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Resource centre on India's rural distress
 
 

Public Health

KEY TRENDS 

 

• The 2019 India TB report says that the country accounted for a quarter of the global tuberculosis (TB) burden with an estimated 27 lakh cases in 2018. In 2018, the country was able to achieve a total notification of 21.5 lakh TB cases, of which 25 percent was from private sector. Majority of the TB burden is among the working age group. Nearly 89 percent of TB cases came from the age group 15-69 years. About 2/3rd of the TB patients were males *15
 
• Maternal Mortality Ratio for India was 370 in 2000, 286 in 2005, 210 in  2010, 158 in 2015 and 145 in 2017. Therefore, the MMRatio for the country reduced by almost 61 percent between 2000 and 2017. MMRatio for China was 59 in 2000, 44 in 2005, 36 in 2010, 30 in 2015 and 29 in 2017. Therefore, the MMRatio for China fell by around 51 percent between 2000 and 2017 *14  
 
• The per capita public expenditure (actual) on health in nominal terms has gone up from Rs. 621 in 2009-10 to Rs. 1,112 in 2015-16. Public expenditure on health (includes health sector expenditure by Centre and States/UTs) as a percentage of GDP was 1.02 percent in 2015-16. There is no significant change in public expenditure on health as a percentage of GDP since 2009-10. The Centre-State share in total public expenditure on health was 31:69 in 2015-16, which used to be 36:64 in 2009-10 *13

• The North-Eastern states had the highest (viz. Rs. 2,878 per capita) and Empowered Action Group (EAG) states (including Assam) had the lowest (viz. Rs. 871 per capita) average per capita public expenditure on health in 2015-16 (excluding UTs). The North-Eastern states had the highest public health expenditure as a percentage of Gross State Domestic Product (GSDP) in 2015-16 (2.76 percent). Public health expenditure as a percentage of GSDP stood at 1.36 percent for EAG states (including Assam) and 0.76 percent for major non-EAG states *13
 
• Of the total disease burden in India in 1990, a tenth was caused by a group of risks including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke, and diabetes. The contribution of this group of risks increased massively to a quarter of the total disease burden in India in 2016 *12

• The Out-of-Pocket Expenditure (OOPE) on health by households is Rs. 3,02,425 crores (62.6 percent of total health expenditure, 2.4 percent of GDP, Rs. 2,394 per capita) for the year 2014-15. Private Health Insurance expenditure is Rs. 17,755 crores (3.7 percent of total health expenditure) for the year 2014-15 *11

• Based on available evidence, cardiovascular disease (24 percent), chronic respiratory disease (11 percent), cancer (6 percent) and diabetes (2 percent) are the leading cause of mortality in India *10
 
• The total number of dengue cases in India has grown from 28,292 in 2010 to 40,425 in 2014. The total number of dengue related deaths stood at 131 in 2014 *10

• The Proportion (per 1000) of Ailing Persons (PAP), measured as the number of living persons reporting ailments (per 1000 persons), was 89 persons in rural India and 118 persons in urban India *9
 
• Private doctors were the most important single source of non-hospitalized treatment in both the sectors (Rural & Urban). More than 70% (72 per cent in the rural areas and 79 per cent in the urban areas) spells of ailment were treated in the private sector (consisting of private doctors, nursing homes, private hospitals, charitable institutions, etc.) *9
 
• It is observed that in rural India, 42 percent hospitalised treatment was carried out in public hospital and rest 58 percent in private hospital. For the urban India, the corresponding figures were 32 percent and 68 percent. It may be noted in this context that households (or persons within households) were segregated in sector (rural/urban) by their place of domicile, and not by the place of treatment *9

 

• Average medical expenditure per hospitalisation case: Higher amount was spent for treatment per hospitalised case by people in the private hospitals (Rs. 25850) than in the public hospitals (Rs. 6120). The highest expenditure was recorded for treatment of Cancer (Rs. 56712) followed by that for Cardio-vascular diseases (Rs. 31647). Average medical expenditure per non-hospitalisation case was Rs. 509 in rural India and Rs. 639 in urban India *9

• As much as 86 percent of rural population and 82 percent of urban population were still not covered under any scheme of health expenditure support. Government, however, was able to bring about 12 percent urban and 13 percent rural population under health protection coverage through Rastriya Swasthya Bima Yojana (RSBY) or similar plan. Only 12 percent households of the 5th quintile class (Usual Monthly Per Capita Consumer Expenditure) of urban area had some arrangement of medical insurance from private provider *9
 
• The draft National Health Policy 2015 proposes a potentially achievable target of raising public health expenditure to 2.5% of the GDP. It also notes that 40% of this would need to come from Central expenditures. At current prices, a target of 2.5% of GDP translates to Rs. 3800 per capita, representing an almost four fold increase in five years *8
 
• Maternal mortality ratio (MMR)* in India stood at 560 maternal deaths (per 100000 live births) during 1990, 460 during 1995, 370 during 2000, 280 during 2005 and 190 during 2013. India could reduce MMR by 65 percent between 1990 and 2013 *7

• At the country level, the two countries that accounted for one third of all global maternal deaths are India at 17 percent (50000) and Nigeria at 14 percent (40000) *7

• U5MR in India declined by 55 percent from 126 in 1990 to 56 in 2012. Infant Mortality Rate declined from 88 in 1990 to 44 in 2012. Neonatal mortality rate declined from 51 in 1990 to 31 in 2012. U5MR in India among boys declined from 121 in 1990 to 54 in 2012. U5MR in India among girls declined from 130 in 1990 to 59 in 2012. The share of neonatal deaths in under-five deaths stood at 55 percent in 2012 as compared to 41 percent in 1990 *6

• Pneumonia is the leading cause of child mortality in India, responsible for the deaths of nearly 400,000 children under five in 2010 *5

• The Indian Commission on Macroeconomics and Health notes that, in India, 13 household person-days per patient were lost per episode of malaria. Furthermore, the commission estimated that the overall monetary losses to families (income losses together with treatment expenses) could amount to between 200 and 400 Indian rupees (US$ 3.5 to 7) *4

• Odisha is one of the most highly malaria-endemic states in India, accounting for 24% of reported cases in 2010 despite consisting of less of than 4% of the national population. Malaria is particularly common among tribal groups which represent 44% of the population of Orissa *4

• Globally 12% of all deaths among adults aged 30 years and over were attributed to tobacco as compared with 16% in India, 17% in Pakistan and 31% in Bangladesh *3

• A recent study illustrated the economic impact of Non-Communicable Diseases (NCDs) in India by estimating that if NCDs like: heart disease, cancer, diabetes, chronic respiratory conditions, and other NCDs were “eliminated”, the country’s 2004 GDP would have been 4 to 10 percent greater *2

• The share of out-of-pocket household health expenditures on NCDs in India increased from 32 percent to 47 percent between 1995–1996 and 2004. Moreover, 40 percent of these expenditures were financed by borrowing and sales of assets, increasing the household’s financial vulnerability *2

• In NFHS-III, 62% of women with two daughters and no sons say they want no more children, compared with 47% in NFHS-II *1
 
 
15. 2019 India TB report, released in 2019, Ministry of Health and Family Welfare, please click here and click here to access
 
14. Trends in Maternal Mortality 2000 to 2017: Estimates by World Health Orgnization (WHO), United Nations Children's Fund (UNICEF), World Bank Group, United Nations Population Fund (UNFPA) and the United Nations Population Division (released in September 2019), please click here and click here to access
 
13. National Health Profile 2018, 13th Issue, Central Bureau of Health Intelligence, Ministry of Health & Family Welfare, please click here to access 
 
12. India: Health of the Nation’s States - The India State-Level Disease Burden Initiative, Disease Burden Trends in the States of India 1990 to 2016 (released in October, 2017), prepared by Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), Institute for Health Metrics and Evaluation (IHME) and Ministry of Health & Family Welfare (MoHFW), please click here to access
 
11. National Health Accounts: Estimates for India 2014-15 (released in October, 2017), prepared by the National Health Accounts Technical Secretariat, National Health Systems Resource Centre and Ministry of Health and Family Welfare, please click here to access
 
10. National Health Profile 2015, Central Bureau of Health Intelligence, Ministry of Health and Family Welfare (please click here to access)
 
9. 71st round NSS report: Key Indicators of Social Consumption in India-Health (published in June 2015), please click here to access the full report; please click here to read the summary of findings
 
8. Draft National Health Policy 2015 (published in December 2014), Ministry of Health and Family Welfare (Please click here to download)
 
7. United Nations' report (released in May, 2014) entitled Trends in maternal mortality estimates 1990 to 2013, (please click here to download)
 

6. Committing to Child Survival: A Promise Renewed Progress Report 2013, UNICEF

 

5. Pneumonia Progress Report, 2012, released by IVAC and John Hopkins Bloomberg School of Public Health, please click here to access

 

4. Defeating malaria in Asia, the Pacific, Americas, Middle East and Europe (2012), World Health Organization and PATH, 

http://www.indiaenvironmentportal.org.in/files/file/Defeat
ing%20malaria.pdf

 

3. WHO Global Report: Mortality Attributable to Tobacco (2012), please click here to access  

 

2. The Growing Danger of Non-Communicable Diseases: Acting Now to Reverse Course, September, 2011, The World Bank, please click here to access

 

1. National Family Health Survey III (2005-06), please click here to access