Paper for International Conference at Chennai

8/3/2019 Paper for International Conference at Chennai

1/17

Prof. Bhagabata Patro Department of Economics,Professor and Chairman, Board of Berhampur University,

Studies in Economics. Bhanja Bihar,Berhampur-760007

Orissa, India.

To 16.10.2011

Dr. S.Thirunavukkarasu

HOD, Economics, R.K.M.Vivekananda College

Chennai-4.

Sub: Submission of paper for the proposed International Seminar.

Dear Sir,

Please refer to our telephonic discussion on participating in the proposed

international seminar. Yesterday, I have sent a copy of the paper which could not be

completed due to problem in the computer. I am now sending the paper for necessary

publication in the book to be brought out on this occasion. The hardcopy of the paper

,registration form alongwith the bankdraft will be sent after my return to Berhampur on

20th

. Please make arrangement for accommodation as discussed. Rest when we will meet

at Chennai. Please confirm receipt of the paper within a day or two or over telephone, so

that I will book ticket .

With thanks.

Yours Sincerely,

Encl: Copy of the paper ( Bhagabata Patro)

-----------------------------------------------------------------------------------------------------------

-

Res: Plot No-15/182, Guru Dronacharya Nagar, Basanta Bihar, Ambapua, Berhampur

-760010 Tel-06802227260; Res: 06802404365; Mob-09861676133; Fax: 0680-

2343633. E-mail: [email protected]


2/17

Challenges to Health Infrastructure Development in the

Twelfth Five year Plan of India-An Inter State Analysis

Prof. Bhagabata Patro

Department of Economics , Berhampur University.

Paper to be presented in the International Conference onDevelopment Perspectives in the Post Reform

Period:Challenges and Strategies." to be held at R.K.Mission

Vivekananda College, Chennai on 29th October ,2011


3/17

Challenges to Health Infrastructure Development in the

Twelfth Five year Plan of India -An Interstate Analysis

Introduction

For growth to be sustained in the long run, the approach should be broad-based

across sectors and sections of the people. Latest emphasis on inclusive growth focuses oneconomic growth which is a necessary and crucial condition for poverty reduction. It

adopts a long term perspective towards sustained growth. Issues of structural

transformation therefore play a vital role. Any observer of the Indian economy today is

struck by three puzzling observations.(World Bank, 2006) . These are;

Economic optimism and changes in fundamentals. Indias economic progress hasbeen significant over the years at around 8 percent in the recent years, but at the

same time, by many individual measures of infrastructure capacity, corruption,education, and regulatory environment, India remains a difficult economic

environment.

Deteriorating performance of the public sector Indias sterling economicperformance has been accompanied by a situation of growing concern that the

basic institutions, organizations, and structures for public sector action are failing

especially for those at the bottom.

The contrasting situation of bad and good in plenty. Wide gap exists In Indiabetween the performance of the top and the bottom. Chronic Poverty and extreme

affluence is visible side by side in the education, health and other sectors of theeconomy. Rural India have poverty rates comparable to borderline failed states,such as Haiti and Nigeria, and have child malnutrition rates higher than any other

country in the world.

Amartya Sen, the Nobel laureate emphasized that development is much more thanincreasing material well-being of a person. It includes expansions in capabilities and

both positive and negative freedoms. Development progress is not simply to be measured

as rise in aggregate of economic activity but as an assessment of the inclusiveness ofeconomic growth, with emphasis on the right distribution of gains. An individual must be

confident of full participation and enjoy the social civic life. There are heated ideological

debates about the proper role of government in some economic spheres, but there is near

universal agreement that the government(at all levels) has a responsibility to its citizensin certain core areas like elementary education, health, rural drinking water, rural

sanitation, child nutrition, housing for the poor, employment guarantee and watershed

management.(Planning Commission ,2008). The eleventh plan declared in its vision thatwith regard to indicators of human development such as literacy and maternal and infant

mortality the improvement is slow and we lag behind several other Asian countries.

(Eleventh Plan, 2007-12). The inequality in the access to these public services has notreduced over the years. Rather than stimulating broad economic and social progress,


4/17

public policy has simply reproduces the prevailing pattern of inequality. (World

Development Report, 2006). Debates may continue over whether this responsibility is

best discharged using direct production of services by the state or by other modes andhow services in these core areas are to be financed. But there is a growing sense among

politicians, civil servants, and academics that the ability of Indias existing institutions to

deliver on those responsibilities is deterioratingeven as the economy booms. In the faceof these problems, a striking feature of the recent Indian experience is a trend of shifting

from public to private provision of many core services. The process of outsourcing few of

the core services to the private sector in a haphazard manner greatly diluted the quality ofthese services and lack of accountability for it. The worst of all is the way it is available

for a selected group of elites neglecting the requirement of masses.

Status of health has significant influence on the development of an economy. It is

directly linked to the productivity of human resources. In the Indian context with around80 percent of the population living in rural areas, the quality of the rural manpower

greatly determines their earning capacity and the level of economic activity in the rural

economy. Poverty in India is mostly a rural phenomenon due to this. Low economic

activity leads to low income and thus low nutritional intake. It acts like a vicious circlefrom which it is difficult to escape. Sustainable high growth of the economy is possible

only when this issue is tackled at the national level. With this background this paperintends to examine i) how there exists a disparity in the interstate availability of health

infrastructure and ii) as to how this influences the per capita income of these states. The

assumption in the second case is that quality health will raise the productivity of all

sectors of the economy.

Health Sector in India: An International Comparison

In the division of functions among the units of governments, the Indian

constitution has placed health in the domain of the state list. But due to paucity ofresources with the states, it is not possible to bring any significant change in healthservice delivery without central support. Central intervention in the health sector appears

to be marginal over the years as is evident from the place of the social sector (which is

placed in the last ) in the Economic Survey document of the central government. TheNRHM is the latest flagship programme of the central government in the health sector to

improve the basic health indicators. It has a focus on child and maternal health care. The

earlier efforts of the centre is mostly related to family welfare and specific disease control

programmes. A comparison of basic health indicators among selected countries revealsthe highly deplorable health situation of the country. Table-I below gives the picture with

regard to few key variables.

Table -1: Selected Health Indicators of Selected Countries in the World

Indicators India USA China Global

Infant Mortality Rate

(under five )2001

93 11 12 81

Maternal Mortality rate

(per 1,00,000 live

440 12 60 NA


5/17

birth)1995

Birth attended by skilledhealth staff( % of total )

2000

42 99 70 Na

Per capita health

Expenditure (in dollars)(1997-2000

23 4499 45 482

Source : World Development Report ,2004.

The situation with regard to health workforce and infrastructure is given in table 2 below

Table-2: A Comparative Picture of Health Workforce and Infrastructure In

Selected Countries . (2000-10)

Items/ Country India USA China GlobalNumb

er (in

000s)

Density

per

10,000people

Numb

er

(in000s)

Density

per

10,000people

Number

(in

000s)

Density

per

10,000people

Number

(in 000s)

Dens

per

10,00peop

Physician 660 6 794 26.7 1905 14.2 9172 14Nursing and

Midwife Personnel

1430 13 2927 98.2 1855 13.8 19380 29.7

Dentistry Personnel 78 7 464 16.3 51 0.4 1933 3.0Pharmaceutical

Personnel

578 5.2 250 8.8 342 2.5 2587 4.1

Community HealthWorkers 51 0.5 1113 8.3 1370 4.0

Hospital Beds per

10000 population

9 31 41 29

Radio Therapy Units

per 1000000population

0.4 11.8 1.1 1.8

Source: World Health Statistics, 2011.

Strategy of the Eleventh Plan:

The eleventh plan has not made any major departure from the earlier plans withregard to health sector priority. As usual it declared, We need to transform public

healthcare into an accountable, accessible and affordable system of quality service. The

plan thought of a comprehensive approach covering individual healthcare, public health,

sanitation, clean drinking water, access to food and knowledge of hygiene and feedingprocess. The time bound goals identified are;

Reducing MMR to 1 per 1000 live birth


6/17

Reducing IMR to 28 per 1000 live birth

Reducing TFR to 2.1

Providing clean drinking water to all villages by 2009.

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

level

Raising the sex ratio for age group 0-6 to 935 for 1000 male child by the endof the plan.

In addition to all these the 11th plan also targeted to reduce Kala-azar by 100 percent,Malaria by 70 percent, Filarial/Microfilaria by 80 percent, Dengue by 50 percent and

other diseases substantially. With regard to infrastructure, the 11th plan through NRHM

stated to have one ASHA for every 1000 population, 2 ANMs for each SCs, Three staffnurses for each PHCs, seven specialists, and nine staff nurses for each CHCs., mobile

health units for each districts, strengthening of SDH and DHs and untied and annual

maintenance grants to all SCs, PHCs and CHCs to meet local health action.

Mid-Term Appraisal of the 11th Plan:

Public Spending on Health

Total public expenditure on health which was targeted to be around 2-3 percent of

GDP has not reached till 2010-11. Only on health it has gone up from 1.02 in 07-08 to1.09 in 09-10 which is a very small increase. This clearly indicates the gap between

target and the actual situation of public funding of the health sector.

Status of Maternal Mortality

The target of MMR for 11-12 was fixed at 100 per 1, 00,000 live birth from the initiallevel of 254. The Mid-term appraisal candidly admitted that it is not at all possible to

achieve this unless there is area specific interventions.

Infant Mortality Situation

The IMR target for the 11th plan was to achieve 28 per thousand live births. By 2008,

for which data is available it has gone down by 4 points in a period of about 2 yearswhich means the decline is 2 points annually. However, the target is to reduce by 6 points

per annum which appear to be impossible for the government to achieve with the present

institutional and manpower pattern.

Total Fertility Rate

Population growth depends on total fertility rate of women which can be controlled

by artificial methods. The target for this is 2.1 by the end of the plan. By 2008, it has

reached to 2.6 as against 2.9 in the year 2006. As the situation reveals, this variable canbe achieved by the end of the plan. But it is worthy to mention that limiting the size of the


7/17

family is probably more due to awareness and education of the people rather than

government measures to have this.

Health Infrastructure

The programme to have an ASHA activist for every 1000 population has notreached so far. As against the requirement of 12 lakh Asha Karmis (population of 121

crore) by the end of 2010 only 8.33 lakh Asha Karmis are at place. The appointment of

specialists, doctors, staff nurses, ANMs and paramedical staff has increased but not aspromised in the plan documents. The appointment of all these personnel on contract basis

defeats the requirement of committed service requirement in hilly and interior regions. It

is difficult to evaluate the performance in these areas due to specific targets mentioned inthe original plan document. With regard to Mobile Medical unit in each of the around 6oo

districts it is reported that only 381 districts have got it . The Economic Survey 10-11

admitted that there is still shortage of 20,486 sub-centers, 4477 PHCs and 2337 CHCs as

per the requirement of 2001 census. So if we take 2011 census figures, the gap will

definitely be enormous. The growth of health services in the private sector over the pastfew years indicate that the health services are beyond the reach of the common man.

About 70 percent of hospitals and 37 percent beds are in the private sector as per thereport of NCMH, 2005.

Health Indicators over Time:

One basic question comes to the mind of a researcher in health economics while

evaluating the role of public sector is whether there is any quantum change in the healthinfrastructure in the country over the last sixty years. This is likely to influence the health

indicators of the country. Table below makes a comparison between situation in 1951,

1981 and in 2011.

Table 3: Evolution of Health Infrastructure in India.

Item 1951 1981 % change

in 81 over

51

2011 % change in

2011 over 81

Number of Medical

colleges

28 111 396 273 246

No. of Hospitals anddispensaries

9209 23555 156 43322 (by2000)

84

PHCs, CHCs & SubCenters

725 57363 7812 163181(by 2000)

184

Beds 117178 569495 486 870161

(by 2000)

53

Doctors 65130 277360 426 757377 273

Nurses 16550 154280 932 1652161 107

Source: Economic Survey, 1994-95 & 2010-11 and National Health Policy, 2002,

Government of India.


8/17

There exists a clean slow down in the health infrastructure and men power in the 81-

11 period as compared to the earlier 51-81 period. The rate of growth of medical collegesin the country has slowed by about half. Similar is the situation for hospitals and

dispensaries. Extreme slow growth is recorded in the availability of bed and doctors.

The only satisfaction is with regard to availability of nurses which has identical growthover he two periods.

Table -4: Trend of Health Indicators in India

Indicator 1951 1981 % change 2011 or the

latest situation

% change

Life Expectancy atbirth

32.1 54.4 169 63.5 116

Birth Rate (1000) 39.9 33.9 85 22.5 66Death Rate (do) 27.4 12.5 46 7.3 58

IMR (1000) 146 110 75 50 45

Source: Economic Survey, 1994-95 & 2010-11 and National Health Policy, 2002,Government of India.

The health indicators for the country over the two periods has shown mixed result.The rise in life expectancy at birth has improved in lesser percentage in the second period

over he first period. The decline in birth rate and in IMR is however very significant I

the 81-11 period. The IMR fall appears to be very sharp. The fall in birth rate has almostremained constant. Some of the improvement in the indicators are the result of general

improvement in awareness and spread of education of the country .


9/17

InterState Variation in Health Services:

Availability of health services across the states in India vary widely. This need tobe recognized at the national level and suitable programmes are required to be formulated

to ensure access to quality health service to all people without any discrimination. Speedy

growth of private health service providers and lagging response of the government

system resulted in right to live being monopolized by the rich people. Treatment ofdiseases like Cancer, CVD, AIDS involve huge expenses without any assurance about the

patients survival. The incidence of some of diseases is highly localized and need

immediate attention. Table -5 below gives the regional variation in the status of healthindicators among the states in India.

Table-5:Inter-State Variation in Health Indicators in India

Sl.No State Life Expectancy at

birth 2002-06

IMR

2009

Birth

Rate

2009

Death

Rate

2009Male Female

1 Andhra Pradesh 62.9 65.5 49 18.3 7.62 Assam 58.6 59.3 61 23.6 8.4

3 Bihar 62.2 60.4 52 28.5 7.04 Chhattisgarh -- -- 54 25.7 8.1

5 Gujarat 62.9 65.2 48.0 22.3 6.9

6 Haryana 65.9 66.3 51.0 22.7 6.6

7 HP 66.5 87.3 45.0 17.2 7.2

8 Jharkhand -- -- 44.0 25.6 7.09 Karnataka 63.6 67.1 41.0 19.5 7.2

10 Kerala 71.4 76.3 12.0 14.7 6.8

11 MP 58.1 57.9 67.0 27.7 8.5

12 Maharashtra 66 68.4 31.0 17.6 6.7

13 Orissa 59.5 59.6 65.0 21.0 8.814 Punjab 68.4 70.4 38.0 17.0 7.0

15 Rajasthan 61.5 62.3 59.0 27.2 6.6

16 Tamilnadu 65.0 67.4 28.0 16.3 7.6

17 UP 60.3 59.5 63.0 28.7 8.218. Uttarakhand -- -- 41.0 19.7 6.5

19 WB 64.1 65.8 33.0 17.2 6.220 All India 62.6 64.2 50.0 22.5 7.3

Source: Economic Survey, Government of India, 2009-10

The table clearly indicates wide variation in the health statistics across states in

India. While Kerala is the best performer state in most of the indicators, the least

performer states are M.P, Orissa and West Bengal. This is probably due to poor healthinfrastructure in these states.


10/17

The chart clearly reveals least fluctuation in case of DR (Death Rate) and widefluctuation in case of FLE (Female Life Expectancy)

Health Indicators and Development Status of States:

The health condition of the people of a state greatly influences the working and earningcapability of the population and hence the gross domestic product. In this section , there

is an attempt to link up health variable across states and the GSDP and PCI of the states

for a particular year. The information relates to major 15 states of the country. Thehealth variables identified for the purpose are the Life expectancy at birth and the Infant

Mortality rate (0-5 Years ). Both these variables taken together reflects the availability ofpublic health service in an economy and the general health condition of the population

The impact of these variables on the GSDP and PCI of the states is examined throughfitting a linear multiple regression model.There are two models assumed for the purpose.

One is the dependency of GSDP (X 1) on Infant Mortality Rate(X2) and Life Expectancy

(X3). In the second model, the Per Capita Income (X4) is substituted for GSDP keepingthe other two independent variables as such. The regression results are presented in the

table given below.


11/17

Table 10: Relationship between Health Indicators and GSDP and PCI of 15 Major States in India

Name of the

States

Life Expectancy

at Birth (avg ofmale and female

)

Infant

MortalityRate

GSDP in Current

Prices (in 000crores ) 2008-9

Per Capita

Income (inrupees)

Andhra Pradesh 66 52 377 40902

Assam 60 64 79 23993

Bihar 65 56 143 13663

Gujarat 67 50 337 49251

Haryana 67 54 183 68914

Karnataka 67 45 271 41513

Kerala 74 12 190 49316

Madhya Pradesh 61 70 172 21648

Maharastra 68 33 693 54867Odisha 61 69 143 30121

Punjab 69 41 166 52879

Rajastan 66 63 202 27001Tamil Nadu 68 31 339 45058

Uttar Pradesh 62 67 412 18710W. Bengal 68 35 354 36322

Source ; Economic Survey, Government of Odisha, 2010-11, Planning

and co-ordination Department , Bhubaneswar.

Model-1:

X 1 = b 0 + b1 X2 +b2 X3 + U

R2 = .134

Items b 0 b1 b2Estimated

Value

1524.450 -14.467 -6.062

se 2104.346 27.657 6.126

t-value .724 -.523 -.990

p-value .483 .610 .342


12/17

In Model-1, with 14 degrees of freedom, the theoretical value of t is higher than thecalculated value of t and thus we have to accept the null hypothesis that there is no

relationship between the independent and the dependent variable. This is applicable for

both the independent variables. However , the low value of R2

indicates the inadequacy ofthe independent variables.

Model-2:

X 4 = b 0 + b1 X2 +b2 X3 + U

R2 = .316

Items b 0 b1 b2Estimated

Value

175677.21 3174.666 93.763

se 170841.972 2245.326 497.335

t-value -1.028 1.414 .189

p-value .324 .183 .854

In Model-2 also, the situation is similar. The value of R2 is however slightly more here.

This means the growth of GSDP and PCI has not been influenced by the health indicator

variables across the states in India.

Health Situation in Selected States

The working of health sector in selected states is carried out in this section.

Information for Orissa, and Gujarat is taken for this purpose. The health servicesimprovement greatly depends on the role of the centre as most of the schemes belong to

CSP and CP category. The states role is to implement the schemes in the best possible

manner. The analysis of the state specific situation gives rise to a finding that plan

expenditure in health sector was very less in the earlier years and is rising in the recentyears but it is still about one third of the total expenditure. Table-6 gives this situation.

Table-6: Pattern of Health Expenditure in Selected States

(Rs. In Crores)

Year Orissa Gujarat

Plan

Exp

Total

Exp

% Plan Exp Total

Exp

%

2004-05 271 633 43 348 899 38.8


13/17

2005-06 34 467 7 289 989 29.2

2006-07 114 588 19 376 1145 32.8

2007-08 211 712 30320 1250 25.6

2008-09 234 895 26 404 1376 29.4

2009-10 304 1128 27 476 1662 28.7

2010-11 512 1533 34 700 2330 30.1

Source:1. Budget at a Glance 2011-12, Finance Department , Government of Orissa.

2. State Finances in India ,RBI, Mumbai.(for different years)

In case of Orissa the plan expenditure is around 30 percent of the total expenditure. It was

a single digit figure for 05-06.This much of plan expenditure is against substantial

vacancy in the non-plan posts of the state health care services. If all the posts in the healthsector are filled up, then this much plan expenditure may not be possible given the total

expenditure on health. For Gujarat also , the situation is not much different . The highest

plan expenditure is recorded for 2004-05 about 38 percent. Thereafter it hoovers around30 percent only. The vacancy position of manpower in the health sector is given in

Table -7 in the two states.

Table-7: Health Manpower Position in the Selected States

Grade Orissa Gujarat 1

Man in

Position

Vacanc

y

Total Man in

Position

Vacancy Total

Grade-A 4082 943 5025 1039 448 1487

Grade-B 4620 634 5254 404 74 478

Grade-C 21936 976 22912 1203 1352 2555

Grade-D 13679 2119 15797 2775 863 3638

Total 44316 4672 48988 5421 2737 8158

Casual 223 106 329

G.Total 4539 4478 49317

Sources: Budget documents of the respective states.

relates to only medical education wing of the health sector

The table reflects that in Orissa a Group-A health worker (who is normally a

doctor or a specialist) serves about 10,000 population, whereas, the national doctor

population ratio is only 1:1600. The vacancy position in Gujarat appears to be more

worse than Orissa. Taking, the all India figure, it can be concluded that due to this acuteshortage of health manpower, the general population are depending more on

pharmacists, nurses, medical sub-staffs and quacks which leads to high mortality rate in

all cases.


14/17

Agenda for the 12th Plan:

The healthcare activities of the 12th plan must emphasise on two important points.

One is the improvement in the quality of health service provided by the public sector

which must be at par with the private sector. The second is as there are lot of healthservice providers in the private sector (a report puts it at 70 percent of the total), there

must be a health service provider regulator to oversee the functioning of theses

agencies. Health cannot be allowed to be traded like any other private goods. Denying thehealth service to a person because he is born in a rural dalit family tantamount to gross

violation of human rights. The public sector health service must emphasise on the

following points in the 12th plan

Realistic Targets: The targets set by the 10th and 11th plan appear to be highly

unrealistic which is difficult to realize. Setting a high target requires significantalteration in budgetary allocation to health sector. Further, it is noticed that the

government is only targeting the health outcomes but not the health infrastructure.Targeting a SC in every village, a PHC in every panchayat, a CHC in every blocka 300 bedded hospital in each sub-division and a 500 bedded hospital in each

district will give the health outcomes automatically. Most of the institutions up to

the block level may be required to function round the clock. The manpower

requirements of all these institutions are carried out seriously and institutions beestablished to generate these man powers within a specific time frame of five

years.

Imposition of Health Cess: Provisioning the health institutions as mentioned in

the earlier point requires huge public expenditure. The number of institutions

producing doctors, nurses and other health workers need to be increasedsubstantially. The present health budget or the normal rise of around 10 percentmay not achieve this desired goal. For this purpose, it is suggested that the

government must go for a health cess of around 5 percent on income tax which

will generate about Rs.20, 000 crores per annum. This is required to beexclusively spent on strengthening of health education institutions in the country

as a CS Scheme. States with deficient medical education institutions may be

supported fully for building and equipment for new medical colleges. In case ofOrissa, it is required to go for 2/3 new medical colleges in the 12 th plan in the

government sector. It can not be left to the private sector, as the doctors coming

out of such institutions may not be interested to serve in tribal and rural area.

Redesigning NRHM: The scope of NRHM has to be broadened to include

general health conditions of the people. Like IMR and MMR the life expectancyof the population shall be taken as an important objective and a targeted variable.

Problems of the senior citizens is required to be looked after more seriously as the

joint family system has crippled due to the influence of western civilization.

Orphans, destitutes and disabled persons may be allowed to live with dignity with


15/17

full support of the government rather than begging here and there. Elimination of

begging should be one of the goals of the 12th plan health policy.

Cost of Health Care: In rural areas there exists a fear for allopathic treatment due

to high cost involved in it. Normally, in the first few days of illness, people go to

unscientific treatment practices like witchcraft which still exists in rural areas.The high cost of allopathic treatment can be brought down if proper regulatory

mechanism of the government is in place. There exists a huge gap between cost of

pathological tests and the price charged to the patients. A uniform and standardprice of all types of tests be determined by the government and made mandatory

for the diagnostic laboratories to display it for public knowledge. Similarly, the

prices of the drugs manufactured by the pharmaceutical companies need to beregulated. The BPL families may be allowed to get their costs reimbursed by the

government for pathological tests and medicines.

Backward Districts Health Development Scheme: It is noticed that there

exists wide variation in the health services not only among states, but also amongdistricts and blocks of a state. To reduce this disparity, there must be a separate

central sector scheme to improve health infrastructure in those areas. For roundthe clock stay of all personnel in the PHC or SC , it is necessary that the place

must have good quality schools, piped water supply, easy transport facility and

communication network. There must a conscious effort to create all these within aspecified period of time.

Provision of Ambulance Facilities: Health problems normally require immediateattention. Every minute in such a situation matters for the patients survival. The

government has to ensure availability of ambulance facilities within a distance of

5-10 kms. For this an ambulance network can be created like fire control network.It must be available round the clock.

Water Supply and Sanitation: Awareness of general hygiene and clean

drinking water supply are the two complementary areas which cannot be ignoredwhen one is interested in good health. The government is progressing very slowly

in these two areas. The achievement, the government is claiming appears to be far

from truth. Government organizations are submitting inaccurate data on theseservices. Independent agencies may be requested to carry out small surveys to

know the exact situation.

Greater role of PRIs and ULBs: To get better results, the GPs be given power tomonitor the performance of SCs and the blocks will look after PHCs and CHCs.

All other hospitals will be kept under the charge of health department officials.

Health Insurance Coverage : Health insurance coverage of the general

population is probably a low priority area for the government of India. The GOI is

more particular about its own employees and covers them under a CGH coveragescheme. The 11th plan tried to put the onus of this on the private providers which


16/17

will not work as it is not a high profit yielding area. Given the experience of the

11th plan , the 12th plan should focus this area more intensively and by 2017 each

and every household in the country must have to be covered under a healthinsurance scheme. The premium of such a scheme must be as low as possible for

the informal sector and to be totally borne by the government for BPL category

population.

Facility for Poor in Private Hospitals : The private sector health providers are

using much of the common property resources and they have a socialresponsibility to discharge. Even though it is mandatory to give their facility to

the poor people at subsidized rates , they are not doing that due to inadequate

vigilance by the government. The 12th plan is required to redesign thisarrangement for grater benefit of the common people. The Andhra Pradesh model

can be followed in reimbursing the cost of poor people for treatment in these

hospitals.

Nutritional improvement of Mothers and Children: Underweight children andmothers are a very common scene in rural areas. This is the prime cause of infant

and maternal mortality. Provision of nutritional food is not possible for thesefamilies due to their abject poverty. The government is satisfied by only providing

rice at a subsidized rate. Other food items like dal, milk etc are equally important

for health living. These items are required to be made available at a subsidizedrate in the rural areas.

Immunisation of children: Regular vaccination of the children in the age groupof 0-5 is very important for preventing many diseases. The availability of such

vaccination shall be made in each villages under a central scheme. Provision of a

refrigerator and other instruments are to be made to such centres.

References:

1. World Bank(2006):India Inclusive Growth and Service delivery: Building on

Indias Success Development Policy Review2. World Bank(2006); World Development Report-2006 Equity and Development; Oxford

University Press.

3. Planning commission (2006) Towards Faster and More Inclusive Growth: An

Approach to the 11th five Year Plan. New Delhi

4. Parliamentarians Forum on Economic Policy Issues (PAR-FORE)(2009) : SocialSector Budgeting: Higher Allocations Mask Poor Utilisation from website

5. Price Waterhouse coopers (2007):Healthcare in India Emerging Market Report6. Government of India., Economic Survey Different years. , Ministry of Finance ,

New Delhi.

7. Jos Manuel Roche (2009): Capability and Group Inequalities: Revealing the

latent structure Working paper, revised by October 2009

8. Ministry of Finance Department of Economic Affairs (1990-2008),Indian PublicFinance Statistics, Economic Division, Government of India.


17/17

9. Planning and Coordination Department (1981 - 2012), Five Year Plans,

Government of Odisha.

10. Sen, Amartya (2001)Development as Freedom, Oxford: Oxford University Press.

Paper for International Conference at Chennai

Documents

Transcript of Paper for International Conference at Chennai