Eleventh Five Year Plan

Health and Family Welfare and AYUSH 61infant and maternal mortality, and diseases (NationalCommission on Macroeconomics and Health, NCMH,2005). The challenge is to provide these areas withaccess to low-cost public health interventions such asuniversal immunization services and timely treatment.These States are also the ones that have acute crises ofhuman and financial resources.3.1.16 Public health care system in rural areas in manyStates and regions is in shambles. Extreme inequalitiesand disparities persist both in terms of access to healthcare as well as health outcomes (Table 3.1.3). Thislarge disparity across India places the burden on thepoor, especially women, scheduled castes, and tribes.Inequity is also reflected in the availability of publicresources between the advanced and less developedStates.3.1.17 Urban growth has led to increase in number ofurban poor. Population projections postulate that slumgrowth is expected to surpass the capacity of civicauthorities to respond to their health and infrastructureneeds. As per 2001 census, 4.26 crore lived inurban slums spread over 640 towns and cities. Thenumber is growing. Though the coverage of healthand family welfare services in urban areas is muchbetter than the rural, lack of water and sanitation andthe high population density in slums leads to rapidspread of infections. These settlements have highincidence of vector-borne diseases, asthma, tuberculosis,malaria, coronary heart diseases, diabetes, etc.Poor housing conditions, exposure to heat and cold,air and water pollution, and occupational hazards addto the environmental risks for the poor. They are vulnerableas they have no backup savings, food stocks,or social support systems to tide over the crisis ofillness. Despite the presence of many private andgovernment hospitals in urban areas, a large chunk ofthe homeless and those living in slums or temporarysettlements are left out of the proper health care system.Thus, even though there is a concentration ofhealth care facilities in urban areas, the urban poorlack access; initiatives in the country to date have beenlimited and fragmented.Disease Burden3.1.18 India is in the midst of an epidemiological anddemographic transition with increasing burden ofchronic diseases, decline in mortality and fertilityrates, and ageing of the population. An estimated2–3.1 million people in the country are living with HIV/AIDS, a communicable disease, with a potential toundermine the health and developmental gains Indiahas made since Independence. Non-communicablediseases (NCDs) such as cardiovascular diseases(CVDs), cancer, blindness, mental illness, etc., haveimposed the chronic disease burden on the alreadyover-stretched health care system of the country. TheNCMH 2005 figures of disease burden are given inTable 3.1.4.COMMUNICABLE DISEASES3.1.19 AIDS is acquiring a female face, that is, graduallythe gap between females and males is narrowing asfar as number of cases and infections are concerned.The youth are becoming increasingly vulnerable. Theprevalence rate of more than 1% amongst pregnantwomen was reported from five States, that is, AndhraPradesh, Maharashtra, Karnataka, Manipur, andNagaland. GoI responded to HIV/AIDS threat bypreventive awareness, targeted interventions, andcare and support programmes. As on 31 December2006, a total of 162257 cases of AIDS were reported.The risk of tuberculosis infection in HIV positiveTABLE 3.1.3Urban/Rural Health IndicatorsCrude Birth Rate Crude Death Rate IMR (per 1000 Prevalence of Anaemia Prevalence of Anaemia(per 1000) (per 1000) live births) among Children (6–35 among Pregnantmonths) (%) Women (%)Urban 19.1 6.0 40 72.7 54.6Rural 25.6 8.1 64 81.2 59.0Total 23.8 7.6 58 79.2 57.9Source: Ministry of Health and Family Welfare (MoHFW), GoI (2006) and NHFS-3, IIPS (2005–06).