Health Status and Problems in India

Health Status and Problems in India

An assessment of the health status and health problems is the first requisite for any planned effort to develop health care services. This is also known as community diagnosis. Healthcare in India features a universal health care system run by the constituent states and territories of India. The Constitution charges every state with "raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties" The data required for analysing the health situation and for defining the health problems comprise as of following.

1. Morbidity and mortality statistics

2. Demographic conditions of the population

3. Environmental conditions which have a bearing on health

4. Socio-economic factors which have a direct effect on health

5. Cultural background, attitudes, beliefs and practices which affect health

6. Medical and health services available

Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies.

Most current health care systems are based on responding to acute problems, urgent needs of patients, and pressing concerns. Testing, diagnosing, relieving symptoms, and expecting a cure are hallmarks of contemporary health care. While these functions are appropriate for acute and episodic health problems, a notable disparity occurs when applying this model of care to the prevention and management of chronic conditions. Preventive health care is inherently different from health care for acute problems, and in this regard, current health care systems worldwide fall remarkably short.

The health problems of India may be conveniently grouped under the following heads:

1. Communicable disease problems

2. Nutritional problems

3. Environmental sanitation problems

4. Medical care problems

5. Population problems

India is undergoing an epidemiologic, demo-graphic and health transition. The expectancy of life has increased, with consequent rise in degenerative diseases of aging and life-styles. Nevertheless, communicable diseases are still dominant and constitute major public health issues.

The emergence of chloroquin resistance in P.falciparum and vector resistance to commonly used insecticides are the main obstacles in the control of malaria in the country. New technologies are being introduced for malaria control under Enhanced Malaria Control Programme. The roll back malaria programme has been launched simultaneously in all malaria endemic countries. These have thrown new challenges in malaria research. The Council's institutes viz. Malaria Research Centre (MRC), Vector Control Research Centre (VCRC) and other institutes are making efforts to address these problems through focused research in vector and parasite biology and ecology, development of malaria control tools, drug development, testing and validation of new technologies.

The Council's Vector Control Research Centre (VCRC) at Pondicherry and RMRC, Bhubaneswar have focused their research in the field of vector biology and control, clinical epidemiology and chemotherapy, applied field research and product development. It is identified in the 13 districts of 7 endemic states, namely, AP, Bihar, Kerala, Orissa, TN, UP, WB, covering about 41 million infected persons. The Centre has geared its activity towards transferring the technical know-how to the field for optimum and appropriate application for elimination of filariasis so that latest technical knowledge is absorbed into the Programme.

Tuberculosis accounts for a loss of approximately 11 million disability adjusted life years (DALYs). The burden of disease may increase further with the emergence of the HIV epidemic. Approximately 1.8 million new cases of which about 0.8 million are highly infectious smear positive are reported every year. About 4.17 lakh persons die of TB every year in the country.

The Revised National TB Control Programme (RNTCP) which covers more than 120 million population has successfully treated approximately 80% of patients in 48 districts of 16 states and Union Territories. Treatment success rates have more than doubled and death rates have decreased by 75 per cent. The ICMR's Tuberculosis Research Centre (TRC) at Chennai is providing research support to the RNTCP through the conduct of basic, applied and operational research to develop better tools and training strategies for tuberculosis control.

As a result of the introduction of multidrug therapy (MDT) in the national disease control programme, 98 of 122 countries have reached the goal of elimination of leprosy as a public health problem. However, the prevalence of leprosy in India is still around 5/10,000 population. Leprosy : The leprosy prevalence rate for the country as a whole is estimated at 2.4 per 10,000 population during 2004.

Kala-azar is a major public health problem in the states of Bihar, West Bengal and Uttar Pradesh. Cases have also been reported in Delhi. It is serious public health problem in Bihar and West Bengal. Kala-Azar cases reported- 17,806 cases with 72 deaths ('86); 14,753 with 150 deaths (2000); 12,120 cases with 212 deaths in 2001 ;) and 11845 cases with 164 deaths in 2002. However, up to April 2003, 4161 cases and 49 deaths were reported. Research on various aspects of kala-azar is being conducted mainly through the Council's Rajendra Memorial Research Institute of Medical Sciences (RMRI) at Patna and various extramural projects. New research areas such as development of DNA/RNA diagnostic probes and their use in mapping of the distribution of the parasite in kala-azar endemic areas and epidemiological modelling have been identified recently. A Leishmania parasite bank has been established. Clinical trials of different combinations of existing drugs for the treatment of kala-azar are being undertaken to optimize the drug dosages and minimize the associated side reactions.

The National Institute of Cholera and Enteric Diseases (NICED), Calcutta and RMRC, Bhuban-eswar continued to pursue their research goals on different facets of diarrhoeal diseases. The NICED, Calcutta has earned an important affiliation with the Japanese International Collaborating Programme. Its active surveillance programme continues to monitor the newly emerging diarrhoeal pathogens and addresses unknown frontiers in clinical diagnosis and disease management.

The four metro cities (Delhi, Mumbai, Calcutta and Chennai) have a high incidence of paralytic poliomyelitis. Urban slums are the main breeding ground of the poliovirus. Eradication of poliomyelitis from these cities is considered difficult because of the high population density, large slum population and also because these cities attract patients from all over the country for treatment.

The human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) is increasing in India. ICMR's research activities have helped to understand the problem of HIV/AIDS and have contributed in formulating strategies for the control and management of the disease. A prospective cohort of HIV seronegative persons attending STD clinics gave the first reliable estimates of incidence of HIV infection in this highrisk population and identified the behavioural and biological risk factors associated with acquiring HIV infection. Presently this cohort is being used for studies on acute pathogenesis and intervention of HIV/AIDS. Basic research including developmental research has been given special importance. High in the priorities are vaccine related virological and immunological studies, development of diagnostic tests for opportunistic infections, testing of drugs for anti-retroviral and immunopotentiating activity and generation of reagent and virus repositories for use in HIV research. HIV infection is unique due to its social aspects. Studies in the social and behavioural sciences have been continuing specially in areas related to women and education, awareness, reproductive health and treatment seeking behaviour. India accounts for 10 percent of the global HIV burden. An estimated 4.58 million men, women and children were living with HIV/AIDS in the country at the end of 2002, with an adult (15-49 years) prevalence rate of 0.8 percent.

Government is implementing the National Blindness Control Programme. About 4.5 million cataracts operation per year up to 2007 are envisaged.

There are about 20-25 lakh cases of cancer and approximately 7-9 lakh cases come up every year. During the Tenth plan, the National Caner Control Programme has been made a Centrally Sponsored Scheme.

Presently, 85 % of rural and 95% of the urban population has access to safe drinking water.

It is a fatal viral disease caused by female Aedes aegypti mosquitoes. First reported in Delhi in 1996 with 10,252 infected cases and 423 deaths. In 2001, 3,188 cases reported and 53 deaths. It is spreading to new areas.

It caused by flavivirus group. In the last five years, it has acquired serious magnitude in 11 states. In 1995, 2974 cases with 942 deaths and in 2002, out of 1464 cases 361 deaths, were reported.

From the nutritional point of view, the Indian society is a dual society, consisting of a small group of well fed and a very large group of undernourished. The high income groups are showing diseases of affluence which one finds in developed countries.

The major problems such as Protein Energy Malnutrition, Nutritional Anemia, and Vitamin A deficiency disorder

Ozg Healthcare Project Consultant


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