Since beginning of this century a large number of policy
changes and initiative has been taken in healthcare sector of India. This had
led to certain changes in healthcare infrastructure and population health
status of the country. During the same time most other nations of the world has
also done significant work in the field of healthcare. So how did India perform
in healthcare in comparison to other countries that are economically similar to
India? Based on the data from World Bank’s, world development indicators and
WHO’s, Global health observatory data repository, I did a study to make this
comparison, which was published in a healthcare research journal. The findings
from this study are interesting and worth sharing with healthcare
professionals.
For the sake of brevity, I have skipped the detailed design
and methodology of the study (those interested can contact me for full paper).
In brief however, the comparison was done between performance of India and overall
performance of ‘Lower Middle Income Economies (LMIC)’ (as India falls in this
category). Along-side a comparison with neighbouring countries (Pakistan,
Sri-Lanka, Bhutan and Bangladesh) was also done. The parameters compared were
healthcare infrastructure and health status of the population and within each parameter
a group of indicators were chosen. The timeframe used for comparison was from
year 2000 to 2015. The findings and learnings from the study are as follows.
Performance in healthcare infrastructure:
The study found that India
had outperformed the overall LMIC in all selected indicators related to
healthcare infrastructure. The present status however is still below the overall
LMIC. Achievements and comparisons in specific are given table below and description
after the table.
(LMIC – Lower middle
income countries, OOP – Out of pocket expenditure)
Findings Related to Health Infrastructure
S.N.
|
Indicator
|
Country
|
India
|
LMIC
|
Pakistan
|
Bangladesh
|
Sri Lanka
|
Bhutan
|
1
|
Per
Capita Expenditure on healthcare
|
2000
|
89
|
99.3
|
80.6
|
29
|
148.7
|
192.7
|
2013
|
215
|
233.5
|
126.3
|
95.3
|
304.1
|
275.5
|
||
% Increase
|
142%
|
135%
|
57%
|
229%
|
105%
|
43%
|
||
2
|
OOP
as percentage of total private expenditure of health
|
2000
|
91.8
|
79.3
|
81
|
97.4
|
80.8
|
100
|
2013
|
85.8
|
76.6
|
86.7
|
93
|
82.9
|
97.1
|
||
% reduction
|
6
|
2.7
|
-5.7
|
4.4
|
-2.1
|
2.9
|
||
3
|
Physician
density (per 1000 population)
|
2000
|
0.54
|
0.84
|
0.64
|
0.23
|
0.42
|
0.05
|
2012
|
0.7
|
0.79
|
0.82
|
0.35
|
0.68
|
0.25
|
||
% Increase
|
29%
|
-6%
|
28%
|
54%
|
59%
|
408%
|
||
4
|
Nurse
and Midwife density (per 1000 population)
|
2006
|
1.34
|
4.35
|
0.3
|
0.28
|
1.32
|
0.22
|
2010
|
1.6
|
1.42
|
0.57
|
0.22
|
1.64
|
0.98
|
||
% Increase
|
19%
|
-67%
|
90%
|
-21%
|
24%
|
345%
|
||
5
|
Hospital
Bed density (per 1000 population)
|
2000
|
0.9
|
3.3
|
1.2
|
0.3
|
2.9
|
1.7
|
2012
|
0.7
|
1.43
|
0.6
|
0.6
|
3.6
|
1.8
|
||
% Increase
|
-22%
|
-57%
|
-50%
|
100%
|
24%
|
6%
|
- A remarkable achievement of India has been significant increase in per capita healthcare expenditure. From a status which was much below overall LMIC at beginning of the century, India is now in a much better situation. But, still there is a long way to go. Sri Lanka and Bhutan has much better per capita expenditure in healthcare than India.
- Similarly, in OOP share in total private healthcare expenditure, although India is much below the overall LMIC, significant improvement in reducing it is a good sign for future healthcare scenario. Most developed economies with better healthcare status, have OOP share between 20 to 50 percent. Thus India should continue making efforts to reduce it further.
- In physician density and nurse-midwife density, while there has been a remarkable decrease in overall LMIC, India could have achieved better results. While nurse and midwife density now fares better than overall LMIC and most other neighbouring countries, physician density is something in which India needs more progress. Compared to global average of 2.5 per 1000 and WHO recommendation of 3.5 per thousand, India still has to make a lot more progress in this area
- Hospital bed density actually reduced in overall LMIC since 2000. High increase in population in the period could be one of the reason of reduction in bed density. However, the reduction in India is lower than overall LMIC, indicating that India added comparatively more hospital beds. Private hospital seems to have played a major role in keeping up the bed density, by increasing its share of beds from 49% to 63% (Mc Kinsey). But Bangladesh, Sri Lanka and Bhutan did a better job and India can take their achievement as benchmark in this indicator. Also the present bed density is less than half of overall LMIC and India should keep a feasible time limit by which the gap should be significantly reduced.
Performance in population health status
Compared to the achievement of India in health
infrastructure, its achievements in health status has been less impressive. In
almost all indicators studied, India’s progress has been similar or just slightly
better to overall LMIC. Specific comparison is given in table below and
description after table.
(IMR – Infant
Mortality Rate, U5MR – Under 5 Mortality Rate, MMR – Maternal Mortality Ratio)
Findings Related to Health Status
S.N.
|
Indicator
|
Country
|
India
|
LMIC
|
Pakistan
|
Bangladesh
|
Sri Lanka
|
Bhutan
|
1
|
Infant
Mortality Rate
|
2000
|
66.5
|
65.8
|
87.9
|
64.4
|
14
|
58.9
|
2013
|
41.4
|
43.4
|
69
|
33.2
|
8.2
|
29.7
|
||
% Decrease
|
37.70%
|
34.00%
|
21.50%
|
48.40%
|
41.40%
|
49.60%
|
||
2
|
Maternal
Mortality Ratio
|
2000
|
370
|
384
|
280
|
340
|
55
|
390
|
2013
|
190
|
235
|
170
|
170
|
29
|
120
|
||
% Decrease
|
48.60%
|
38.70%
|
39.30%
|
50.00%
|
47.30%
|
69.20%
|
||
3
|
Under
5 years age mortality rate
|
2000
|
91.4
|
92.4
|
112.6
|
88.1
|
16.3
|
79.4
|
2013
|
52.7
|
57.8
|
85.5
|
41.1
|
9.6
|
36.2
|
||
% Decrease
|
42.30%
|
37.40%
|
24.10%
|
53.30%
|
41.10%
|
54.40%
|
||
4
|
Adult
Mortality Rate
|
2000
|
234.7
|
233.9
|
188.2
|
172.9
|
172.4
|
294.8
|
2013
|
196.1
|
195.23
|
171.4
|
138
|
132.1
|
211.8
|
||
% Decrease
|
16.40%
|
16.50%
|
8.90%
|
20.20%
|
23.40%
|
28.20%
|
||
5
|
Life
expectancy at birth
|
2000
|
62.2
|
62.8
|
63.9
|
65.3
|
71.2
|
60.3
|
2013
|
66.5
|
66.6
|
66.6
|
70.7
|
74.2
|
68.3
|
||
% Decrease
|
6.90%
|
6.10%
|
4.20%
|
8.30%
|
4.20%
|
13.30%
|
- India’s marginally better reduction in IMR and U5MR than overall LMIC and neighbouring countries indicates that India could do more in this area. At present level, it looks difficult that India would achieve the millennium development goals (MDG) of IMR of 27 and U5MR of 42 by the year 2015. Hence re-looking at the efforts of child health programmes is needed to boost these indicators further.
- Achievements in MMR appears to be much better than overall LMIC but its present situation is worst amongst all neighbouring countries. Similar to IMR and U5MR, MMR may also not be able to meet MDG target of 109 by year 2015. Hence along with child health, maternal health requires equal focus and efforts.
- India’s achievement in reducing adult mortality rate and increasing life expectancy at birth is also not impressive with just slightly better values than overall LMIC. The present status also fares slightly poorer. Thus looking into the specific reasons needs to be done immediately.
A combined look at India’s situa improvements have been achieved in both parameters, it has been
specifically better in healthcare infrastructure. This may ultimately lead to even
better health status in near future. The
findings that India do not have remarkable edge over its neighbouring
counterparts in achievements either in health infrastructure and health status indicates
that India could do better.
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