Saint Louis University School of Medicine

Family and Community Medicine

Written output for Unit 10

HEALTH SYSTEMS REPORT

Submitted to:
Dr. Nelson Hora, MD

Submitted by:
Group 6, Section C

Group Members:
ABELLA, Jehonah Pia Marie T.
ARANCA, Measy Faith L.
AYBAN, Shielynne Khale M.
BADINAS, Angel Faith C.
BAGAOISAN, Jennifer B.
BAGUEC, Angie B.
BAUTISTA, Marvin James Mishael R.
CAFÉ, Arvin O.
CARREON, Cedrex O.

Submitted on:
November 5, 2021
 COMPARATIVE STUDY OF HEALTH CARE SYSTEM IN INDIA

I. Brief Description of the Country

● POPULATION
The current population of India is 1,398,087,214 as of Tuesday, November 2, 2021, based on the latest
United Nations data.

● LAND AREA
India is known as the seventh largest country in the world, with a total area of 3,287,263 sq kilometers
(1,269,219 sq miles).

● GROSS NATIONAL PRODUCT

The Gross National Product (GNP) of India decreased to 13,280,223 INR tens of million in 2020 from
14,522,931 INR tens of million in 2019.

● MAJOR INDUSTRIES/ ECONOMIC ACTIVITIES

1. Agricultural Sector
Its share in the country’s GDP has declined and is currently at 14%. However, more than 50% of the
total population of the country is still dependent on agriculture.
2. Industry Sector
The industrial potential of the economy has increased since 1991.
3. Services Sector
The services sector benefited most from the New Economic Policy. Banking, Finance, Business
Process Outsourcing and Information Technology services have seen double-digit growth.
4. Food Processing
Food processing has emerged as a high-growth, high-profit sector. The vast availability of raw
materials, resources, favorable policy measures and numerous incentives have led India to be
considered as a key attractive market for the sector.
5. Manufacturing Sector
The manufacturing sector is the second largest contributor to India’s GDP.

● LITERACY RATE
Currently, India has a literacy rate of 74.04% (2021). Literacy rate has increased by 12% from the time of
Independence in 1947. However, it’s still lag behind the world average literacy rate of 84%. Going by
previous growth rate, India will be able to achieve its universal literacy target not before 2060.

● UNEMPLOYMENT RATE
The Unemployment rate is 6.9% (September 2021). Centre for Monitoring Indian Economy Consumer
Pyramids panel of households includes over 174,405 households including over 522,000 members who
are over 15 years old.
● POVERTY RATE (How is poverty rate defined?)
The poverty rate is the ratio of the number of people (in a given age group) whose income falls below the
poverty line; taken as half the median household income of the total population. It is also available by
broad age group: child poverty (0-17 years old), working-age poverty and elderly poverty (66-year-olds or
more). As per the real-time data from World Poverty Clock, 7% of the Indian population are living in
extreme poverty and 0.6 Indians are escaping extreme poverty every minute. By 2030, the target of the
government is to eradicate extreme poverty for all people everywhere, currently measured as people
living on less than $1.25 a day.

● FORM OF GOVERNMENT
India is a Federal Parliamentary Republic based on the Westminster system.
Main powers Election process Election cycle

Executive The president serves as The president is indirectly 5 years

commander-in-chief, can grant elected by an electoral
pardon or reduce the sentence of a college.
convicted person, and appoints
various governors and other
positions.

Judicial Enforces fundamental rights; issues Appointed by the Life appointment

directions, orders, or writs; and may president.
direct the transfer of any civil or
criminal case.

Legislative Lok Sabha and Rajya Sabha are the The Rajya Sabha has 233 Lok Sabha: 5
main legislative bodies of members who are years; Rajya
government that are responsible for indirectly elected by the Sabha: 6 years
executing the legislative tasks of the state legislatures. The Lok
government. Sabha has 543 members
who are elected by
plurality vote in single-
member constituencies
and 2 members who are
appointed by the
president.

● LATEST TOP CAUSES OF MORBIDITY AND MORTALITY STATISTICS

The top cause of morbidity and mortality is heart disease followed by Chronic obstructive pulmonary
disease (COPD), Stroke, Diarrheal diseases, Lower respiratory infection, Tuberculosis, Neonatal
disorders, Asthma, Diabetes and last is chronic kidney disease.
● LATEST INFANT AND MATERNAL MORTALITY RATES
Maternal Mortality Ratio (MMR) of India for the period 2016-18, as per the latest report of the national
Sample Registration system (SRS) data is 113/100,000 live births, declining by 17 points, from 130/
100,000 live births in 2014-16. This translates to 2,500 additional mothers saved annually in 2018 as
compared to 2016. Total estimated annual maternal deaths declined from 33,800 maternal deaths in 2016
to 26437 deaths in 2018. Pregnancy-related complications are the number one cause of death among girls
between 15 and 19 years of age. Because adolescent girls are still growing themselves, they are at greater
risk of complications if they become pregnant. Moreover, child brides are less likely to receive proper
medical care while pregnant or to deliver in a health facility, compared to women married as adults.

● MAJOR HEALTH CONCERNS OF THE COUNTRY (INDIA) AT PRESENT.

At present (2021), the major health concerns in India are Cancers, Congenital abnormalities, Cataracts,
Diabetes, Heart diseases, Hearing loss, Infectious diseases, Obesity, Hair loss, Maternity and Infertility.

II. History of the Health Care System

● DID THE COUNTRY TRY OTHER HEALTH CARE SYSTEMS BEFORE THE PRESENT ONE?
Yes, at some point, to a certain extent. India's Ministry of Health was established with independence
from Britain in 1947. The National Health Policy was endorsed by Parliament in 1983. The policy aimed at
universal health care coverage by 2000, and the program was updated in 2002. In order to address lack
of medical coverage in rural areas, the national government launched the National Rural Health Mission
in 2005. This mission focuses resources on rural areas and poor states which have weak health services in
the hope of improving health care in India's poorest regions.

The recommendation for THREE-TIERED HEALTH-CARE SYSTEM to provide preventive and curative health
care in rural and urban areas placing health workers on government payrolls and limiting the need for
private practitioners became the principles on which the current public health-care systems were
founded. This was done to ensure that access to primary care is independent of individual socioeconomic
conditions. However, lack of capacity of public health systems to provide access to quality care resulted
in a simultaneous evolution of the private health-care systems with a constant and gradual expansion of
private health-care services.
Primary Health Care System Secondary Health Care System Tertiary Level Health Care System

● It is also called essential

● This level serves as the first ● Regional Hospital
health care of India. referral unit or FRU's in the ● Super Specialty Hospital
● Sub Centers health system. ● Medical College hospital
● Public Health Centers ● Community Health Centre ● Central Government
or CHC's Institutes
● District Hospitals
● WHAT FACTORS LED THEM TO SHIFT TO THEIR PRESENT HEALTHCARE SYSTEM?
There’s a need to make people and processes in the healthcare sector more accountable; for that greater
operational transparency needs to be brought in urgently. India’s healthcare system has been battling
various issues, including the low number of institutions and less-than-adequate human resources for quite
a while now.
1. Lack of infrastructure- India has been struggling with deficient infrastructure in the form of lack
of well-equipped medical institutes for quite a while now. To add to it, the rate of building such
medical teaching or training facilities remains less as compared to the need of the hour. For a
considerable time, the government regulation mandated that private medical colleges must be
built on at least five acres of land. As a result, quite a few private colleges were built in rural areas,
where it became quite difficult to recruit adequately qualified, full-time doctors due to lack of
proper living conditions, besides low pay scales.
2. Shortage of efficient and trained manpower- One of the most pressing problems in India remains
a severe shortage of trained manpower in the medical stream, this includes doctors, nurses,
paramedics and primary healthcare workers. The doctor-to-patient ratio remains abysmally low,
which is merely 0.7 doctors per 1,000 people. This is compared to the World Health Organization
(WHO) average of 2.5 doctors per 1,000 people.
3. Unmanageable patient-load- Even prior to the outbreak of the Covid-19 pandemic, healthcare
facilities had been feeling the strain due to unmanageable patient-load. Moreover, serving a
population of 1.4 billion remains a Herculean task in itself when it comes to suitably managing
healthcare facilities. In addition, there is the challenge to think beyond the obvious and promote
virtual care protocols, and telehealth services, which can be leveraged to reduce the patient-load
burden to a large extent.
4. Public health policy and proactive healthcare- The latest National Health Policy (NHP) 2017
highlights the ‘Health for All’ approach to provide assured healthcare for all at an affordable cost.
However, there is scope to do much more under the NHP 2017. Ideally, the public health policy
needs to be focused towards proactive healthcare, not reactive healthcare. Besides, in the case
of the government’s Ayushman Bharat scheme, the Pradhan Mantri Jan Arogya Yojana (PM-JAY),
the universal health insurance scheme, has received considerable attention and resources than
the health and wellness centers (HWCs) component. This asymmetry needs to be suitably
addressed for the growth of healthcare in the future.
5. High out-of-pocket expenditure remains a stress factor- While public hospitals offer free health
services, these facilities are understaffed, poorly equipped, and located mainly in urban areas. It
is a known fact that accessible and affordable healthcare in the public sector can considerably
reduce the rise in dependence on private institutions. However, governmental facilities leave no
alternatives but to access private institutions and incurring high out-of-pocket expenses in
healthcare. Most health services are, therefore, provided by private facilities, and 65 percent of
medical expenses in India are paid out of pocket by patients.
● COMPARE THE COUNTRY’S HEALTH SITUATION BEFORE AND AFTER THE PRESENT SYSTEM WAS
INSTITUTED.
Popular indigenous healthcare traditions include:
1. The Ayurveda (meaning science of life) system deals with causes, symptoms, diagnoses, and
treatment based on all aspects of well-being (mental, physical, and spiritual).
2. The Siddha system defines disease as the condition in which the normal equilibrium of the five
elements in human beings is lost resulting in different forms of discomfort.
3. Yoga is a science as well an art of healthy living physically, mentally, morally and spiritually.
4. Naturopathy believes that all the diseases arise due to accumulation of morbid matter in the body
and if scope is given for its removal, it provides cure or relief.
5. The Unani system of medicine believes that the body is made up of four basic elements viz., earth,
air, water and fire, which have different temperaments i.e., cold, hot, wet and dry.
6. Faith / spiritual healers, who are largely present in rural parts of India. Some spiritual leaders use
one or more of the traditional therapies, viz, Ayurveda, Yoga or Naturopathy as one of the healing
modes to cure their clients.

The modern (allopathic) health care system in India consists of a public sector, a private sector, and an
informal network of care providers. India’s health system can be categorized into three distinct phases:
1. In the initial phase of 1947-1983, health policy was assumed to be based on two broad principles:
(i) that none should be denied healthcare for want of ability to pay, and (ii) that it was the
responsibility of the state to provide healthcare to the people. This phase saw moderate
achievements.
2. In the second phase of 1983-2000, a National Health Policy was announced for the first time in
1983, which articulated the need to encourage private initiative in healthcare service delivery and
encouraged the private sector to invest in healthcare infrastructure through subsidies.
3. The third phase, post-2000, is witnessing a further shift and broadening of focus; the current phase
addresses key issues such as public-private partnership, liberalization of insurance sector, and the
government as a financier. It has framed policies that allow the design and implementation of
programs on newborn care in an inclusive manner.

III. Present Health Care System

● WHAT ARE THE MAJOR FEATURES?

The health sector in India is public, government, private or individual owned.
1. Private sector healthcare providers are owned and run by individuals or a group of individuals and
it is registered under the Clinical Establishment Act. It consists of dispensaries, clinics, nursing
homes and hospitals that may practice Allopathic, Ayurvedic, Homeopathic or Unani System of
Medicine. They are more inclined towards curative aspects.
2. Public sector comes under the Ministry of Health and Family Welfare, Government of India. They
also consist of dispensaries, clinics, nursing homes and hospitals that follow various kinds of
medicine systems. Moreover, it includes all India networks of government health facilities in the
 form of sub centers, primary health centers, rural hospitalizing, urban health centers, municipal
and other government hospitals.
3. Charitable institutions, NGOs, pharmaceutical companies, chemist shops, research organizations,
medical colleges and other health-related training and research institutes that may be publicly or
privately owned.

● WHAT ARE THE MAJOR THRUSTS?

1. Infrastructure development - The participation of the private sector in healthcare infrastructure
development is expected to bring innovation strategies thereby quickly bridging the resource gap
in infrastructure for healthcare. The following are some areas where energies could be focused
to extract workable solutions:
● Planning, design and development of healthcare facilities in whole or specialty wise
● Owning and operating diagnostic services for public health systems
● Own and operate other services like mobile clinics
2. Management and operations - The huge infrastructure of the Indian public health system lacks
in realizing its complete potential partly due to inadequate expertise in managing the operations
of the units, be it PHCs or large hospitals. Agencies can provide a multitude of services like
● Infrastructure maintenance and upkeep
● Key service delivery of medical treatment
● Hospital management including housekeeping, catering, etc.
● Medicine store and inventory management
● Medical equipment purchases and maintenance
● Transportation
● security
3. Capacity Building and Training - Capacity building and training activities by the government need
sharpened focus not only for a quantitative increase in trained manpower but also for improving
the effectiveness of existing methods in training.
4. Financing Mechanism - Covering payments for healthcare through insurance is still at a low
penetration level compared to international standards and a large population that is more prone
to financial burden on incurring healthcare expenses, is largely uninsured.
5. IT infrastructure development for Networking and Data transfer - Quality of healthcare
provisions in India is inconsistent in terms of level of access and quality of service delivery leading
to massively disparate outcomes among states and even districts in the country.
6. Materials Management - Management of materials used in healthcare delivery is critical and
forms the vital link enabling last mile delivery of healthcare.

● WHAT ARE THE MAJOR STRATEGIES EMPLOYED?

1. RMNCH+A services. This policy aspires to elicit developmental action of all sectors to support
Maternal and Child survival. It strongly recommends strengthening of general health systems to
prevent and manage maternal complications, to ensure continuity of care and emergency services
for maternal health
 2. Child and Adolescent Health. The policy affirms pre-emptive care to achieve optimum levels of
child and adolescent health. It envisages school health programmers as a major focus area as also
health and hygiene being made a part of the school curriculum. Also, gives special emphasis to
the health challenges of adolescents and the long-term potential of investing in their health care.
3. Interventions to Address Malnutrition and Micronutrient Deficiencies Recognizing this problem,
the policy declares that micronutrient deficiencies would be addressed through a well-planned
strategy on micronutrient interventions. The focus would be on reducing micronutrient
malnourishment and augmenting initiatives like micronutrient supplementation, food
fortification screening for anemia and public awareness.
4. Universal Immunization. Priority would be to further improve immunization coverage with
quality and, improve vaccine security as per National Vaccine Policy 2011. The focus will be to
build upon the success of Mission Indra Dhanush and strengthen it.
5. Communicable diseases. For integrated disease surveillance programs, the policy advocates the
need for districts to respond to the communicable disease priorities of their locality. This could be
through network of well-equipped laboratories backed by tertiary care centers and enhanced
public health capacity to collect, analyze and respond to the disease outbreaks
6. Non-communicable diseases. This policy recognizes the growing need for palliative and
rehabilitative care for all geriatric illnesses and advocates the continuity of care across all levels.
It recognizes the critical need of meeting the growing demand of tissue and organ transplant in
the country and encourages widespread public awareness to promote voluntary donations.
7. Mental health. This policy will take into consideration the provisions of the National Mental
Health Policy 2014.
8. Population Stabilization. Recognizing improved access, education and empowerment would be
the basis of successful population stabilization. The policy imperative is to move away from camp-
based services with all its attendant problems of quality, safety and dignity of women, to a
situation where these services are available on any day of the week or at least on a fixed day.

● WHAT AMOUNT (GROSS AMOUNT, AS PERCENT OF THE NATIONAL BUDGET, AND AS PERCENT OF GNP)
IS ALLOTTED FOR HEALTH CARE?
On February 1, 2021 the Union Budget of India presented the allotted Rs 71,268.77 Crore for the Union
Health and Family Welfare Ministry or an equivalent of 482,795,315,923.30 in Philippine peso. It is an
increase of about 10 percent from the previous year’s budget. According to the Down to Earth
Organization, India spent 1.8 percent of its GDP on health in year 2020 to 2021. The lowest among any
government spends on health in the world. As a result, India is among the 10 top nations with the highest
out-pocket-expenditure (OOPE).

● HOW BIG A ROLE DOES THE GOVERNMENT PLAY?

1. Health system strengthening- The National Rural Health Mission (NRHM) launched by the
Government of India is a leap forward in establishing effective integration and convergence of
health services and affecting architectural correction in the health care delivery system in India.
 2. Health information system- The Integrated Disease Surveillance Project was set up to establish a
dedicated highway of information relating to disease occurrence required for prevention and
containment at the community level.
3. Health research system- There is a need for strengthening research infrastructure in the
departments of community medicine in various institutes and to foster their partnerships with
state health services.
4. Regulation and enforcement in public health- A good system of regulation is fundamental to
successful public health outcomes. Revival of public health regulation through concerted efforts
by the government is possible through updating and implementation of public health laws,
consulting stakeholders and increasing public awareness of existing laws and their enforcement
procedures.
5. Health promotion- Stopping the spread of STDs and HIV/AIDS, helping youth recognize the
dangers of tobacco smoking and promoting physical activity.
6. Human resource development and capacity building- Public Health Foundation of India is a
positive step to redress the limited institutional capacity in India by strengthening training,
research and policy development in public health.
7. Public health policy- Facilitate changes in resource allocation for public health interventions and
a platform for concerted intersectoral action, thereby enabling policy coherence.
8. Scope for further action in the health sector- innovative schemes through public-private
partnerships are being tried in various parts of the country in promoting referrals. Similarly, the
much-awaited National Urban Health Mission might offer solutions with regards to urban health.

● HOW BIG A ROLE DOES THE PRIVATE SECTOR PLAY?

There is a growing appreciation and recognition of the role of the private sector in the development of
better health systems and the improvement of healthcare worldwide. India has a complex health-care
delivery system with an admixture of public and private providers which has evolved into a competitive,
performance-driven industry demanding the best management skills related to workforce, technology,
and finance.

The public sector was the forefront provider of health at the time of independence when private health
sector accounted for only 8% of total patient care (World Bank, 2004), but now, it is estimated that 93%
of all hospitals, 64% of beds, 80%–85% of doctors, and 80% of outpatient and 57% of inpatient services
are catered to by private sector. This inclination toward availing services from private sector is also
corroborated from NFHS-4 report, which states that 56.1% and 49% of members of surveyed urban and
rural households, respectively, sought private health care in times of sickness, while for public sector, it
was only 42% and 46.4%, respectively. In terms of health insurance, the public sector provides wider
coverage, but overall contributions of the private sector as regards to infrastructure, i.e., health
enterprises, doctors, and medical colleges are greater than that of the government sector. Private
healthcare sector is good at areas which it was designed to excel at. Playing to its strengths, it can be a
powerful ally in India’s aspiration to operate a universal healthcare system supported by an enabling
financing, policy and regulatory framework that shapes a competitive market for innovative goods and
services.
● HOW MUCH EMPHASIS IS PLACED ON PRIMARY HEALTH CARE AND PREVENTIVE SERVICES? HOW ARE
THESE IMPLEMENTED?
The very essential components of primary health care – promotion of food supply, proper nutrition, safe
water and basic sanitation and provision for quality health information concerning the prevailing health
problems – are largely ignored. Access to healthcare services, provision of essential medicines and scarcity
of doctors are other bottlenecks in the primary health care scenario. Complete absence of evidence-based
guidelines on clinical scenarios and treatment plans in the primary health care sector, together with
overburdening of the secondary and tertiary care sectors, has substantially lowered the quality of care in
the nation. India’s 2017 National Health Policy commits the government to investing a major proportion
(>2/3rds) of resources to PHC.

The main mechanisms to achieve this are the 150 000 Health and Wellness Centers (HWCs), which are
intended to become the main points of contact for communities within the public health system. These
centers will provide comprehensive health care, covering around 70% of out-patient care, including
noncommunicable diseases and maternal and child health services. These centers will also provide free
essential drugs and diagnostic services as well as referral access to secondary and tertiary health care. As
a part of the government’s effort to achieve universal health coverage through its flagship initiative, the
Ayushman Bharat program. Launched in 2018, the program includes the health insurance component, the
Pradhan Mantri Jan Aarogya Yojna (PM-JAY).

As of the current situation which strikes all the country, several secondary and tertiary care hospitals that
cater to millions of daily outpatients have been converted into temporary dedicated COVID-19 hospitals
to provide care to the patients with moderate and severe COVID-19 as per the designated clinical criteria.
Consequently, the health care needs of patients with chronic diseases and maternal and child health
requires alternative primary care service delivery.

IV. Conclusions and Recommendations

● WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF THE PRESENT SYSTEM?
ADVANTAGES DISADVANTAGES

Implementation of the National Rural Health Deficient infrastructure: Health coverage is

Mission (NRHM) as a means to strengthen the universal but the system is under-funded and
rural public health system. With its core focus to facilities experience shortages of staff and
reduce maternal and child mortality. supplies. Nonavailability of facilities like water and
electricity deeply undermines the functioning of
existing facilities.

Launching of the strategic approach, Deficient manpower: On the one hand, there is
reproductive, maternal, newborn, child and unwillingness of doctors and other health
adolescent health (RMNCH+A), to accelerate personnel to serve in rural areas; on the other
hand, even in the urban areas. More rural areas
 actions for equity, harmonization and improved also suffer more from physician shortages and less
coverage of services. adequate health care, especially as greater
concern for the government is to first satisfy the
needs of the urban elite.

Launching of the Ayushman Bharat, which Unmanageable patient load: Secondary or

encompasses the National Health Protection tertiary level public hospital in bigger cities is today
Scheme (Pradhan Mantri Jan Arogya Yojana or bursting at seams due to a heavy rush of patients.
PM-JAY), for coverage of tertiary care for The huge unplanned increase of Indian cities has
vulnerable populations and Health and Wellness resulted in urbanization of rural poverty causing
Centers initiative for the delivery of expansion of slums and marginal populations
comprehensive and integrated primary care. starved of health and other basic amenities.

Health care facility accreditation is also well- Equivocal quality of services: Health disparities
developed in India. are prevalent between poorer and richer states
with underfunded health systems that in many
cases are inefficiently run and underregulated.

High out-of-pocket expenditure: Due to the lack

of resources and services, many Indian citizens
turn to the private sector for care. This becomes
difficult to access for lower-income individuals
because most of the health system is funded by
out-of-pocket payments.

● WHICH FEATURES OF THE HEALTH CARE SYSTEM ARE APPLICABLE TO THE PHILIPPINE SETTING?
⮚ Both India and the Philippines have complex health systems that are still largely in their
developmental stages. For many years, they have suffered from chronic underinvestment in basic
health resources such as infrastructure, supplies, and health workers, leading to the uneven
distribution of health facilities and personnel.
⮚ The rural-urban dichotomy in health services in India reflects the rural–urban divide by province and
wealth status apparent in the Philippine health system. Hence, an inequality in terms of the health
outcomes in the provinces exists.
⮚ Persistent problems faced by decentralized health systems, particularly long-standing tensions
between national and local government, have greatly affected health outcomes in both countries 🡪
the delivery of health services falls largely into the hands of local governments – states in India, and
provinces and municipalities in the Philippines.
⮚ While both nations' health systems have made significant progress, many difficulties remain.
Constant review of health-related programs and initiatives is required to identify emerging issues in
the health-care system and design effective and efficient remedies.
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Group Members Division of Works:

ABELLA, Jehonah Pia Marie T. – Answered Demographic Profile/ Presentor

ARANCA, Measy Faith L. - Answered Demographic Profile/ Presentor
AYBAN, Shielynne Khale M. - Answered Demographic Profile/ Powerpoint Slides Presentation
BADINAS, Angel Faith C. - Answered Demographic Profile/ Written Output Compilation
BAGAOISAN, Jennifer B. - Answered Demographic Profile/ Presentor
BAGUEC, Angie B. - Answered Demographic Profile/ Powerpoint Slides Presentation
BAUTISTA, Marvin James Mishael R. - Answered Demographic Profile/ Reporter
CAFÉ, Arvin O. - Answered Demographic Profile/ Video Output Compilation
CARREON, Cedrex O. - Answered Demographic Profile/ Powerpoint Slides Presentation