressure on the available resources, result in reduction in per capita income and resources; this, in turn, will result in deterioration in quality of life.
Following are the adverse effects of population growth on the Indian Economy:
• adverse effects on savings
• unproductive investment
• slow growth of Per Capita Income
• underutilization of labour
• growing pressure on land
• adverse effect on quality of population and
• adverse social impact.
2 Expanding middle class
India traditionally has been a rural, agrarian economy. Nearly three quarters of the population still lives in rural areas, and as of 2004, an estimated 27.5 percent of Indians were living below the national poverty line. Some 300 million people in India live on less than a dollar a day, and more than 50 percent of all children are malnourished.
However, India’s thriving economy is driving urbanization and creating an expanding middle class, with more disposable income to spend on healthcare. While per capita income was $620 in 2005, over 150 million Indians have annual incomes of more than $1,000, and many who work in the business services sector earn as much as $20,000 a year. While this is a fraction of the income that their US peers earn, it is the equivalent of more than $100,000 per year when adjusted for purchasing power parity. More women are entering the workforce as well, further boosting the purchasing power of Indian households. Between 1991 and 2001, the percentage of women increased from 22 percent to 26 percent of the total workforce, according to the latest Indian government census. Many of these women are highly educated: the ratio of women to men who have a college degree or higher level of education is 40:60.
Today at least 50 million Indians can afford to buy Western medicines – a market only 20 percent smaller than that of the United Kingdom. If the economy continues to grow faster than the economies of the developed world, and the literacy rate keeps rising, much of western and southern India will be middle class by 2020.
3 Rise of diseases
Another factor driving the growth of India’s healthcare sector is a rise in both infectious and chronic degenerative diseases. While ailments such as poliomyelitis, leprosy, and neonatal tetanus will soon be eliminated, some communicable diseases once thought to be under control, such as dengue fever, viral hepatitis, tuberculosis, malaria, and pneumonia, have returned in force or have developed a stubborn resistance to drugs. This troubling trend can be attributed in part to substandard housing, inadequate water, sewage and waste management systems, a crumbling public health infrastructure, and increased air travel.
In addition to battling infectious diseases, India is grappling with the emergence of diseases such as AIDS as well as food-and water-borne illnesses. And as Indians live more affluent lives and adopt unhealthy western diets that are high in fat and sugar, the country is experiencing a rise in lifestyle diseases such as hypertension, cancer, and diabetes, which is reaching epidemic proportions.
4 Deteriorating infrastructure
India’s healthcare infrastructure has not kept pace with the economy’s growth. The physical infrastructure is woefully inadequate to meet today’s healthcare demands, much less tomorrow’s. While India has several centers of excellence in healthcare delivery, these facilities are limited in their ability to drive healthcare standards because of the poor condition of the infrastructure in the vast majority of the country.
Of the 15,393 hospitals in India in 2002, roughly two-thirds were public. After years of under-funding, most public health facilities provide only basic care.
With a few exceptions, such as the All India Institute of Medical Studies (AIIMS), public health facilities are inefficient, inadequately managed and staffed, and have poorly maintained medical equipment. The number of public health facilities also is inadequate. For instance, India needs 74,150 community health centers per million population but has less than half that number. In addition, at least 11 Indian states do not have laboratories for testing drugs, and more than half of existing laboratories are not properly equipped or staffed. The principal responsibility for public health funding lies with the state governments, which provide about 80 percent of public funding. The federal government contributes another 15 percent, mostly through national health programs and the rest of the 5 percent comes from the individual donations, charity funds and non-governmental organisations.

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