Good water supply and sanitation is a major input for good health of population - India Health Report 2010

This report is for those interested in India health and health industry status; it provides an excellent introduction-cum-survey.


Shankar Acharya
Last week saw the publication by BS Books of the India Health Report 2010 (henceforth referred to as IHR10), edited (and mostly written) by Ajay Mahal, Bibek Debroy and Laveesh Bhandari. For anyone interested in India’s health status, access to health care and medicines, emerging health problems, the infrastructure of health services, medical ethics, health-care financing, government programmes and regulations and key issues in health sector reform, this 138-page report is an excellent introduction-cum-survey. Here I provide a highly selective summary to whet the appetite of readers to peruse the full report.


The first chapter makes the case for much greater policy attention to health issues. For many years, analysts have noted the close positive correlation between a country’s per capita income and the life expectancy at birth (LEB) of its people, as also the close negative correlation between per capita income and the infant mortality rate (IMR). Until 20 years ago, the general presumption was that economic development and the associated improvement in living standards led to lower IMRs and higher LEBs. Over the past two decades, research has accumulated, indicating that health conditions could be improved substantially even at low income levels through appropriate policy interventions. Thus, China’s IMR in 1980 was only two-fifths the level of India’s at a time when many believed their average incomes were quite similar . Basically, China had already reaped the fruits of sustained attention (during the Maoist decades) to primary health care and integrated rural development with substantial focus on improved water supply and sanitation. In contrast, Indian government policy had accorded much less resources and attention to health care, including public health.

It is also somewhat shaming to note that Bangladesh has achieved a much steeper reduction in IMR between 1980 and 2007 than India, despite significantly lower growth in per capita income in the former.

Health and nutrition go together, especially for children. It presents comparative data for undernutrition over time. While child nutrition has certainly improved in India since 1980, the IHR10 emphasises that the rate of improvement is much less than in Latin America and Asian countries such as China, the Philippines and Sri Lanka.

The IHR10 describes the well known diversity in the socioeconomic record across India’s states. Thus, in 2005-07, the IMR in Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh was around 65-70 per 1,000 live births, as compared to 13 in Kerala, 34 in Maharashtra and 35 in Tamil Nadu. Indeed, IMRs in backward Indian states are quite comparable to many sub-Saharan African countries; not what one might expect from an aspiring economic superpower.

The chapter on access to health care presents very useful data which support a number of important (if not novel) conclusions. First and most obviously, the overwhelming majority of Indians have inadequate access to quality health care. Access is particularly poor for rural households, scheduled tribes and women. Second, private health-care providers predominate in both institutional and non-institutional services. Third, “unqualified” practitioners are in the majority among service providers. Fourth, and distressingly given the above, the bulk of ailments among the poorest quintiles are treated at private facilities. Fifth, about 7-8 per cent of households drop below the poverty line because of medical expenses. Finally, there are critical gaps in healthcare infrastructure, especially in terms of health centres and trained staff.

India Health Report 2010

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