Eleventh Five Year Plan

Health and Family Welfare and AYUSH 65Notes: TB = Tuberculosis, MO = Medical Officer, MCH = Maternal and Child Health.FIGURE 3.1.8: NRHM–Illustrative Structureprivate sector but in 2002, the country had 11345private/NGO hospitals (allopathic) with a capacity of262256 beds. These are mostly in the private sectorlocated in cities and towns.Drawbacks of the Public Health System3.1.32 The public health system in our country hasvarious drawbacks (see Box 3.1.1). The conceptualizationand planning of all programmes is centralizedinstead of decentralized using locally relevant strategies.The approach towards disease control and preventionis fragmented and disease-specific rather thancomprehensive. This leads to vertical programmes foreach and every disease. These vertical programmesare technology-centric and work in isolation ofeach other (Box 3.1.2). The provision of infrastructureis based on population norms rather than habitationsleading to issues of accessibility, acceptability, andutilization. Inadequate resources also lead to lack ofclient conveniences and non-availability of essentialconsumables and non-consumables. The gap betweenrequirement and availability of human resources atvarious levels of health care is wide and where they areavailable, the patient–provider interactions are besetwith many problems, in addition to waiting time(opportunity cost) for consultation/treatment. Thesystem lacks a real and working process of monitoring,evaluation, and feedback. There is no incentivefor those who work well and check on those who donot. Quality assurance at all levels is not adhered todue to lacunae in implementation. This results in semiusedor dysfunctional health infrastructure. There islack of convergence with other key areas affectinghealth as the system has been unable to mobilizeaction in areas of safe water, sanitation, hygiene, andnutrition. Despite constraints of human resources,practitioners of Indian Systems of Medicine (ISM),Registered Medical Practitioners (RMPs), and otherlocally available human resources have not been adequatelymobilized and integrated in the system.