15 May 2017

How India performed in healthcare compared to other similar nations?

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.
Overall it could be stated that in health infrastructure, while India is doing better than overall LMIC, it need to do a lot more to bring its status at par and to improve its position world-wide.

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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4 comments:

  1. Very informative sir. May I request you to please send the full paper on my email id –ritesh.laddha@gmail.com

    Thanks in anticipation

    Regards,
    Ritesh

    ReplyDelete
    Replies
    1. Thanks. Have emailed you the full paper.

      Delete
  2. Dr Arif, very informative, keep it up

    Dr Shailesh Tripathi

    ReplyDelete