INDIAN HEALTH SYSTEM-

AN OVERVIEW

I. Medicine in Antiquity

Health and illness were interpreted in a cosmological and

anthropological perspective.

Medicine was dominated by magical and religious beliefs which

were an integral part of ancient cultures and civilizations.

Since there is an organic relationship between medicine and

human advancement, any account of medicine at a given period

should be viewed against the civilization human advancement at

that time.

A. Primitive Medicine

Salient Features:

Medicine was conceived in sympathy and born out of necessity

Since man‘s knowledge was limited, the primitive man attributed

disease, all human sufferings and calamities to wrath of gods, invasion of

body by evil spirits and malevolent influence of stars and planets

The concept of disease is known as ―supernatural theory of disease‖

They used to perform surgeries like circumcision, amputations and

trephining of skulls with improvised stone and flint instruments

In 5000 BC, the medicine was intermingled with

superstition, religion, magic and witchcraft.

B. Indian Medicine

Siddha and Ayurveda medical systems are truly Indian in origin.

Ayurveda is practiced in all parts of India, but Siddha is practiced only in

Tamil Nadu

Ayurveda by definition implies the ―knowledge of life‖ or the

knowledge by which life may be prolonged. Its origin is traced back to

the Vedic times, about 5000 B C.

Hygiene was given an important place in ancient Indian Medicine.

Medical Historians admit that Indian medicine has played in Asia the

same role as the Greek Medicine in West for it has spread in

Indochina, Indonesia, Tibet, Central Asia, and Japan, exactly as the

Greek Medicine has done in Europe and Arab Countries.

The other systems of medicine that are not of Indian origin are Unani-

Tibb and Homeopathy.

All these systems of medicine are very much alive today in India

and have become part of Indian culture. They also continue to an

important source of medical relief to the rural population.

C. Medicine practiced in other countries

Chinese Medicine – world‘s first organized body of medical knowledge

dating back to 2700 B .C

Egyptian Medicine – one of the oldest civilizations in about 2000 B. C

where art of medicine was mingled with religion.

Mesopotamian Medicine – ―Cradle of Civilization‖ 6000 years ago.

Greek Medicine – 460 – 136 B. C; the Greeks enjoyed the reputation –

the civilizers of the ancient world, taught people to think in terms of

why and how

Roman Medicine – First Century B.C; While the politics of the world

became Roman, medicine remained Greek.

Middle Ages – Period between 500 and 1500 A.D – establishment of

hospitals, religious institutions, schools of medicine etc.

II. Dawn of Scientific Medicine

The period following 1500 A.D was marked by political, industrial,

religious and medical revolutions.

Revival of Medicine – 1453 – 1600 A D – an age of individual scientific

endeavor; Paracelsus helped turn medicine towards rational research;

Fracastorius, an Italian physician enunciated the ―theory of contagion‖;

Ambriose Pare advanced the art of surgery.

17th and 18th Centuries – Harvey‘s discovery of the circulation of blood,

Leeuwenhoek‘s microscope, Jenner‘s vaccination against small pox etc

Sanitary Awakening in England in mid nineteenth century

Rise of Public Health in England around 1840.

Germ Theory of Disease – Louis Pasteur in 1860 demonstrated the

presence of bacteria in air. In 1877, Robert Koch showed that Anthrax is

caused by bacteria. Gonoccus was discovered in 1847, typhoid bacillus in

in 1880, cholera vibrio in 1883

III. Modern Medicine

The dichotomy of Medicine divided into preventive and curative

medicine was quite evident in 19th Century.

After 1900, medicine moved towards specialization. Multi-factorial

causation of disease was put forward by Pettenkoefer.

Development of anti-viral vaccines like for Polio, Small Pox

Discovery of synthetic insecticides such as DDT, HCH, malathion etc

Discovery of drugs, chemoprophylaxis

Concept of disease eradication

Development of screening for the diagnosis of disease in its pre-

symptomatic stage in 20th century

Development of Family, Social and Community Medicine

Healthcare revolution in terms of

• Health for all by 2000

• Concept of Primary Healthcare

• Millennium Development Goals in 2000

• National Health Policy 2003

5,000 year old ancient civilization

325 languages spoken – 1,652 dialects

18 official languages

29 states, 5 union territories

3.28 million sq. kilometers - Area

7,516 kilometers - Coastline

1.1 Billion population.

5600 dailies, 15000 weeklies and 20000 periodicals in

21 languages with a combined circulation of 142

million.

GDP $576 Billion. (GDP rate 8%)

Parliamentary form of Government

World’s largest democracy.

World’s 4th largest economy.

World-class recognition in IT, bio-technology and

space.

Largest English speaking nation in the world.

3rd largest standing army force, over 1.5Million

strong.

2nd largest pool of scientists and engineers in the

World.

5,000 year old ancient civilization

325 languages spoken – 1,652 dialects

18 official languages

29 states, 5 union territories

3.28 million sq. kilometers - Area

7,516 kilometers - Coastline

1.1 Billion population.

5600 dailies, 15000 weeklies and 20000 periodicals

in 21 languages with a combined circulation of 142

million.

GDP $576 Billion. (GDP rate 8%)

Parliamentary form of Government

World‘s largest democracy.

World‘s 4th largest economy.

World-class recognition in IT, bio-technology and

space.

Largest English speaking nation in the world.

3rd largest standing army force, over 1.5Million

strong.

2nd largest pool of scientists and engineers in the

World.

Health sector in India is the responsibility of the state, local

and also the central government.

But in terms of service delivery it is more concerned with the

state.

The center is responsible for health services in union

territories without a legislature and is also responsible for

developing and monitoring national standards and

regulations, linking the states with funding agencies, and

sponsoring numerous schemes for implementation by state

governments.

Both the center and the state have a joint responsibility for

programs listed under the concurrent list.

MILESTONES IN INDEPENDENT INDIA

PRIMARY HEALTH CENTERS 1952

FAMILY PLANNING 1952

GREEN REVOLUTION 1967 - 1977

NATIONAL HEALTH PROGRAMS – From 1957

NATIONAL HEALTH POLICY – 1982 & 2002

NRHM 2005

PHFI -2008

Healthcare has emerged as

one of the largest service

sectors in India. Rather

dynamic, it is constantly

developing building further

on the areas it is most

competent at.

Further there are many

factors that differentiate

it from its foreign

counterparts along with

making it thriving in itself

Particulars 2005 2006 2007 2008 2009

Life expectancy 64.3 64.7 65.1 65.4 65.8

Healthcare spendingUS$ bn

40.4 45.7 52.1 56 60.9

Healthcare spending (%

of GDP)

5.3 5.3 5.4 5.4 5.5

Healthcare spendingUS$ per head

37 41 46 49 53

In 2004, national healthcare

spending equaled about 5.2

per cent of nominal GDP, or

about US$ 34.9 billion.

Healthcare spending in India

is expected to rise by 12 per

cent per annum through

2005-09 (in rupee terms) and

scale up to about 5.5 per

cent of GDP, or US$ 60.9

billion, by 2009

Total expenditure on health 5.2% of GDP

Public health investment 0.9% of GDP

Budget allocation for health 1.3% of central budget

Govt expenditure 25%

Out of pocket expenditure 75%

(www.searo.who.int/EN/Section313/Section1519_10852.htm )

Central contribution to state 15%

State budgetary allocations reduced from 7% to 5.5%

India's health budget has gone up by nearly Rs.4000 crore to Rs.21113.33 crore ($4.35 billion)

(www.thaindian.com/newsportal/.../public-health-infrastructure )

India’s medical infrastructure at a glance

◦ 5,097 hospitals

◦ 8,70,161 hospital beds

◦ 5,03,900 doctors

◦ 7,37,000 nurses

◦ 162 medical colleges

Per Lakh

Population

Beds Hospitals Dispensaries

Urban 178.78 3.6 3.6

Rural 9.85 0.36 1.39

Source: Review of Health Care in India, 2005

S No Indicator Numbers

1 Total Population (2007) 1169 million

2 Crude Birth Rate (2007) 23

3 Crude Death Rate (2006) 7.5

4 Annual Growth Rate % (2007) 1.8

5 Population Doubling time (at current growth rate) 30 years

6 Population rural % (2007) 71

7 Adult Literacy Rate% (2007) 66

8 Density of Population per sq. km (2001) 325

9 Sex Ratio female per 1000 male (2004 -2006) 892

10 Population below 15 years % (2006) 33.1

11 Population above 60 years % (2006) 7.3

12 Average Family Size (2007) 2.8

13 Age at marriage, female (2003) 20.1 years

14 Annual per capita GNP Rs. 33,131

India Demographic Profile

Monitorable, time bound goals for the

Eleventh Five Year Plan (2007 – 2012)

Reducing Maternal Mortality Ration (MMR) to 1 per 1000 live births

Reducing Infant Mortality Rate (IMR) to 28 per 1000 live births

Reducing total fertility rate (TFR) to 2.1

Providing clean drinking water for All by 20009 and ensuring no slip

backs

Reducing malnutrition among children of age group 0-3 to half its

present level

Reducing anemia among women and girls by 50%

Raising the sex ratio for age group 0-6 to 935 by 2011-2012 and 8950

by 2016 - 17

Healthcare Delivery in India

1. PUBLIC HEALTH SECTOR

a) Primary Health Care

– Primary Health Centres

– Sub-centres

b) Hospitals / Health centres

– Community Health Centres

– Rural Hospital

– District Hospitals/health centres

– Specialist Hospitals

– Teaching Hospitals

c) Health Insurance Schemes

– Employee State Insurance Scheme

– Central Govt. Health Scheme

d) Other Agencies

– Defence

– Railways

2. PRIVATE SECTOR

a) Private Hospitals, polyclinics, nursing homes, and

dispensaries

b) General Practitioners and clinics

3. INDIGENOUS SYSTEMS OF MEDICINE

a) Ayurveda and Siddha

b) Unani

c) Homeopath

d) Un-registered practitioners

4. VOLUNTARY HEALTH AGENCIES

5. NATIONAL HEALTH PROGRAMMES

Healthcare Delivery in India Contd…..

Public and Private sectors The majority of healthcare

services in India are provided by

the private sector.

At present, India‘s healthcare

burden has gone beyond the

Government‘s budgetary

applications.

The increased spending power

middle class is driving growth

opportunities for corporate

healthcare providers. Factors

like privatization of medical

insurance are making the market

more attractive for international

and national corporate players.

The Government has taken an

initiative to institutionalize a

mechanism of public-private

partnerships (PPP) in

healthcare, right up from the

district level.

0%

20%

40%

60%

80%

Public Health Infrastructure

1950-2000 rural health facilities up from 725 to 163,000

Yet shortfall by 16% in PHCs and 58% in CHCs

PHI not satisfying as service delivery hampered by policy andmanagement concerns

Non availability of staff

Weak referral system

Recurring funding shortfalls

Lack of accountability for quality of care

Problems

Very low use of massive PH infrastructure

Poor availability and access

Unsatisfactory work of the PHI

So poor seeking private health care

Only 20% of OPD and 45% of inpatient care obtained from govt healthinfrastructure while the rest is from the private sector

((www.searo.who.int/EN/Section313/Section1519_10852.htm )

GOI has resolved to launch the National Rural Health Mission

(NRHM) to carry out necessary architectural correction in

the basic health care delivery system in 2005.

The Mission adopts a synergistic approach by relating health

to determinants of good health viz. segments of

nutrition, sanitation, hygiene and safe drinking water.

It also aims at mainstreaming the Indian systems of

medicine to facilitate health care.

Encouraging Trends in Public Health

NRHM

NRHM PLAN OF ACTION

increasing public expenditure on health, reducing regional

imbalance in health infrastructure

pooling resources

integration of organizational structures, optimization of health

manpower

decentralization and district management of health programmes

Community participation and ownership of assets

Induction of management and financial personnel into district

health system

Operationalizing community health centers into functional hospitals

Meeting Indian public health standards in each block of the country

Source: http://www.mohfw.nic.in/NRHM.htm

PUBLIC Health foundation of india

The Public Health Foundation of India (PHFI) is a response to

redress the limited institutional capacity in India for

strengthening training, research and policy development in the

area of Public Health.

It is a public private partnership that was collaboratively evolved

through consultations with multiple constituencies

*Source: www.phfi.org

PHFI - Structure and objectives

Structured as an independent foundation, PHFI adopts a

broad, integrative approach to public health, tailoring its

endeavors to Indian conditions and bearing relevance to

countries facing similar challenges and concerns.

The PHFI focuses on broad dimensions of public health that

encompass promotive, preventive and therapeutic

services, many of which are frequently lost sight of in policy

planning as well as in popular understanding.

*Source: www.phfi.org

Private Healthcare

More preference

Inpatient care more in govt sector since low cost rather thanquality

Emphasis on secondary and tertiary care

Not mandatory to register so no clear picture

Unregulated, with serious complaints of poor quality, overcharging, and unethical behavior.

Accounts for

• 1. 67% of total 30,000 hospitals

• 2. 33% of 1,000,000 beds

• 3. 60% of 5 million doctors

Large Demand Supply Gap

100 beds per 100,000 population (WHO norms 300 beds)

No of doctors per 1000 low as per WHO norms

Investment range to bridge gap in next 10 yrs from 100,000 to

140,000 crores

Can create huge income and employment growth in next 10 years

Govt should encourage private, social and community insurance

Existing financing and payment system not suitable for countering

market failures

Affordability

Low use of PHI so high out of pocket expenses

Health insurance

Regional licensing of HI business and HI schemes as Yeshaswini etc

Cost benefit analysis of ESI

Cost of care can be contained

Improvement in public sector service levels

Referral systems enforcement

Controlling infectious diseases

Ensure availability of proper and adequate health services for

any insurance scheme to succeed

In 2003, fee-charging private companies accounted for 82%

of India‘s $30.5 billion expenditure on healthcare.

Private firms are now thought to provide about 60% of all

outpatient care in India and as much as 40% of all in-patient

care.

It is estimated that nearly 70% of all hospitals and 40% of

hospital beds in the country are in the private sector.

Achievements during the plan periods

S No Parameter 1st Plan (1951 - 56) 10th Plan (2002 - 2007)

1 Primary Health Centre 725 22,370.00

2 Sub centres NA 145,272.00

3 Commmunity Health Centres 0 4,045.00

4 Total Beds (2002) 125000 914,543.00

5 Medical Colleges 42 270.00

6 Dental Colleges 7 205.00

7 Allopathic Doctors 65000 767,500.00

8 Nurses 18500 928,149.00

9 ANMs 12780 526,242.00

10 Health Visitors 578 50,393.00

11 Health Workers (F) 0 147,439.00

12 Health Workers (M) 0 62,881.00

13 Village Health Guides (2002) 0 323,000.00

14 Block Extension Educators 0 4,068.00

Indicator 1951 1981 2000

Demographic Changes

Life Expectancy 36.7 54 64.6(RGI)

Crude Birth Rate 40.8 33.9(SRS) 26.1(99 SRS)

Crude Death Rate 25 12.5(SRS) 8.7(99 SRS)

IMR 146 110 70 (99 SRS)

Achievements Through The Years - 1951-2000

Source: National Health Policy 2002

Epidemiological Shifts 1951 1981 2000

Malaria (cases in million) 75 2.7 2.2

Leprosy cases per 10,000 population 38.1 57.3 3.74

Small Pox (no of cases) >44,887 Eradicated

Guineaworm ( no. of cases) >39,792 Eradicated

Polio 29709 265

Infrastructure

SC/PHC/CHC 725 57,363 1,63,181

(99-RHS)

Dispensaries &Hospitals( all) 9209 23,555 43,322 (95–96-CBHI)

Beds (Pvt & Public) 117,198 569,495 8,70,161

(95-96-CBHI)

Doctors(Allopathy) 61,800 2,68,700 5,03,900

(98-99-MCI)

Nursing Personnel 18,054 1,43,887 7,37,000

(99-INC)

Achievements Through The Years - 1951-2000

Source: National Health Policy 2002

SectorPopulation

BPL (%)

IMR/

Per 1000

Live Births

(1999-SRS)

<5Mort-

ality

per 1000

(NFHS II)

Weight For

Age-

% of

Children

Under 3

years

(<-2SD)

MMR/

Lakh

(Annual

Report

2000)

Leprosy

cases per

10000

popula-

tion

Malaria +ve

Cases in

year 2000

(in

thousands)

India 26.1 70 94.9 47 408 3.7 2200

Rural 27.09 75 103.7 49.6 - - -

Urban 23.62 44 63.1 38.4 - - -

Better

Performing

States

Kerala 12.72 14 18.8 27 87 0.9 5.1

Maharashtra 25.02 48 58.1 50 135 3.1 138

TN 21.12 52 63.3 37 79 4.1 56

Low

Performing

States

Orissa 47.15 97 104.4 54 498 7.05 483

Bihar 42.60 63 105.1 54 707 11.83 132

Rajasthan 15.28 81 114.9 51 607 0.8 53

UP 31.15 84 122.5 52 707 4.3 99

MP 37.43 90 137.6 55 498 3.83 528

Differentials in Health Status Among States

Sourc

e:

Nati

onal

Healt

h P

oli

cy 2

002

National Health policy – 2002

Goals to be achieved by 2015 Eradicate polio and Yaws 2005

Eliminate Leprosy 2005

Eliminate Kala azar 2010

Eliminate Lymphatic Filariasis 2015

Achieve zero level growth of HIV/AIDS 2007

Reduce mortality by 50% on account of TB, Malaria and 2010

other vector and water borne diseases

Reduce prevalence of blindness to 0.5% 2010

Reduce IMR to 30/100 and MMR to 100/Lakh 2010

Increase utilization of public health facilities from 2010

current level of <20% to >75%

Establish an integrated system of surveillance, National 2005

Health Accounts and Health Statistics

Increase Health expenditure by Government as a %of GDP 2010

from the existing 0.9 to 2.0%

Increase share of the central grants to constitute at least 2010

25% of total health sharing

Increase state sector health spending from 5.5% to 7% of budget 2005

Further Increase to 8% of the budget 2010

Source: National Health Policy 2002

Indicator Infant

Mortality/1000

Under 5

Mortality/1000

% Children

Underweight

India 70 94.9 47

Social Inequity

Scheduled Castes 83 119.3 53.5

Scheduled Tribes 84.2 126.6 55.9

Other Disadvantaged 76 103.1 47.3

Others 61.8 82.6 41.1

Differentials in Health status Among Socio-Economic

Groups

Source: National Health Policy 2002

Tenth Plan

(2002-2007)National Population

Policy 2000 (2010)

1 Crude Birth Rate 23.0 (2007) 21

2 Total Fertility Rate 2.8 (2007) 2.3 2.1

3 Couple Protection Rate 56 (2000-07) 65 Meet all needs

4 IMR 57 (2007) 45 <30

5 Neonatal Mortality 37 (2006) 35

6 Maternal Mortality 301 (2003) 2 1

7 Under 5- Mortality 72 (2007)

IndicatorS No Current level

Goals and Target Period

Indicators

Indicator

%Population with

income of <$1

day

Infant Mortality

Rate/1000

%Health

Expenditure to

GDP

%Public

Expenditure on

Health to Total

Health

Expenditure

India 44.2 70 5.2 17.3

China 18.5 31 2.7 24.9

Sri Lanka 6.6 16 3 45.4

UK - 6 5.8 96.9

USA - 7 13.7 44.1

Public Health Spending in select Countries

India Current Scenario: Health

Resurgence of Communicable Diseases

Declining Public Investments and Expenditures in Health and Healthcare

Breakdown of the Public Health System

Access to Basic Healthcare Declining

Absence of Regulation and Control, and Quality Standards in Private Healthcare

Corporatisation and Rising Costs of Healthcare and Changed Character of the Economy

Growing incomes and literacy bode well for the

Indian healthcare services market

Much of India‘s healthcare expenditure comes from private

patients‘ pockets, primarily the higher-income households.

A survey by NCAER, an independent economics research

agency, suggests that per-capita expenditures on healthcare

rise with higher education levels. Households that have

higher education levels tend to spend more per illness than

households with lower education levels.

Rising literacy in India is improving health awareness

India’s low cost of medical care, a strong value

proposition

India offers highly cost-competitive medical treatment and

technological advances in many areas.

With diagnostic tests in India being inexpensive, India also

has the potential to emerge as a hub for preventive health

screening.

Not only are skilled Indian surgeons available for less, they

are also less susceptible to costly litigation. This brings

down the overall cost of treatment.

India’s value proposition goes far beyond cost;

quality second to none

Apart from being in step with changing healthcare delivery

technology, leading Indian medical care facilities are

increasingly complying with stringent quality standards and

queuing up for international accreditations( such as from

the Chicago-based Joint Commission of Accreditation of

Hospital Organizations (JCAHO) )

With an increasing number of Indian hospitals offering

services at the cutting edge, there is a growing acceptance

of India-based medical care among global insurers.

The medical devices market in India is highly promising. The

market size for medical devices in India is expected to touch

US$ 1.7 billion by 2010, against US$ 1.2 billion presently.

Presently, nearly 90 per cent of the demand is being met by

imports since domestic production comprises primarily of

low-tech devices.

Pathology Services:

The US$ 500 million domestic pathology industry has been

growing over the last five years at an estimated

Compound Annual Growth Rate (CAGR) of 20 per cent per

annum. It currently comprises almost 2.5 per cent of the

overall healthcare delivery market. The major players are

Dr. Lal‘s Pathlabs, Metropolis, SRL Ranbaxy, Thyrocare,

and Nicholas Piramal.

Medical Tourism

An important contributor to the GDP from the Indian Healthcare

Sector is the Medical Tourism subdivision. Approximately 1,80,000

patients arrived in 2004 from across the globe for medical

treatment. India is seeing a surge of patients from developed

countries as well as from countries in Africa and South and West

Asia that lack adequate healthcare infrastructure.

Apart from state of the art facilities, India provides low-cost

treatments which is what makes it so attractive to foreign

customers.

According to a joint study by the Confederation of Indian Industry

and McKinsey, Indian medical tourism was estimated at $350

million in 2006 and has the potential to grow into a $2 billion

industry by 2012.4.

To encourage the growth of medical tourism, the government also

is providing a variety of incentives, including lower import duties

and higher depreciation rates on medical equipment, as well as

expedited visas for overseas patients seeking medical care in India.

In addition to receiving traditional medical treatments, a growing

number of western tourists are traveling to India to pursue alternate

medicines such as ayurveda, which has blossomed in the state of

Kerala, in southwestern India. The number of medical tourists visiting

Kerala was close to 15,000 in 2006 and is expected to reach 100,000 by

2010.

India has the potential to attract one million medical tourists each

year, which could contribute $5 billion to the economy, according to the

Confederation of Indian Industries

Health insurance:

India offers tremendous opportunity for private medical

insurance players. Increasing awareness levels and large-

scale group insurance policies have pushed growth in the

health insurance segment in recent years.

Due to liberalization and a growing middle class with

increased spending power, there has been an increase in the

number of insurance policies 2001-02, 7.5 million policies

were sold. By 2003-4, the number of policies issued had

increased by 37%, to 10.3 million policies issued in the

country.

In the wake of liberalization, health insurance is projected

to grow to $5.75 billion by 2010, according to a study by the

New Delhi-based PHD Chamber of Commerce and Industry

In order to spur the private health insurance sector, the

Insurance Regulatory & Development Authority (IRDA) has

increased the FDI limit from 26 per cent to 51 per cent.

Health insurance premium touched US$ 533.3 million by the

end of 2005-06

Healthcare BPO:

India is capable of offering a wide spectrum of outsourced

Healthcare services. Outsourcing of pathology and laboratory tests

by foreign hospital chains is becoming is a huge opportunity

because of the high cost differential in India.

Types of services:

• Data capture

• Documentation

• Commercial

• Administration

• Human resources

• Customer care

Telemedicine:

Only 25% of India‘s specialist physicians reside in semi-urban

areas, and a mere 3 % live in rural areas. As a result, rural

areas, with a population approaching 700 million, continue

to be deprived of proper healthcare facilities

One solution is telemedicine—the remote diagnosis, monitoring

and treatment of patients via videoconferencing or the Internet.

Telemedicine is a fast-emerging trend in India, supported by

exponential growth in the country‘s information and

communications technology (ICT) sector, and plummeting

telecom costs.

Several major private hospitals have adopted telemedicine

services, and a number of hospitals have developed public-

private partnerships (PPPs), among them Apollo, AIIMS, Narayana

Hrudayalaya, Aravind Hospitals and Sankara Nethralaya.

Growth incentives…

Policy initiatives

National Accreditation Board of Hospitals and Healthcare

Providers (NABH)- committee to make provisions for

access, assessment, care of patients and protect patient‘s

rights.

Clinical Establishment Act, 2006: Low cost and Good

quality healthcare.

Policy decision on easy provision of ‗medical visas‘.

National Rural Health Mission

Increased foreign investments in various Healthcare

segments such as Insurance.

Development of competent technology.

Well trained personnel.

Conclusion:

The Indian healthcare sector can be viewed as a glass half

empty or a glass half full. The challenges the sector faces are

substantial, from the need to improve physical infrastructure

to the necessity of providing health insurance and ensuring

the availability of trained medical personnel. But the

opportunities are equally compelling, from developing new

infrastructure and providing medical equipment to delivering

telemedicine solutions and conducting cost-effective clinical

trials. For companies that view the Indian healthcare sector

as a glass half full, the potential is enormous.

The Indian health care sector is predicted to touch $14.2

billion by 2012 due to rising income levels, high

populations, and change in the illness pattern in the country

The value of domestic health care will rise up to four times by

2017.

Private and public spending in Indian health sector would touch

$14.2 billion in 2013, at an annual growth rate of 5.8 percent

from 2009