JANUARY

INDIA
To ensure quality of medical education, a common national entrance exam is being debated. A licentiate exam
will be introduced for all medical graduates, with renewal at periodic intervals (MOH, 2014).
Although there has been some progress made and new legislation introduced, progress in government
regulation has been slow and implementation challenging (MOH, 2014; Gudwani et al., 2012), and there is no
single government authority responsible to ensure quality of care (Wennerholm, 2013). Although the Clinical
Establishments (Registration and Regulation) Act is one of the most important, far-reaching pieces of public
health legislation enacted to date, its effective and uniform implementation in each state remains to be seen.
What is being done to reduce disparities?
Significant inequalities with respect to health care access and health outcomes exist between states, rural and
urban areas, socioeconomic groups, castes, and genders. For example, the infant mortality rate is 48 per 1,000
live births in rural areas, while it is 29 in urban areas (Save the Children, 2013). With respect to access, it is
estimated that the urban rich obtain 50 percent more health services than the average Indian citizen (Gudwani
et al., 2012). And the number of government hospital beds per population in urban areas is more than twice the
number in rural areas (Balarajan et al., 2011), and urban areas have four times more health workers per
population (Planning Commission of India, 2011).
Recognizing the lack of a comprehensive national health care system as an important factor in health
inequalities, the government views universal coverage through the National Health Mission as the main strategy
to address the problem, along with a strengthening of the primary health care infrastructure in both rural and
urban areas.
While there is no single agency responsible for ensuring that health inequalities are reduced, a number of new
initiatives have been launched on behalf of low socioeconomic groups and other vulnerable populations.
For example, with respect to maternal care, there is the Janani Suraksha Yojana, which provides mothers with
cash incentives for institutional delivery, transportation in case of emergency, and additional incentives for
accredited social health activists. Another initiative is expanding the use of information and communication
technology in an attempt to increase rural Indians’ access to health services.
Broadly, there is growing recognition about the need to address the growing burden of noncommunicable
diseases, which are responsible for two-thirds of the total morbidity burden and just over half of deaths (WHO,
2015). Starting in 2013–14, the National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Strokes is being implemented in 35 states and union territories (MOH, 2015a).
It must be emphasised, however, that the effort against these diseases is still in its initial stages.
What is the status of electronic health records?
The establishment of a composite health information system (HIS) is proposed in the government’s 12th fiveyear
plan. The HIS will be based on adoption of national electronic health record standards, linked systems at
the state and national levels, issuance of a unique health card to every citizen, and creation of a national health
information center (MOH, 2015a).
States can develop systems to suit their needs and priorities, as long as they are consistent with standards set
by the new National eHealth Authority (NeHA). NeHA will be the nodal authority responsible for development
of the HIS and for enforcing the laws and regulations relating to privacy and security of patient health
information and records (MOH, 2015b).
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