Eleventh Five Year Plan

Health and Family Welfare and AYUSH 67Box 3.1.1Drawbacks of the Public Health System• Centralized planning instead of decentralized planning and using locally relevant strategies• Institutions based on population norms rather than habitations• Fragmented disease specific approach rather than comprehensive health care• Inflexible financing and limited scope for innovations• Semi-used or dysfunctional health infrastructure• Inadequate provision of human resources• No prescribed standards of quality• Inability of system to mobilize action in areas of safe water, sanitation, hygiene, and nutrition (key determinants of healthin the context of our country)—lack of convergence• Inability to mobilize AYUSH and RMPs and other locally available human resourcesBox 3.1.2Vertical ProgrammesTechnology-centric• See the disease as being caused by an agent (parasite/virus/bacteria) and fail to see its social and ecological setting.• Response is heavily dependant on technology.Fragmented• Only one or two of all the factors that go into the disease setting (and that too in isolation) are addressed.Administration• The entire planning and packaging is done centrally.• Only local aspect is the application (under a chain of command).• Limited role for community participation.The Result• An inappropriate package for local needs.• Local people are indifferent—sometimes even resistant.• Even the administration cannot in perpetuity keep its attention on the programme alone.Growth of Private Sector, Health CareUtilization, and Cost3.1.33 The growth of private health sector in India hasbeen considerable in both provision and financing.There is diversity in the composition of the privatesector, which ranges from voluntary, not-for-profit,for-profit, corporate, trusts, stand-alone specialistservices, diagnostic services to pharmacy shops and arange of highly qualified to unqualified providers, eachaddressing different market segments.3.1.34 We have a flourishing private sector, primarilybecause of a failing in the public sector. The growthof private hospitals and diagnostic centres was alsoencouraged by the Central and State Governments byoffering tax exemptions and land at concessional rates,in return for provision of free treatment for the pooras a certain proportion of outpatients and inpatients.Apart from subsidies, private corporate hospitalsreceive huge amounts of public funds in the form ofreimbursements from the public sector undertakings,the Central and the State Governments for treatingtheir employees.3.1.35 The cost of health care in the private sectoris much higher than the public sector. Many smallproviders have poor knowledge base and tend to followirrational, ineffective, and sometimes even harmfulpractices for treating minor ailments. Bulk of thequalified medical practitioners and nurses are subjectto self-regulation by their respective State MedicalCouncils under central legislation. In practice, however,regulation of these professionals is weak and closeto non-existent.