Comparative analysis of health system of Nepal and India

Presented by:

Suvash Regmi Suraksha Shah Lipasha Shrestha Priyankya Aryal

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Introduction

India and Nepal are the South Asian neighboring nations sharing culture, tradition and political scenario. Both the countries are dependent on agriculture in a large scale. Agriculture plays a vital role in the living style of the people in these respective countries.

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CONTD..

All the sectors have been under political influence since their independence from foreign rule and anarchism respectively. Both these countries have similarities in the health system and health services provided. Heath system in both countries are to a large extend privatized as the public sector is not much effective regarding the tertiary care.

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CONTD

Lack of human resource, skilled human resource, logistics, updated equipments, methods, research in health, awareness level of the citizens, not following the health referral system, poverty, illiteracy etc. are the reasons behind lagging in availability and accessibility of health services that results in poor health status of these two countries.

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CONTD.

The factors affecting health of population are based on the following trends which are similar in both the countries and statistical influence only being a difference, not the problems and services provided in health sector.

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Factors affecting health in both countries

Economic trend Poverty Demography Food supply and nutritional status Social Trends Lifestyle and Risk Factors

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PROBLEMS, CONSTRAINTS, CHALLENGES

Difficult to get trained human resource to work in remote areas. Lack of awareness in legalization of safe abortion. Difficult terrain is a challenge to reaching the most at-risk populations. International Non-Government Organisations

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Contd..

Ensuring effective synergy, coordination and collaboration with key public and private Sector stakeholders is essential to program success.

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Health System in India

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Introduction

The political economy context The organisational structure and delivery mechanism Top 5 Diseases Health financing mechanisms Coverage patterns Current status of health and health care
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The Political Economy Context

A democratic federal system which is subdivided into 28 States, 7 union territories and 593 districts In most of the states three local levels of government (Panchayati-raj) Per capita income US $890. 435 million Indians are estimated to live on less than US $ 1 a day 36% of the total number of the worlds poor are in India Tax based health finance system with health insurance 80% health care expenditure born by patients and their families as out-of -pocket payment (fee for service and drugs) Expenditure on health care is second major cause of indebtedness among rural poor
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Characteristics of Indian Health System

Complex mixed health system

- Publicly financed government health system - Fee-levying private health sector

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Different Phases of Indian Health System Development

Pre-independence phase Development centred phase Comprehensive Primary Health Care phase Neoliberal economic and health sector reform phase Health systems phase

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Main Systems of Medicine

Western allopathic Ayurveda Unani Siddha Homeopathy

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Government Health System

Three levels of responsibilities-

Firsthealth is primarily a state responsibility

Second- the central government is responsible for developing and monitoring national standards and regulations - sponsoring various schemes for implementation by state governments - providing health services in union territories Thirdboth the centre and the states have a joint responsibility for programmes listed under the concurrent list.
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Administrative Structure
1. Central Ministries of Health and Family Welfare - Responsible for all health related programmes - Regulatory role for private sector 2. State Ministries of Health and Family Welfare 3. District Health Teams headed by Chief Medical and Health Officer
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Service Delivery Structure

Sub Health Centres- staffed by a trained

female health worker and/or a male health worker for a population of 5000 in the plains and a population of 3000 in hilly and tribal areas.

Primary Health Centresstaffed by a medical officer and other paramedical staff for a population of 30,000 in the plains and a population of 20,000 in hilly, tribal and backward areas. A PHC centre supervises six to eight sub centres.
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Service Delivery Structure

Community health centres- with 30-50 beds and basic specialities covering a population of 80,000 to 120,000. The CHC acts as a referral centre for four to six PHCs. District/General hospitals- at district level with multi speciality facilities (City dispensaries) Medical colleges, All India institute of Medical Sciences and quasi government institutes.
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Physical infrastructures

Regarding the hospitals and hospital beds, the scenario presents the dominance of healthcare facilities in the private sector. Public health infrastructure in rural areas consists of a three-tier system, a sub centre for every 5,000 population with a male and female worker; a PHC for every 30,000 population with a medical doctor and other para medical staff, and a Community Health Centre (CHC) for every 100,000 population with 30 beds and basic specialists. In urban areas, it is two tier systems with Urban Health Centre (UHC)/Urban Family Welfare Centre (UFWC) for every 100,000 population followed by general hospital. In 2001, there were about 1,37,311 Sub Centres (SCs), 28,000 dispensaries, 22,842 PHCs, 3,043 CHCs and 3,500 UFWCs and an additional 12,000 secondary and tertiary hospitals in the public sector, besides an estimated 68 percent of total hospitals in the private sector.

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Health Care Workforce

Community and traditional health workers density (per 10 000 population) <1 (2004) Dentistry personnel density (per 10,000 population) <1 (2004) Number of community and traditional health workers 50,393 (2004) Number of dentistry personnel 55,058 (2004)

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Contd

Number of nursing and midwifery personnel 1,372,059 (2004) Number of other health service providers 695,024 (2003) Number of Pharmaceutical personnel 559,408 (2003) Number of Physicians 645,825 (2004)
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Contd..

Nursing and midwifery personnel density (per 10,000 population) 13.00 (2004) Other health service providers density (per 10,000 population) 7.00 (2003) Pharmaceutical personnel density (per 10,000 population) 5.00 (2003) Physicians density (per 10,000 population) 6.00 (2004)
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Contd.

SC/Public Health Center (PHC)/Community Health Centers (CHC) - 1,63,181 Dispensaries & Hospitals - 43,322 Beds (Pvt & Public) - 8,70.161 Doctors (Allopathy) - 5,03,900 Nursing Personnel) - 7,37,000 *MOHFW
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Top Five Diseases

HIV/AIDS MALARIA TUBERCULOSIS DENGUE PNEUMONIA

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Health Financing Mechanisms..

Revenue generation by tax Out of pocket payments or direct payments Private insurance Social insurance External Aid supported schemes

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Spending on Health

National health Accounts and Health statistics by 2010 show increase in the expenditure by government as a percentage of GDP from the the then existing 0.9 percent to 2 percent increase share of central grant to constitute at least 25 percent of total spending by 2010, increase State sector health spending from 5.5 percent to 7 percent of the budget by 2010 and further increase it by 8 percent by 2010.
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CONTD..

Out of this only 15 % is publicly financed 4% from social insurance, 1% by private insurance remaining 80% is out of pocket spending ( 85% of which goes in private sector) Only 15% of the population is in organised sector and has some sort of social security the rest is left to the mercy of the market
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The Aspects of Neoliberal Economic Reforms Affecting Public Health

Increasing unregulated privatisation of the health care sector with little accountability to patients Cutting down government Health care expenditure Systematic deregulation of drug prices resulting in skyrocketing prices of drugs and rising cost of health services Selective intervention approach instead comprehensive primary health care Measure diseases in terms of cost effectiveness Techno centric approach( emphasis on content instead processes)

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Contradictions

India has the largest numbers of medical colleges in the world It produces the largest numbers of doctors among developing countries It gets medical Tourists from developed countries This country is fourth largest producer of drugs by volume in the world
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But... the current situation.

Only 43.5% children are fully immunised. 79.1% of children from 6 months to 5 years of age are anaemic. 56.1% ever married women aged 15-49 are anemic. Infant Mortality Rate is 58/1000 live births for the country with a low of 12 for Kerala and a high of 79 for Madhya Pradesh. Maternal Mortality Rate is 301 for the country with a low of 110 for Kerala and a high of 517 for UP and Uttaranchal in the 2001-03 period. Two thirds of the population lack access to essential drugs. 80% health care expenditure born by patients and their families as out-of -pocket payment (fee for service and drugs) Health inequalities across states, between urban and rural areas, and across the economic and gender divides have become worse Health, far from being accepted as a basic right of the people, is now being shaped into a saleable commodity Prepared by Suvash Regmi

Contd.

poor are being excluded from health services Increased indebtedness among poor (Expenditure on health care is second major cause of Indebtedness among rural poor) Difference across the economic class spectrum and by gender in the untreated illness has significantly increased Cutbacks by poor on food and other consumptions resulting increased illnesses and increasing malnutrition
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Health Inequities

The infant mortality Rate in the poorest 20% of the population is 2.5 times higher than that in the richest 20% of the population A child in the Low standard of living economic group is almost four times more likely to die in childhood than a child in a better of high standard living group A person from the poorest quintile of the population, despite more health problems, is six times less likely to access hospitlisation than a person from richest quintile.
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Health Inequities

A girl is 1.5 times more likely to die before reaching her fifth birthday The ratio of doctors to population in rural areas is almost six times lower than that for urban areas. Per person, government spending on public health is seven times lower in rural areas compared to government spending urban areas
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Diseases such as dengue fever, hepatitis,tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs. And in 2011, India finally developed a totally drug-resistant form of tuberculosis. India is ranked 3rd among the countries with the most number of HIV-infected. Diarrheal diseases are the primary causes of early childhood mortality. These diseases can be attributed to poor sanitation and inadequate safe drinking water in India. However in 2012, India was polio free for the first time in its history.
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Thank You.
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