The Central Bureau of Health Intelligence (CBHI) has released the National Health Profile (NHP) 2019 and it is a sobering state of Indian health with some things to cheer.
- The information that NHP provides is essential for health system policy development and governance, health research, health education, training and human resource development.
- It covers indicators such as socio-economic, demographic, health status, health finance, human resources and healthcare infrastructure.
- It allows for evidence-based interventions by the government and the effective implementation of various programmes.
- It is also one of the few reports that provide a detailed profile of the prevalence of communicable and noncommunicable diseases in the country.
- Here are some important insights from NHP 2019.
- As per NHP, the country has registered an improvement in sex ratio.
- For every 1000 males, there are 943 females in 2011. In 2001, the sex ratio was 933.
- In rural areas, it has increased to 949 from 946.
- In urban areas, it is an increase of 29 points from 900 to 929.
- Kerala has the highest sex ratio for the total population – 1084, it is 1078 for rural areas and 1091 for urban areas.
- Chandigarh has the lowest sex ratio in rural areas at 690.
Birth and Death Rate
- As per the report, there is a decline in birth and death rate in the country.
- From 25.8 in 2000, the birth rate declined to 20.4 in 2016. Similarly, the death rate declined to 6.4 per 1000 population from 8.5 over the same period.
- Also, the natural growth rate declined from 17.3 in 2000 to 14 in 2016.
- In 2017, the birth rate was 20.2 per 1000 population and the death rate was 6.3.
- The natural growth rate was 13.9.
Total Fertility Rate
- TFR or Total Fertility Rate that is the average number of children that will be born to a woman during her lifetime has fallen in 12 states below the two-child norm.
- Nine states have replacement levels of 2.1 or above.
- The lowest fertility rate is among Delhi, Kerala and West Bengal.
- From 49.7 years in 1970-75, the life expectancy in the country has increased to 68.7 years in 2012-16.
- In the same period, it is 70.2 for females and 67.4 years for males.
- The highest population density is in Delhi NCR with 11,320 people per square kilometre.
- The lowest is in Arunachal Pradesh at 17 per square kilometre.
- According to the survey, there is a high incidence of the young and economically active population in the country.
- In 2016, 27% of the estimated population is below 14 years.
- The majority of the population – 64.7% – is in the age group of 15-59 years. This is an economically active group.
- The elderly population in the age group of 60-85 is 8.5% of the total population.
- The survey notes that despite a decline in birth rate and natural growth rate, the population of the country is increasing. This is because the decline in birth rate is not as rapid as the death rate.
Infant Mortality Rate
- The Infant Mortality Rate (IMR) declined to 33 per 1000 live births in 2016. But there is a gap in rural and urban areas.
- While it is 37 in rural areas, in urban areas it is 27.
- As per the report, of the total disease burden of the country, non-communicable diseases (NCD) dominate over communicable diseases.
- The survey notes that, of the 6.51 crore people who visited an NCD clinic, 4.75% of them have diabetes, 6.19% have hypertension, 0.3% are diagnosed with cardiovascular diseases, 0.26% have common cancers and 0.10% are diagnosed with a stroke.
- On the communicable diseases, the survey noted that the prevalence of malaria has declined in the country between 2012 and 13. But, there was a rise in 2014 and 2015 and began to decline from 2015.
- The number of deaths due to malaria was high (77,140 cases and 26 deaths) in Chattisgarh, the report noted.
- Other communicable diseases like Dengue and Chikungunya, are a great public health threat to India, the report noted.
- The diseases transmitted by Aedes mosquitoes are adding to the healthcare burden of the country.
- In 2014, there was a considerable decrease in swine flu cases/deaths compared to 2012 and 2013. But, it increased sharply in 2015 and decreased again in 2016. In 2017 and 18, there was an increase again.
- As per the survey, 4.13 lakh people died due to accidental injuries in 2015 and 1.33 lakh people due to suicide in the same year.
- The suicide deaths are a cause for concern as it is significantly high among the young population of the country. 44,593 suicide cases were reported for the age group of 30-45 years.
- Death due to snake bites – 1.64 lakh.
- There are 2.68 crore disabled persons in the country.
- As per the health manpower data of the NHP, there are 11,54,686 allopathic doctors in the country up to 2018.
- The total registered Dental surgeons are at 2,54,283 and an increasing trend has been noted between 2007 and 2018.
- The registered AYUSH Doctors in the country as of January 2018 was 7,99,879
Health Spend As a % of GDP
- According to the survey, public health spend as a % of GDP has increased by just a few percentage points between 2009-10 and 2017-18.
- While it was 1.12% of GDP in 2009-10, it is 1.28% in 2017-18. The increase is a meager 0.16 %.
- In nominal terms, from Rs 621 in 2009-10, it has increased to Rs 1,657 in 2017-18.
- The report also points to inequity in access to healthcare in the country.
From the data provided by the NHP 2019, not all things rosy with the status of Indian healthcare. The most shocking thing is the low levels of public health expenditure at a time when the government is claiming to provide Universal Health Coverage through Ayshman Bharat.
As per the report, the per capita public healthcare expenditure of the country is $16. Compare this with Norway’s $6,366, Japan’s $3,538, and Brunei Darussalam’s $ 599 (the data is sourced from the Global Health Expenditure Database of the World Health Organisation). India has much catching to do.
The out of pocket expenditure is high in the country and as reported in the NHP there is high inequity in access to quality healthcare.