Үндістандағы денсаулық сақталу жүйесі: мәселелер мен перспективалар

Overview of health in India

India's population in 2021 as per World Bank is 1.39 billion. Being the world's most populous country and one of its fastest growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues. The Human Rights Measurement Initiative finds that India is fulfilling 80.5% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, India achieves 92.1% of what is expected based on its current income. The infant mortality rate has declined from 74 per 1,000 live births in 1994 to 37 per 1,000 live births in 2015. However, the differentials of rural (41) and urban (25) as of 2015 are still high. In 2016, the infant mortality rate was estimated to be 34.6 per 1,000 live births.

Obesity in India has grown to epidemic levels in India in the 21st century, with morbid obesity affecting 5% of the population. One factor that may impact the rise of obesity in India is the growing establishment of fast food and mithai shops within India. Fast food is among one of India's largest growing markets, especially amid the COVID 19 pandemic where it saw tremendous growth due to the speed of service and no contact model. Moreover, the rise of food delivery apps such as Zomato and Swiggy in India has allowed access to fast foods on an unparalleled level in India. By increasing the ease of access to such unhealthy foods, Indians are more likely than ever before to choose such options rather than cooking at home. In 2021, the most ordered foods on Swiggy were biryani and paneer butter masala, both of which are highly fattening when ordered from restaurants. Such delivery apps also use what some may consider predatory business tactics to hook customers on to their services. First time customers are offered a month's worth of free delivery and discounts to build their reliance on delivery apps, so even after the trial ends the customers continue paying and ordering food. Even prior to COVID and online food ordering services, fast food has been readily available around the streets of Indian cities, just minutes away from most residential areas. Ever since McDonalds entered India in 1996, numerous fast food chains have followed suit including Dominos, Pizza Hut, Burger King, and KFC.

Diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India due to increased resistance to drugs. In 2011, India reported a 'totally drug resistant' form of tuberculosis India is the highest TB burden country in the world in terms of absolute number of incident cases that occur each year. TB primarily affects people in their most productive years of life. While two thirds of the cases are male, TB takes disproportionately larger toll among young females, with more than 60 per cent of female cases occurring by the age of 34 years. In 2018, the TrueNat test, an indigenously developed technology under the "Make in India" initiative, was deployed in about 350 PHCs. This led to marked increase in access to highly sensitive molecular tests with augmented capacity for resistance testing at the peripheral level. HIV/AIDS in India is ranked third highest among countries with HIV infected patients. National AIDS Control Organisation, a government apex body is making efforts for managing the HIV/AIDS epidemic in India. Diarrheal diseases are the primary causes of early childhood mortality. These diseases can be attributed to poor sanitation and inadequate safe drinking water. India has the world's highest incidence of rabies. Malaria has been a seasonal health problem in India from a very long time. The maximum number of malaria cases and deaths have been reported mostly form the rural parts of Orissa. The overall prevalence of the disease has diminished in 2012 and 2013 however there is a slight increase in 2014 and again started decreasing from 2015. WHO (World Health Organization) adopted a strategy in May 2015, that provides a technical guidance to countries emphasizing the importance of scaling up malaria responses and moving towards elimination of malaria. This is known as The Global Technical Strategy for Malaria (2016 2030) A major scale up of malaria responses will not only help countries reach the health related targets for 2030, but will contribute to poverty reduction and other development goals. Kala azar is the second largest parasitic killer in the world. Most of the cases (76%) were found in Bihar in 2016. Dengue and chikungunya transmitted by Aedes mosquitoes, is another problem of concern in India. Dengue outbreaks have continued since the 1950s but severity of disease has increased in the last two decades. In 2016, India reported a total of 58,264 cases of chikungunya. Chicken pox is a highly contagious and a viral infection which breaks out in many parts of India. Cases were reported to be 61,118 & deaths to be 60 in 2016. In 2012, India was polio free for the first time in its history. This was achieved because of the Pulse Polio programme started in 1995–96 by the government.

India has witnessed huge progress in the health status of its population since independence. The transition has been seen in economic development, nutritional status, fertility and mortality rates and consequently, the disease profile has changed considerably. Although great efforts have been done to control the communicable diseases, but they still contribute significantly to disease burden of the country. Decline in disability and death from communicable diseases has been accompanied by a gradual shift to, and accelerated rise in the prevalence of chronic non communicable diseases such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease, cancers, mental health disorders and injuries. Indians are at particularly high risk for atherosclerosis and coronary artery disease. This may be attributed to a genetic predisposition to metabolic syndrome and adverse changes in coronary artery vasodilation. The burden of the Non Communicable Diseases (NCD) in India with a population of the over 1.3 billion is huge. NCDs in India contributed to 6.8 million deaths in 2019, which is about 67.6% percent of overall deaths. In the same year Ischemic heart disease accounted for highest mortality followed by COPD, Stroke and Diabetes among all NCD related deaths. Starting in early 1990s, there have been wide disparities in terms of NCD burden on Indian diaspora. While life expectancy has increased it is the number of years lost due to ill health, disability or early death (DALY) rate that is almost doubled. It was 29.17% in 1990 and reached 57.92% in 2019 according to IHME. Also NCDs are accounting for more than 90% of total prevalent cases in India at any given point of time. Between ages 15–49 NCDs mortality share was 35.56% in 1990 while the share is increased to 48.95% in 2019

Despite health improvements over the last thirty years, lives continue to be lost to early childhood diseases, inadequate newborn care and childbirth related causes. More than two million children die every year from preventable infections. Approximately 1.72 million children die each year before turning one. The under five mortality and infant mortality rates have been declining, from 202 and 190 deaths per thousand live births respectively in 1970 to 64 and 50 deaths per thousand live births respectively in 2009 and to 41.1 (in 2018) and 34.6 (in 2016) deaths per thousand live births respectively. A study conducted by the Future Health Systems Consortium in Murshidabad, West Bengal indicates that barriers to immunization coverage are adverse geographic location, absent or inadequately trained health workers and low perceived need for immunization. Infrastructure like hospitals, roads, water and sanitation are lacking in rural areas. Shortages of healthcare providers, poor intrapartum and newborn care, diarrheal diseases and acute respiratory infections also contribute to the high infant mortality rate. This was relatively higher than Bangladesh and Brazil (7%) and China (4%). Several million more have multiple episodes of diarrhea and still others fall ill on account of Hepatitis A, enteric fever, intestinal worms and eye and skin infections caused by poor hygiene and unsafe drinking water. Access to protected sources of drinking water improved from 68% of the population in 1990 to 88% in 2008. Breast cancer : One of the most severe and increasing problems among women in India, resulting in higher mortality rates. Maternal mortality : Indian maternal mortality rates in rural areas are one of the highest in the world. and half of all residents of rural areas live below the poverty line, struggling for better and easy access to health care and services. Health issues confronted by rural people are many and diverse – from severe malaria to uncontrolled diabetes, from a badly infected wound to cancer. Postpartum maternal illness is a serious problem in resource poor settings and contributes to maternal mortality, particularly in rural India. A study conducted in 2009 found that 43.9% of mothers reported they experienced postpartum illnesses six weeks after delivery. Furthermore, because of limited government resources, much of the health care provided comes from non profits such as The MINDS Foundation.

India's urban population has increased from 285 million in 2001 to 377 million (31%) in 2011. It is expected to increase to 535 million (38%) by 2026 (4). The United Nations estimates that 875 million people will live in Indian cities and towns by 2050. If urban India were a separate country, it would be the world's fourth largest country after China, India and the United States of America. According to data from Census 2011, close to 50% of urban dwellers in India live in towns and cities with a population of less than 0.5 million. The four largest urban agglomerations Greater Mumbai, Kolkata, Delhi and Chennai are home to 15% of India's urban population.

Analysis of National Family Health Survey Data for 2005–06 (the most recent available dataset for analysis) shows that within India's urban population – the under five mortality rate for the poorest quartile eight states, the highest under five mortality rate in the poorest quartile occurred in UttarPradesh (110 per 1,000 live births), India's most populous state, which had 44.4 million urban dwellers in the 2011 census followed by Rajasthan (102), Madhya Pradesh (98), Jharkhand (90) and Bihar (85), Delhi (74), and Maharashtra (50). The sample for West Bengal was too small for analysis of under five mortality rate. In Uttar Pradesh was four times that of the rest of the urban populations in Maharashtra and Madhya Pradesh. In Madhya Pradesh, the under five mortality rate among its poorest quartile was more than three times that of the rest of its urban population.

Among India's urban population there is a much lower proportion of mothers receiving maternity care among the poorest quartile; only 54 per cent of pregnant women had at least three ante natal care visits compared to 83 per cent for the rest of the urban population. Less than a quarter of mothers within the poorest quartile received adequate maternity care in Bihar (12 percent), and Uttar Pradesh (20 percent),and less than half in Madhya Pradesh (38 percent), Delhi (41 percent), Rajasthan (42 percent), and Jharkhand (48 percent). Availing three or more ante natal check ups during pregnancy among the poorest quartile was better in West Bengal (71 percent), Maharashtra (73 percent).

According to Huffington Post, doctors spoke about the problems with "corporate hospitals" and senior surgeons being told to sell surgeries to their patients even if they weren't needed. In one instance, a doctor was told he would be sacked if he didn't have enough patients to operate on. The majority of India's private, for profit hospitals charge exorbitant costs for medical services and supplies, which has put a strain on the country's public finances.