|
4. HEALTH RESOURCES
4.1 Human resources
for health
Several measures were initiated to contain absenteeism and to fill the
posts of medical officers in remote areas. The measures include recruiting
doctors on contract appointment, compulsory rural posting for certain period,
earmarking certain percentage of postgraduate seats for doctors who have
served in rural areas, and provision of rural service allowance, etc.
Proposals like medical practitioners to undergo knowledge and skill upgradation and recertification every five years are
proposed in the Tenth Plan. Other measures include promoting Open
Universities for providing continuous upgradation
of medical knowledge, setting up of Medical Grants Commission for funding new
Government Medical and Dental colleges, developing decentralised district
based health manpower planning that would meet the demands of health
services, and encouraging all States to establish University of Health
Sciences (UHS)
India stands compared unfavourably with
world levels, even with low income countries, in the capacities of human
resources. The number of physicians per 10,000 populations for the world is
1.5, for India
it is 7 which is at par with low income countries. For public sector, the
figure is paltry 2. Similarly, number
of nurses per 10,000 population in India is 8, while it is 33 for
the world and 16 for low income countries. There are over 250 medical
colleges in the modern system of medicine and over 400 in Indian system of
medicine and Homeopathy (ISM&H).
The country produces over 25000 doctors annually in modern system of
medicine and a similar number of ISM&H practitioners, nurses as well as para professionals.
The serious issue in human resource management is huge gaps in
critical health manpower in government institutions, particularly in rural
areas, that provide healthcare to the poorer segments of population. A large
number of vacant posts of both ANMs and doctors are
reported at the primary level in government hospitals. Also, most of the
specialist positions in government hospitals in rural areas are lying vacant.
The situation at the secondary and tertiary level is somewhat better, as doctors
generally reside in urban areas.
Vacancies continue to exist in the posts of laboratory technicians,
radiographers and other para-professionals which
have serious service implications, particularly for programmes like malaria
and tuberculosis. Other constraints include the low priority given to
in-service training, inadequate staffing of training institutions, quality of
trainers, and inadequate facilities in training institutions.
While several initiatives have been taken for effective management of
human resources, certain systemic issues such as remuneration, and seniority
based promotion disregarding suitability and merit that contribute to low
morale and uncommitted staff remains unresolved across States and need to be
dealt with on a priority basis.
Related Links
 Ministry
of Health and Family Welfare
Health Man power
Ayush
Human Resources – WHO/HQ
4.2 Financial resources for health
External assistance to health sector has always been low ranging from
1 to 3 percent in any given year. The healthcare expenditure, which is
largely financed by the private sector is about 75
percent.
The NHP 2002 and the Common Minimum Programme (CMP) of the present
Government have identified the necessity to rise the public spending on
health. Various measures have been initiated to raise the resources for
health, such as public private partnerships (tele
medicine), voluntary and community health insurance, income tax exemption to
set up private hospitals in the rural areas, and encouragement to private agencies
in secondary and tertiary levels of healthcare.
Total health expenditure as
percentage of GDP, public/private sector share
In 2003 percentage of expenditure as
percentage of GDP is 8.8%. The public expenditure on health is 25% and
private expenditure is 75%.
Sources of financing
The public health spending is abysmally low in a country where about
26 percent of people living below poverty line are critically dependent on
public health services, and the range and
complexities of health issues are substantial with the equal presence of both
communicable and non-communicable diseases.
The share of social insurance is estimated at only 4.2 percent while
other forms of health insurance
such as private health insurance constitute a negligible proportion (about
0.2 percent).
Related Links
Health Policy 2002
GDP – WHO/HQ
4.3 Physical infrastructure for health
Regarding the hospitals and hospital beds, the scenario presents the
dominance of healthcare facilities in the private sector. Public health
infrastructure in rural areas consists of a three-tier system, a sub centre
for every 5,000 population with a male and female worker; a PHC for every
30,000 population with a medical doctor and other para
medical staff, and a Community Health Centre (CHC) for every 100,000
population with 30 beds and basic specialists. In urban areas, it is two tier
systems with Urban Health Centre (UHC)/Urban Family Welfare Centre (UFWC) for
every 100,000 population followed by general hospital.
In 2001, there were about 1,37,311 Sub Centres (SCs),
28,000 dispensaries, 22,842 PHCs, 3,043 CHCs and
3,500 UFWCs and an additional 12,000 secondary and
tertiary hospitals in the public sector, besides an estimated 68 percent of
total hospitals in the private sector.
The existing public health infrastructure, though can meet prescribed
norms is not evenly distributed across the States. Many institutions are not
functional due to staff shortage and non-availability of drugs and
consumables and essential equipment. Facility Survey of 1999 by Government of
India indicates that about three-fourths of the CHCs
have no adequate equipments and only one-third of the PHCs
provided delivery care. As a result of such inadequate public health
facilities, it has been estimated that less than 20 percent of the
population, which seek OPD services, and less than 45 percent of that which
seek indoor patient treatment, avail of such services in public hospitals. A
large portion of population seek medical care services from private sector
despite the fact that most of these patients do not have the means to make
out-of-pocket payments for private health services (NHP 2002). The private
sector is almost unregulated, with serious complaints of poor quality, over
charging, and unethical behaviour.
Related Links
Indian
statistics
Urban Health resource Center
4.4 Essential drugs and other supplies
The
administration of drugs and pharmaceuticals is divided between the ministry
of chemicals and fertilizers (MCF) and the Ministry of Health and Family
Welfare (MoHFW). The former is responsible for drug
policy, regulation of industry, and price control, while the latter is
responsible for laying down standard, quality control, introduction of new
drugs, and enforcement of relevant laws and regulations assigned to the
Central Drug Standard Control Organization (CDSCO).
The basic
objectives of Government’s Policy relating to the drugs and pharmaceutical
sector were enumerated in the Drug Policy of 1986. These basic objectives still remain largely
valid. New drug policy (National Pharmaceutical Policy) was announced in
2002.
The
National Pharmaceutical Policy 2002 states that the Ministry of Health and
Family Welfare would:
Progressively benchmark the
regulatory standards against the international standards for manufacturing,
Progressively harmonize standard
for clinical testing with international practices,
Streamline the procedures and
steps for quick evaluation and clearance of new drug applications, developed
in India through indigenous R and D, and set up a world class Central Drug
Standard Control Organization (CDSCO) by modernizing, restructuring and
reforming the existing system, and establish an effective network of drug
standards enforcement administrations in the States with the CDSCO as a nodal
centre, to ensure high standards of quality, safety and efficacy of drugs and
pharmaceuticals.
In India,
5 laboratories have been given the responsibility for testing of samples of
drugs collected for regulatory purposes. The details about testing
facilities, samples collected for testing and the number failed, are given
here.
CENTRAL
DRUGS LABORATORY, KOLKATA
The main
functions of this laboratory are to:
test the samples of imported
drugs;
act as an appellate laboratory
under Drugs and Cosmetics Act; and
act as Government analyst for 21
States/Union Territories as well as for samples drawn by the Central Drug
Inspectors.
It also
supplies reference standards of various drugs to drug manufactures.
During
the period April 2003 to March 2004, 2183 samples of imported drugs were
tested of which 258 samples were found not of standard quality.
CENTRAL INDIAN PHARMACOPOEIA LABORATORY, GHAZIABAD
The
laboratory functions as:
Appellate laboratory for testing
of condoms;
Govt. Analyst for States/Union
Territories not having their own laboratory facilities;
A centre for testing of samples on
behalf of Central Government; and
A laboratory attached to the
Indian Pharmacopoeia.
During
the period April 2003 to March 2004, a total of 1929 samples were tested of
which 120 were found not to conform to standard quality.
CENTRAL DRUG TESTING LABORATORY, CHENNAI
This
laboratory tests the drug samples received from Drug Inspectors of Central
Drugs Standard Control Organization, South Zone, Chennai, ADC (1), Chennai Port,
Sub-Zone, Hyderabad and Technical Officer, Cochin Port.
During the period April 2003 to March 2004, a total of 503 drugs
samples were tested of which 6 were found not to conform to standard quality.
CENTRAL DRUG TESTING LABORATORY, MUMBAI
The
laboratory acts as Government Analyst and assists CDSCO in the analysis of
drug formulations and drug substances.
It is a reference laboratory for testing of Copper T and Tubal rings.
During the period April 2003 to March 2004 a total of 2226 drugs
samples were tested of which 189 were found not to conform to standard
quality.
REGIONAL DRUG TESTING
LABORATORY, GUWAHATI
The
laboratory was inaugurated on 3rd October 2002 to cater to needs
of drug testing of North Eastern states.
During the period October 2002 to March 2003, 201 samples were tested
of which 22 samples were reported to be not of standard quality.
Medicines
production capability in the country
The total estimated value of bulk drugs and formulations manufactured
in India
was Rs 196,370 million in 1999-2000.
Rational
use of medicines
Rational use of drugs is not properly followed in India because
of inadequate attention of the subject in medical schools as well as lack of
emphasis on CME (Continuing Medical Education). Most practitioners never
bother to keep abreast of latest technological developments. The WHO first
introduced the concept of rational use of drugs during 1973-75. However, this
came into effect only in 1994 when for developing a drug policy for Delhi, based on this concept, a triangle was formed of political leaders,
bureaucrats and technical experts dedicated to the cause of rational use of
drugs. The programme from then onwards extended rapidly. A number of NGOs and
professional organizations have organized conferences and training workshops.
Unless the relevant governments and professional associations own up the
programme and promote it actively, it shall become difficult for the rational
use of drugs.
Central Drugs
Standard Control Organization, MoHFW, India
Central drug Laboratory, MoHFW, India
EDM -
WHO/SEARO
Medicines – WHO/HQ
4.5 International partnership for health
External assistance in India
is around 1-3 percent of the total health spending in any given year. It has
an impact on health, contributing to hastening India's demographic and
epidemiological transition. From the 90s, the ODA assistance has increased
from US $ 305 million to US $ 623 million. It rose from 3.17 percent to 6.69
percent. Earlier most of the donor agencies provided aid for primary
healthcare and immunization programmes with focus on projects related to
strengthening of service delivery, capacity building, training and IEC.
Multilateral and Bilateral donors such as UNICEF, UNFPA, WHO, USAID, DFID,
SIDA, and CIDA provided assistance for specific programmes in family
planning, leprosy, malaria control, HIV/AIDS, etc.
The World Bank emerged as the major funding agency for health
constituting around 10-20 percent of the total external aid. Its primary
focus was on constructing sub centres, post-partum facilities and family
welfare centres. The MCH programme turned out to be quite successful and
turned into a comprehensive strategy with a primary focus on the reduction of
maternal and child mortality. Different population projects and projects on
leprosy, malaria, TB and blindness are also funded. UNICEF funding on
immunization was another major achievement.
Different studies taken up by funding agencies have helped in better
improvement of health services in India. These include World Bank
assessment on public sector health expenditure, and studies carried out by
National Institute of Public Finance and Policy (NIPFP) and NCAER, which
contributed to the understanding of the utilization of public funds at
tertiary, secondary and primary levels, between centre and State between,
public healthcare and medical care, urban and rural. The burden of diseases
studies by Administrative Staff College of India (ASCI) helped in
understanding disparities in the epidemiological shifts taking place in the
country. DFID conducted studies to improve efficiencies in hospitals, on
contracting of services, financing of PHCs,
hospital autonomy, cost effectiveness, procurement systems and
decentralization.
Global fund for AIDS
tuberculosis and malaria
The funding on HIV/AIDS has been substantial by the World Bank. DANIDA
and DFID also provided funding to deal with diseases like blindness, TB,
HIV/AIDS, leprosy, etc. The WHO occupies a unique position as the designated
UN organization for health. It has strategies to identify priority areas such
as TB, HIV/AIDS, polio eradication, safe motherhood and tobacco control and
by identifying parameters and indicators for increasing the sensitivity of
health systems to the needs of the poor.
Related Links
The
Global Fund 
|
