India Country Health System Profile - Trends in Socioeconomic Development

India

2. TRENDS IN SOCIOECONOMIC DEVELOPMENT

2.1 Economic trends

India witnessed higher economic growth rate in post reform period. The Gross Domestic Product (GDP) in the post reform period has improved from an average of about 5.7 percent in the 1980s to an average of about 6.1 percent in the eighth and ninth plan periods (1990s) and the Tenth Plan aimed to achieve 8 percent growth per annum. The annual growth rate in GDP in the year 2003-04 is 8.1 percent (Economic Survey 2003-04). Agriculture continues to be a critical sector, though its contribution to GDP has declined to 26.9 percent in 1999-2000 from 44 percent in 1973-74. The contribution of service sector, on the other hand, has been increasing. India has been witnessing a strong Balance of Payments in recent years, which is US $ 119.3 billion on May 31, 2004.

India is less indebted as debt service ratio was 123 percent of exports of good, services and income during 2003 (World Development Indicators, 2005).

The total external assistance (foreign aid) received by India in 1990-91 was US $ 4527.4 million, which went down to US $ 3826.7 million in 2003-04. This includes grants and loans (Economic Survey 2004-05, Ministry of Finance, Government of India). The amount of external assistance has gone down due to reduced loan amount though the grants have increased.

The share of social sector in total expenditurealmost remained stagnant during last decade and declined marginally, from 20.3 percent in 1990-91 to 19.8 in 2003-04.

India has been performing poorly in social sectors. India's rank in terms of the UNDP Human Development Index (HDI) is 126 among 177 countries, which manifests from a stagnant and declining share of social sector in total expenditure of the Government. Similarly, India has been performing poorly in the area of Gender Development. India’s rank in terms of UNDP Gender Development Index (GDI) is 96 among 177 countries, which show lack of attention being given towards gender development.

In India labour force has increased from 360.6 million in 1990 to 473.3 million in 2003 with average annual growth rate of 2.1 percent during 1990-2003 (World Development Indicators, 2005).

Poverty

The incidence of poverty has declined by almost 50 percent between 1977-78 and 1999-2000, from 51.3 percent in 1977-78 to 28.6 percent in 1999-2000. During the same period, the rural poverty declined from 53.1 percent to 27.1 percent and urban poverty from 45.2 percent to 23.6 percent (10^th Plan). As per survey conducted in the year 1999-2000, 34.7 percent of India’s population was living on less than US $ 1/day (World Development Indicators, 2005).

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2.2 Demographic trends

Average annual exponential growth rate of population declined from 2.14 in 1991 to 1.95 in 2001. The Crude Birth rate (CBR) decreased from 29.5 per 1000 population in 1991 to 23.8 per 1000 population in 2005. The Crude Death rate (CDR) was estimated to be 7.6 per 1000 population in 2005 compared to 9.8 per 1000 population in 1991. The total fertility rate during 2005-06 was 2.7 as against 3.8 during 1990.

As per Census 2001, the population below 15 years was 35 percent, >60 years was 8 percent, and between 15 and 59 years of age was 57 percent of the total population.

Life expectancy at birth

The increased life expectancy and uneven performance between fertility and mortality rates have posed dual challenges to simultaneously improve both primary and secondary healthcare services. The life expectancy at birth has increased to 59.7 for male and 60.9 years for female in 1991-1995 from 58.1 and 58.6 years for male and female respectively during 1987-1991. The Technical Group on Population, Registrar General of India has projected levels of expectation of life during 2001-2006 as 63.87 years for male and 66.97 for female, demanding specialized healthcare services for the increased number of older persons.

Infant Mortality Rate

Infant mortality rate (IMR) has also declined to 57 per 1000 live births in 2005-06 from 80 in 1991.

Trends in urbanisation

The urban population has increased by 4.5 times during 1951-2001, when the total population has increased by 3 times during the same period. The present share of urban population, which was at 27.78 percent of the total population, is expected to grow at 4 percent per annum and would account for 40 percent of the total population in the next ten years (10^th Five Year Plan). This has resulted in increased slums and as such urban health has become an issue of great concern. The NHP 2002 has proposed for a two tier urban healthcare system with a Primary Health Centre (PHC) for a lakh population and a general hospital besides that.

Related Links

Census India

Indian Health Statistics

WHR – WHO/HQ

2.3 Social trends

The literacy rate though has increased to 65.38 percent from 52.20 percent between 1991 and 2001, the male-female and urban-rural variations are continuing. The variations show that while male literacy rate was 76 percent in 2001, the female literacy rate was 54 percent. Similarly the urban literacy rate was 80 percent, while rural literacy rate was 59 percent. High dropout rates, low levels of learning achievement and low participation of girls are critical constraints in the education sector. To universalise elementary education, different schemes like mid-day meal and the Sarva Shiksha Abhiyan (SSA) 2001 were initiated in the recent past.

The changing economic situation created by urbanization, industrialization and new economic liberalization has transformed the Indian social structure and values from a traditionally agrarian economy to a modern industrial order. There has been a growth rate of 2.29 percent in the labour force since 1996-2001.

The problem of drug abuse is no more confined to a particular section of society but has infiltrated all strata. The large uncontrolled influx of rural migrants to urban areas in search of better earnings and job opportunities leaves them totally vulnerable, particularly the children of these migrant families. The negative influence of the electronic media appears to have resulted in an increase in juvenile delinquency, robberies, murders and kidnappings.

In 2002-03, India had 651,382 primary schools, 245,274 middle schools, 137,207 high/higher secondary schools/intermediate colleges, 9,166 colleges for general education, 2,610 colleges for professional education and 385 Universities/Deemed Universities/Research Institutions (Ministry of Human Resource Development).

The emerging nuclear family is exposed to severe economic and social constraints and changes. The traditional mechanisms for social security and adjustment in times of crisis and conflict are fast disappearing. This transformation has resulted in the creation of several social problems for individuals and groups such as older persons, the disabled, drug addicts, street children, child labour, HIV-infected populations, etc. There has also been increased violence - individually as well as collectively - especially towards women and young girls, which has assumed a serious dimension.

Related Links

Education

Census, Gov

UNESCO

2.4 Food supply and nutritional status

The Indian population is passing through a nutritional transition and is expected to witness higher prevalence of adult non-communicable diseases. Added to these are high prevalence of low birth weight, high morbidity and mortality in children, and poor maternal nutrition continues to be a major nutritional concern in India (Rao Shobha, 2001).

The proportion of newborns weighing less than 2500 grams at birth was reported to be 23 percent in 1998-99.

National Family Health Survey (NFHS) III (2005) indicated that almost half of children under three years of age were underweight (46%) and stunted (38%).

According to the same survey, nearly three-quarters (79%) of children in the age group of 6 to 35 months showed some level of anaemia including 46 percent being moderately anaemic and five percent severely anaemic.

It has been estimated that 200 million people are exposed to the risk of iodine deficiency and 70 million suffer from Goitre and other IDDs (IDD & Nutrition cell, 1998).

Nationwide intervention programmes are in operation over two decades. Some of the major ones are Integrated Child Development Services (ICDS), Iodine Deficiency Control Programme (IDCP), the Child Survival Programme and mid day meal programme for school children. In the 10^th five-year plan, focus has been given to nutritional education. Nutrition monitoring and surveillance will be given high priority so that it will be possible to closely monitor the impact of on-going demographic, developmental, economic transition and ecological and life style changes of nutritional and health status of population.

UNICEF-sponsored Multi Indicator Cluster Survey in 2000 indicated that only 37 percent children aged 0-3 years were breastfed.

Related Links

Nutrition – WHO/SEARO

Nutrition – WHO/HQ

2.5 Lifestyle and Risk Factors

About twenty one percent of persons aged 15 years and above were reported to chew tobacco. Seventeen percent of men and two percent of women aged 15 years and above were reported to consume alcohol. While only 3 percent of women were reported currently smoking, 29 percent of men in same age group (15 years and above) smoke (NFHS, 1999). Currently, there is an increasing trend in smoking among youth. Other significant changes in lifestyles relate to lack of physical activity among the affluent, increased use of fast foods, and violence, particularly against young women and children.

The government has taken action to promote healthy lifestyles through sports, health education, setting up of no smoking zones, legislation banning smoking in public places, and establishing drug detoxification centres. However, the revenues from tobacco and alcohol manufacturing constitute substantial part in the total revenue of the government.

Policies and programmes addressing sexual health in schools, communities and the workplace

Policies:

The National Population Policy – 2000

National AIDS Policy – 2002

National Youth Policy – 2003

Programmes:

National Health Programs

Ministry of Youth Affairs and Sports

Villagers Talk AIDS