Primary Health Care in Developing Countries: The Indian Scenario - Essay Example

Primary Health Care in Developing Countries: The Indian Scenario 'Primary health care' is a term that is very often used by policy makers in today'sworld. However, assessing and improving the quality of health care was, until recently, a low priority, both for policy makers in developing countries, and for technical agencies. When we talk of primary health care, what is it that we actually mean Before we go into the details, there is a need to understand the wider significance of the term with the health sector. The paper has been divided into the following sections which would help us in understanding the topic better. 1. What is primary health care 2. The Indian scenario- demographic, social and political features of India 3. Epidemiological profile of India 4. The health scenario of India 5. Disease burden and 6. Relation between health and development WHAT DO WE MEAN BY PRIMARY HEALTH CARE Primary health care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford. It forms an integral part both of the country's health system of which it is the nucleus and of the overall social and economic development of the community (WHO). It values to achieve health for all and requires health systems that "Put people at the centre of health care"1. To achieve this, there is a need to understand citizen's expectation of health and health care and to see to it that their voice and choice decisively influences the way in which health services are designed and operated. The Alma Ata Declaration in 1978 gave an insight into the understanding of primary health care. It mobilized a "Primary Health Care movement" of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the "politically, socially and economically unacceptable"2 health inequalities in all countries. It viewed health as an integral part of the socio-economic development of a country. It provided the most holistic understanding to health and the framework that States needed to pursue to achieve the goals of development. The Declaration recommended that primary health care should include at least: education concerning prevailing health problems and methods of identifying, preventing and controlling them; promotion of food supply and proper nutrition, and adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; promotion of mental health and provision of essential drugs. It emphasized the need for strong first-level care with strong secondary- and tertiary-level care linked to it. It called for an integration of preventive, promotive, curative and rehabilitative health services that had to be made accessible and available to the people, and this was to be guided by the principles of universality, comprehensiveness and equity. In one sense, primary health care reasserted the role and responsibilities of the State, and recognized that health is influenced by a multitude of factors and not just the health services. It also recognized the need for a multi-sectoral approach to health and clearly stated that primary health care had to be linked to other sectors. At the same time, the Declaration emphasized on complete and organized community participation, and ultimate self-reliance with individuals, families and communities assuming more responsibility for their own health, facilitated by support from groups such as the local government, agencies, local leaders, voluntary groups, youth and women's groups, consumer groups, other non-governmental organizations, etc. The Declaration affirmed the need for a balanced distribution of available resources (WHO 1978). THE INDIAN SCENARIO Demographic, Social and Political features of India India is the seventh largest country by geographical area and the second most populous country of the world. It has an estimated population of 1.15 billion3, representing 17% of the world population4. Almost 70% of Indians reside in rural areas, although in recent decades migration to larger cities has led to a dramatic increase in the country's urban population. It has 28 states and seven Union territories with a parliamentary system of democracy. DEMOGRAPHIC PROFILE of India Total population (millions) (2005) 1134.4 Annual population growth rate (%) [2005-2015] 1.4 Urban population [% of total population] (2005) 28.7 Population under age 15 [% of the total population] (2005 33.0 Population aged 65 and older [% of the total] 2005 5.0 Human Development Index (HDI) Value 0.619 Life Expectancy at birth (2005) 63.7 Life Expectancy index 0.645 Adult Literacy [% aged 15 and above] (1995-2005) 61.0 GDP per Capita (Purchasing power parity US$) 2005 3452 per annum GDP index 0.591 Source: UNDP HDR 2007/2008 Fighting climate change: Human solidarity in a divided world. India is a home of diverse ethnic community. Four major world religions, Hinduism, Buddhism, Jainism and Sikhism originated there, while Zoroastrianism, Judaism, Christianity and Islam arrived in the first millennium CE and shaped the region's diverse culture. Every state and union territory has its own official languages, and the constitution also recognizes in particular 21 other languages that are either abundantly spoken or have classical status. The number of dialects in India is as high as 1,652.5 India's GDP is US$1.089 trillion, and has the world's twelfth largest economy at market exchange rates and the fourth largest in purchasing power. Economic reforms since 1991 have transformed it into one of the fastest growing economies. India's nominal per capita income US$977 is ranked 128th in the world. In the late 2000s, India's economic growth has averaged 7% a year, which will double the average income in a decade.6 EPIDEMIOLOGICAL PROFILE OF INDIA India has a human development index of 0.619 and is ranked 128th globally which means it has an index value with medium human development. Table 1 shows in detail the demographic and Epidemiological profile of India. EPIDEMIOLOGICAL PROFILE of India Commitment to health: resources, access and services Health expenditure MDG One-year olds fully immunized Children with diarrhea receiving oral re-hydration and continued feeding (% under age 5) 1998-2005b MDG Birthrate attained by skilled health personnel (%) 1997-2005b Physicians (per 100,000 people) 2000-2004b Public (% of GDP) 2004 Private (% of GDP) 2004 Per Capita (PPP US $) 2004 Against tuberculosis (%) 2005 Against measles (%) 2005 0.9 4.1 91 75 58 22 43 60 Note: b: Data refers to the most recent year available during the period specified. Source: UNDP HDR 2007/2008 Fighting climate change: Human solidarity in a divided world. Water, sanitation and nutritional status MDG population using improved sanitation (%) MDG population using improved water source (%) MDG Population undernourished (% of total population) MDG Children under weight for age (% of children under age 5) 1996-2005b Children under height for age (% of children under age 5) 1996-2005b Infants with low birth weight (%) 1998-2005b 1990 2004 1990 2004 1990/92a 2002/04a 14 33 70 86 25 20 47 51 30 Note: a: Data refers to the average for the years specified b: Data refers to the most recent year available during the period specified Source: UNDP HDR 2007/200 Fighting climate change: Human solidarity in a divided world. Inequalities in maternal and child health Survey Year Births attended by skilled health personnel (%) One-year olds fully immunizeda (%) Children under height for age (% under age 5) Infant mortality rateb (per 1000 live births) Under-five mortality rateb (per 1000 live births) Poorest 20% Richest 20% Poorest 20% Richest 20% Poorest 20% Richest 20% Poorest 20% Richest 20% Poorest 20% Richest 20% 1998-99 16 84 21 64 58 27 97 38 141 46 Note: a: Includes tuberculosis (BCG), measles, mumps and rubella (MMR) and diphtheria, pertussis and tetanus (DPT) vaccinations. b. Based on births in the 10 years preceding the survey. Source: UNDP HDR 2007/200 Fighting climate change: Human solidarity in a divided world. THE HEALTH SCENARIO OF INDIA The health of a nation is an essential component of development, vital to the nation's economic growth and internal stability. Being a welfare state, Government of India since independence, envisaged a national health system where in the State plays a leading role in determining priorities and financing and providing services to the population. Since then, India has built up a vast health infrastructure and health personnel at primary, secondary, and tertiary care in public, voluntary, and private sectors. For producing skilled human resources, a number of medical and paramedical institutions including Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) institutions have been set up. 7 DISEASE BURDEN India is in the midst of an epidemiological and demographic transition with increasing burden of chronic diseases, decline in mortality and fertility rates, and ageing of the population. An estimated 2-3.1 million people in the country are living with HIV/ AIDS, a communicable disease, with a potential to undermine the health and developmental gains India has made since Independence. Non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), cancer, blindness, mental illness, etc., have imposed the chronic disease burden on the already over-stretched health care system of the country. Disease Burden Estimation, 2005 Disease/ Health Condition Estimate of Cases/lakh Projected number (2015) of Cases/lakh Communicable Diseases Tuberculosis 85 (2000) NA HIV/AIDS 51 (2004) 190 Diarrhoeal Diseases Episodes per Year 760 880 Malaria and other Vector Borne Diseases 20.37 (2004) NA Leprosy 3.67 (2004) Expect to be Eliminated Otitis Media 3.57 4.18 Non-Communicable Conditions Cancers 8.07 (2004) 9.99 Diabetes 310 460 Mental Health 650 800 Blindness 141.07 129.96 CVDs 290 (2000) 640 COPD and Asthma 405.20 (2001) 596.36 Other Non-Communicable Injuries-deaths 9.8 10.96 Number of Hospitalizations 170 220 Source: NCMH (2005). Communicable Disease The gap between females and males is narrowing as far as number of cases and infections are concerned with AIDS. The youth are becoming increasingly vulnerable. The prevalence rate of more than 1% amongst pregnant women was reported from five States, that is, Andhra Pradesh, Maharashtra, Karnataka, Manipur, and Nagaland. GoI responded to HIV/AIDS threat by preventive awareness, targeted interventions, and care and support programmes. As on 31 December 2006, a total of 162257 cases of AIDS were reported. Tuberculosis (TB) remains a public health problem, with India accounting for one-fifth of the world incidence. Every year 1.8 million people in India develop tuberculosis, of which 0.8 million are infectious smear positive cases. The emergence of HIV-TB co-infection and multi drug resistant tuberculosis has increased the severity and magnitude of the problem. Revised National TB Control Programme (RNTCP) has achieved nationwide coverage in March 2006. A National Vector Borne Disease Control Programme was initiated during the Tenth Plan with the convergence of ongoing programmes on malaria, kala-azar, filariasis, Japanese encephalitis, and dengue. Malaria cases in India declined from 3.04 in 1996 to 1.82 million cases in the year 2005. The number of Plasmodium falciparum (Pf) cases has also been decreasing More than 80% of malaria cases and deaths are reported from NE States, Chhattisgarh, Jharkhand, MP, Orissa, Andhra Pradesh, Maharashtra, Gujarat, Rajasthan, WB, and Karnataka. The goal of leprosy elimination at national level ( Read More