Primary Health Care in India: Coverage and Quality Issues

Abstract

India’s achievements in the field of health have been less than satisfactory and the burden of disease among the Indian population remains high. Infant and child mortality and morbidity and maternal mortality and morbidity affect millions of children and women. Infectious diseases such as malaria and especially TB are reemerging as epidemics, and there is the growing specter of HIV/AIDS. Many of these illnesses and deaths can be prevented and/or treated cost-effectively with primary health care services provided by the public health system. An extensive primary health care infrastructure provided by the government exists in India. Yet, it is inadequate in terms of coverage of the population, especially in rural areas, and grossly underutilized because of the dismal quality of health care provided. In most public health centers which provide primary health care services, drugs and equipments are missing or in short supply, there is shortage of staff and the system is characterized by endemic absenteeism on the part of medical personnel due to lack of oversight and control. As a result most people in India, even the poor, choose expensive health care services provided by the largely unregulated private sector. Not only do the poor face the double burden of poverty and ill-health, the financial burden of ill health can push even the non-poor into poverty. On the other hand, population health is instrumental for both poverty reduction and for economic growth, two important developmental goals. India spends less than 1% of its GDP on public health, which is grossly inadequate. Public investment in health, and in particular in primary health care, needs to be much higher to achieve health targets, to reduce poverty and to raise the rate of economic growth. Moreover, the health system needs to be reformed to ensure efficient and effective delivery of good quality health services. Nirupam Bajpai is a Senior Development Advisor and Director of the South Asia Program at the Center on Globalization and Sustainable Development, Columbia University. Sangeeta Goyal is a visiting Assistant Professor at the School of International and Public Affairs at Columbia University. This paper has been prepared for the United Nations Millennium Project on the Millennium Development Goals. Nirupam Bajpai presented this paper to His Excellency, Dr. A P J Abdul Kalam, President of India, the Honorable Dr. Manmohan Singh, Prime Minister of India, Dr. Anbumani Ramadoss, Health Minister of India and P Chidambaram, Finance Minister of India during his two day visit to New Delhi on June 17 and 18, 2004.