Emedinews : The Indian Health Sector: Where are we after 64 years of independence?

This year we will be completing 64 years of independence. These years have witnessed several ups and downs in the field of health. Smallpox and guinea warm disease were eradicated from India.  The last case of guinea worm disease (Dracunculiasis) was reported in July 1996 from Jodhpur, Rajasthan.

But, post independence a lot of new diseases have come up in India. These are: HIV/AIDS, SARS, Bird Flu, Dengue, Chikungunya and H1N1 Flu (Swine Flu).  There was also a resurgence of many diseases like plague and dropsy.  There has been a resurgence of malaria. India is almost free from polio. We are on the path of eradicating Polio. Will this occur in the coming 2 to 3 years or will it take longer? Only the time will tell.

In terms of lifestyle diseases, India has taken the top spot.  Coronary artery disease, hypertension and diabetes have almost tripled in the last three decades. The new epidemics of the society are potbelly obesity, diastolic failure, left arterial failure, atrial fibrillation, metabolic syndrome, polycystic ovarian disease, non-alcoholic static hepatitis, diabetes, hypertension, coronary artery disease etc.

Since independence, the life expectancy has risen from 33 to 64% (2009); infant mortality has declined from 146 to 50/1000 live births (2009); under-5 year mortality rate has also declined from 236 to 69/1000 life births (2009).  Crude death rate has reduced from 27 to 9 and maternal mortality rate has reduced from 1321 to 252 per 100,000 life births.

The hospital strength has increased from 2694 in 1947 to 13692 in 1993.  Hospitals’ beds have increased from 117000 to 692030 (1993) and from 6600 dispensaries to 279403 (1993).  The prevalence of leprosy has also declined from 57 per 1000 in 1981 to 3.74 per 10,000 in 2001.  It is expected to have this prevalent less than 0.5/1000 in the next five year plan.  The number of elderly people is also increasing.  The number for the age of 60 was 19.61 million (5.5% of the population) and the same number in 2001 was 75.93 million (7.43% of the population).  17% of the population was residing in urban areas in the year 1947, and the same has increased to 28% in 2001.

Another problem that has surfaced in a big way is the rising trend of multi drug resistance. Multi drug resistance is common in diseases like Typhoid, Malaria, TB, HIV/AIDS, and hospital-acquired infections.  NDM1 bacteria are the newest entrant to the kitty of drug resistant bugs, the so called super bugs.  

 Unfortunately, the country has not been able to eradicate or reduce the incidence of rheumatic heart disease or most of the communicable diseases.  They still remain the number one cause of mortality in the country.

 In the urban areas, there has been a change in the trend of cancers.  Once, cancer of cervix was the leading cause; it has now been surpassed by breast cancer in the urban areas.  And in men, cancer of lung has overtaken as the number one cancer in urban areas with cancer of oral cavity taking the second spot.

With large number of tertiary hospitals and reverse brain drain from the West, medical tourism is booming in India.  Medical tourism is attracting a large number of patients from Pakistan, Afghanistan, Nigeria and other Asian and African countries.  The time is not far when even patients from the West will prefer India as the medical destination.

In 1947, there was hardly any medical technology available in India, but today any technology launched in the US is available in India within next three months.  The same is true as regards devices and the medicines.

But there is still a long way to go before health care is available to all Indians.