India Health Report 2010 - Indicus Analytics and Business Standard publication

India Health Report 2010

Editors

Ajay Mahal, Bibek Debroy, Laveesh Bhandari

India Health Report

achievements with regard to the three key goals of health policy—improved health status, financial risk protection, 

and equity. It does so by identifying some of the factors and the state of policy instruments that have facilitated 

these  achievements  in  the  areas  of  access,  quality  and efficiency. Hence, it looks at public health interventions, 

regulations, financing, and the organisation of healthcare. The role of both public and private institutions in the pro-

vision of such services is studied in this overall context. The focus, therefore, is to analyse the status of health 

in India, and this is done by bringing together data and analyses from government documents, health economics 

and policy literature and a host of other sources. 

Organised in nine chapters, the report begins by making a case for investing in health as a sound economic decision. 

Ajay Mahal and Victoria Fan (Chapter 1) make the point that investing in health should be a priority, even when 

resources are otherwise limited, owing to the high returns from such investment. As such, they highlight the need 

to enhance protection against the financial risk inherent in an unhealthy population. They argue their case at four 

levels: (a) health is a major factor in influencing aggregate economic outcomes; (b) instances of ill health can expose 

entire households to financial risk and, in many cases, im poverishment; (c) health status itself is an indicator of 

human well-being; and (d) in a society undergoing great economic and social transition, such as India, improvements 

in health carry an added importance (and correspondingly constitute a greater challenge).

As the mere provision of health infrastructure does not necessarily ensure universal accessibility, in Chapter 2, 

Laveesh Bhandari and Aali Sinha examine the multiple facets governing the access to, and utilisation of, health-

care services: awareness levels; locational or financial constraints;  efficiency  of  public  and  private  healthcare 

providers; issues of quality and reliability of service and treatment; analysis of hospitalisation and out-of-pocket 

expenditure, etc. They conclude that despite heavy public intervention, the health burden carried by Indians con-

tinues to be significant. They underline the importance of effectively addressing the constraining issues through

effective systemic changes.

In Chapter 3, Sumita Kale studies the new issues in disease management in India today, many of which are linked to growing prosperity in the country. 

One set of issues she examines is the rising incidence of diseases like ischemic heart, diabetes, cancer, HIV/AIDs, where health education and regular 

screening can play a significant preventive role. She also highlights the need to match society’s rising affluence with an environment where mental and physical disorders 

and disabilities are included in the mainstream discussion on health management.

In Chapter  4, Laveesh Bhandari and Ankur Gupta discuss the status of the four major inputs fundamental to 

a good health profile in India: well-trained, adequate and well-motivated healthcare providers; a well spread and 

acces sible healthcare infrastructure; a good water supply and sanitation system which also facilitates hygienic prac-

tices; and a population that is well supplied nutritionally and practices a hygienic lifestyle. Bhandari and Gupta 

highlight a single key problem underlying all these inputs: the lack of a public health focus. Seeing the multiplicity of 

government units involved in the various aspects of health administration, they recommend a centralised authority 

that is able to synchronise and coordinate various policy measures in line with the received evidence on improving 

health outcomes.

Medical ethics encompasses a vast range of issues, and in Chapter 5 Sumita Kale and Laveesh Bhandari focus on 

one: the growing distrust in India of the medical profession. This, the chapter argues, has come about in response to 

the unethical commercial links between healthcare providers  and  drug/device  manufacturing  companies  and 

suppliers. They explain the market failure resulting from information asymmetry when healthcare providers, driven 

by commercial considerations, provide biased information to patients. Given that the vast majority of the patients are 

uneducated and uninformed, thus unable to understand the implications of the treatment or to seek redressal, the issue 

of conflict of interest becomes even greater in India. Kale and Bhandari call for stricter action from the government 

and regulatory agencies to safeguard patient interest and restore the moral character of what is expected to be a noble

profession.

In Chapter 6, Sakthivel Selvaraj and Veena Nabar take up  issues  involving  the  pharmaceutical  industry.  

They document the inequitable access to medicines across regions and income classes, and highlight the need for efficient procurement systems for public healthcare facilities. 

They examine all aspects of the industry, ranging from market structure, pricing policies, and the role played by patents in stifling competition, 

and go on to link the impact of regul ation on these crucial issues. They recommend a good quality and sturdy regulatory 

mechanism that can take and implement decisions aimed at ensuring low cost availability of medicines in a sustainable manner.

In Chapter 7, Devendra B Gupta and Laveesh Bhandari study the government’s two-pronged approach to ensuring 

better health outcomes for all: regulation and government programmes aimed at delivering better healthcare to all. 

They review the evolution of the government’s role over time, focusing on central government policies. They also 

examine the status of regulations and regulatory mechanisms in India today and call for a central entity that can 

provide the necessary leadership to create mechanisms that can adequately address issues of market failure in the health 

sector.

In Chapter 8, Ajay Mahal documents the inequity and inefficiency prevalent in healthcare financing. The chapter 

reviews the recent initiatives in health financing systems— various government schemes for financing public health 

expenditures  and  health  insurance  programmes  in  the private and public domain. More crucially, he provides an 

alternative methodology of conceptualising health financing policy, one that discards the current lacunae and flawed 

focus and works towards greater coverage rather than (cost) efficient access. This is critical to achieving a sustainable, 

equitable and efficient healthcare system in India. 

In the concluding chapter, Bibek Debroy and Ajay Mahal tie up all the threads and examine the evolution of 

health care reform in the country, through policy changes, programmes and legislation. They point to the need for a

change in approach at the institutional level, that healthcare must become a priority, and that the mindset in health policy 

must move on from targets of infrastructure provision to improvements in health per se.

At the most basic level, the Indian health sector is char acterised by the lack of access to good quality health-

care services for all, a result of a host of specific issues that  are  identified  in  the  body  of  this  report.  These 

specific constraints can all be traced to problems of poor planning, low resource allocation, missing institutions, and 

inadequate implementation. In an attempt to address these specific constraints, India Health Report  2010 identifies 

some of the changes required at the central, state and local government levels, in policy and regulation, in imple-

mentation and planning, and in education and advocacy. 

More importantly, it identifies the one factor that lies behind each of these bottlenecks: the lack of focus on 

health. Lack of focus shows up in many different ways— inadequate resource allocation, institutional and regulatory 

gaps, laxity in implementation of government programmes, etc. The one and the most important change that India 

needs is focused attention on the health sector. 

Greater focus is not only about greater resource allocation, though that is important; nor is it about devising 

large-scale government programmes for healthcare delivery, though they form an important component of India’s large 

portfolio of welfare programmes. Focus requires adequately empowering the institutions that govern India’s healthcare 

sector and making them answerable for health outcomes. For instance, the Ministry of Health and Family Welfare needs 

to be strengthened in terms of both scale and scope; it also needs to be made more answerable for India’s poor health 

outcomes, and a strong public health focus needs to be put in place either within the ministry or with a new entity so 

empowered.

The innumerable problems that impact health outcomes in India need to be seen foremost in the context of missing and/or weak institutional structure. 

It, therefore, becomes important to empower institutions that oversee India’s health sector and make them answerable.