The trajectory of India‘s development in health and well-being from 1947 to 2023 showcases a remarkable evolution. The nation’s endeavours to tackle some of the deadliest diseases and enhance the quality of life for its citizens reflect a story of transformation and growth.
A triumph in death rate reduction
One of the most remarkable accomplishments India has achieved post-independence is the substantial reduction in death rate. In 1947, the average life expectancy for an Indian citizen was a mere 32 years. Fast forward to 2023, and this figure has risen significantly to an impressive 70.19 years. This transformation, endorsed by the World Health Organization (WHO), underscores the progress in human development.
Infant mortality and child health: A
striking improvement
The United Nations’ data sheds light on India’s commendable strides in child health. The infant mortality rate, which stood at 145.6 per 1000 live births in 1947, has seen a remarkable improvement and dropped to 27.695 per 1000 live births in 2023. This splendid improvement underscores the nation’s commitment to ensuring a healthier start for its youngest citizens.
National initiatives and disease eradication
India’s post-independence journey has been punctuated by the initiation of numerous national-level campaigns aimed at combatting various diseases. From AIDS to tuberculosis and malaria, the Indian government has championed initiatives that have not only saved lives but also demonstrated the nation’s proactive approach to public health challenges.
Empowering health through
national schemes
The launch of transformative schemes such as the National Health Mission and the National Rural Health Mission has bolstered India’s commitment to enhancing child and maternal health. These initiatives have played a pivotal role in ensuring accessible healthcare services and reducing health disparities across different regions of the country.
India’s progress in the field of medical education is another testament to its journey of transformation. There were mere 28 medical colleges in the 1950s but the current count of 612 medical colleges speaks volumes about the nation’s dedication to nurturing a skilled healthcare workforce.
India’s evolution in the realm of health and development over the years serves as an inspiring example for developing nations across the globe.
Public healthcare
Public healthcare is free for every Indian resident.
The Indian public health sector encompasses 18% of total outpatient care and 44% of total inpatient care. Middle and upper class individuals living in India tend to use public healthcare less than those with a lower standard of living. Additionally, women and the elderly are more likely to use public services. The public health care system was originally developed in order to provide a means to healthcare access regardless of socioeconomic status or caste. However, reliance on public and private healthcare sectors varies significantly between states. Several reasons are cited for relying on the private rather than public sector; the main reason at the national level is poor quality of care in the public sector, with more than 57% of households pointing to this as the reason for a preference for private health care. Much of the public healthcare sector caters to the rural areas, and the poor quality arises from the reluctance of experienced healthcare providers to visit the rural areas. Consequently, the majority of the public healthcare system catering to the rural and remote areas relies on inexperienced and unmotivated interns who are mandated to spend time in public healthcare clinics as part of their curricular requirement. Other major reasons are long distances between public hospitals and residential areas, long wait times, and inconvenient hours of operation.
National Health Policy
The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002, and then again updated in 2017. The recent four main updates in 2017 mention the need to focus on the growing burden of non-communicable diseases, the emergence of the robust healthcare industry, growing incidences of unsustainable expenditure due to healthcare costs, and rising economic growth enabling enhanced fiscal capacity. Furthermore, in the long-term, the policy aims to set up India’s goal to reform its current system to achieve universal health care. In practice however, the private healthcare sector is responsible for the majority of healthcare in India, and a lot of healthcare expenses are paid directly out of pocket by patients and their families, rather than through health insurance due to incomplete coverage.
Government health policy has thus far largely encouraged private-sector expansion in conjunction with well designed but limited public health programs.
Shortage of doctors in rural areas
Rural areas in India have a shortage of medical professionals. 74% of doctors are in urban areas that serve the other 28% of the population, leaving many with unmet medical needs.
This is a major issue for rural access to healthcare. The lack of human resources causes citizens to resort to fraudulent or ignorant providers. Doctors tend not to work in rural areas due to insufficient housing, healthcare, education for children, drinking water, electricity, roads and transportation.
Additionally, there exists a shortage of infrastructure for health services in rural areas. In fact, urban public hospitals have twice as many beds as rural hospitals, which are lacking in supplies. Studies have indicated that the mortality risks before the age of five are greater for children living in certain rural areas compared to urban communities. Due to these geographic barriers, limited healthcare infrastructure, and a shortage of healthcare professions, rural areas face unique challenges. Scholars believe that if healthcare providers are able to understand these cultural nuances, they may be able to provide culturally-sensitive services specifically tailored to the needs and preferences of these communities. Children face a myriad of health risks in relation to the healthcare challenges those in rural areas encounter. Across three different measuring points from 1992 through 2006, more developed states in India had a lower proportion of households with an underweight boy or girl than less developed states, which tend to contain more rural communities.
Full immunization coverage also varies between rural and urban India, with 39% completely immunized in rural communities and 58% in urban areas across India. Vaccine illiteracy remains a significant obstacle in the path towards greater immunization coverage, often due to misinformation, unreliable healthcare, a lack of awareness among parents, and other social factors. Inequalities in healthcare can result from factors such as socioeconomic status and caste, with caste serving as a social determinant of healthcare in India. One study showed more health disparities arise when comparing urban versus rural homes rather than between castes; using three rounds of the National Family Health Surveys, researchers calculated the Multidimensional Poverty Index, which is aimed at further elucidating the indicators and social determinants of health. Between urban and rural households, the headcount ratio difference was found to be 20-30% in 2005-2006, while between scheduled castes/scheduled tribes and other households the difference was only 10-15%. Other critical social determinants of health in India include sanitation/hygiene, environmental pollution, nutrition, and more. Across all states, less than 50% (and in some less than 25%) of urban homes had unimproved sanitation, compared to over 50% (and in some over 75%) of rural homes, according to the 2007-2009 District Level Household Survey. Sanitation and hygiene are directly linked to disease and overall rural health outcomes.
Similar with many other countries, often those in rural India rely on informal providers to deliver necessary medical care. Utilizing modern and traditional medical practices, such as allopathic medicines and herbal remedies, informal providers have varying degrees of skills and education, but usually no formal medical qualifications. Yet, they far outnumber the quantity of medical providers in India; a study from Madhya Pradesh found there to be 24,807 qualified medical doctors, compared to 89,090 informal providers. They are also the most common first call for those in rural areas requiring medical services. Due to the lack of accessible healthcare in rural India, informal providers respond to much of the resulting unmet medical needs, proving them integral to rural health infrastructure.