Broken system

The growing spread of disease and the gaping inadequacies in public health care show that the government has to do a lot to achieve the goal of providing universal access to affordable and quality health care.

An Indian health employee checks on the condition of a child suffering from diarrhoea at the Community Health Centre in Dehgam town, some 40 kms from Ahmedabad, on May 15, 2013. Two people including a toddler have succumbed to a diarrhoea outbreak in the area, with another 65 people receiving treatment at the local hospital. AFP PHOTO / Sam PANTHAKY

THE dilapidated state of public sector health care in major States and the country's inability to wipe out various diseases, as demonstrated by latest data from the National Health Mission under the Ministry of Health and Family Welfare, are clear indicators that the government has a long way to go before it can achieve the goal of providing universal access to equitable, affordable and quality health care.The key components of public sector healthcare are the sub-centre, the primary health centre (PHC) and the community health centre (CHC). The sub-centre is the first point of contact for the community in accessing health care. Its primary focus was originally on reproductive and child health services, but services concerning the treatment of important non-communicable diseases have now been included in its remit.

The government's primary objective in the field of rural health was to establish one sub-centre for every 5,000 people in the plains and 3,000 in tribal and hilly areas, one PHC for every 30,000 people in plains and 20,000 in tribal and hilly areas, and one CHC for a population of one lakh. (This is subject to tweaks as the population density is not uniform across the country.)

Most States have an adequate number of doctors at primary health centres. Some major States figure among the worst performers, with Uttar Pradesh recording the highest shortfall, followed by Gujarat, Madhya Pradesh and Chhattisgarh.

Kerala and Goa have the best public sector health care infrastructure in the country, with sufficient centres and doctors. The southern States rank high in all indices.

In the area of disease prevention and treatment, much needs to be done. The number of suspected cases of dengue has remained high in the past five years and the number of deaths due to it above 100 every year. Japanese encephalitis has seen a worrying rise in incidence and fatalities over the past five years, while malarial and kala azar-related deaths and suspected cases of chikungunya have fallen. The number of new cases of leprosy detected has remained above one lakh in the past three years.