On the first of this month, the Ministry of Health and Family Welfare released the National Family Health Survey 4 (2015-16). Surveying 601,500 households, 699,686 women and 103,525 men, it manages to paint an improved picture on some critical aspects of family health and the facilities available to households over the last 10 years, between 2015-16 and 2005-06 when the National Family Health Survey 3 was conducted.
For example, water supply in the households and sanitation facilities have become better over the last 10 years. Sanitation improved by 48.4 percent in households compared to 29.1 per cent 10 years ago. But then why has the prevalence of diarrhoea increased? Of course, it is good news that oral rehydration salts administered is much better at 50.6 per cent than 10 years ago when it was 26 per cent in the treatment of diarrhoea.
We all know how critical is the state of general health in the country where there is a real shortage of good public health facilities and doctors. The government spends only 1.4 per cent of the GDP on health as compared to 8 per cent in the United Kingdom and 3 per cent in China. The global average spending on health is 5.99 per cent of the GDP. The poor have to spend from their own pockets if they want treatment from private hospitals. Often, the congestion in public hospitals is so severe that people with low financial means have to borrow in order to get treated in private hospitals. The cost in private hospitals is much higher and there is no regulation regarding charges.
It is heartening to know that there has been a big improvement (from NFHS-3 to NFHS-4) regarding health insurance with any ‘usual member covered by a health scheme or health insurance’ in a household rising from 4.8 per cent to 28.7 per cent.
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Infant mortality rate has come down from 57 to 41 (The Budget figure is 37 per 1000 live births). But children under five years who are severely wasted increased to 7.5 per cent from 6.4 per cent 10 years ago even though children between age of 6 and 59 months who had anaemia decreased. This is in contrast to the increase in obesity among men and women in the last 10 years.
Many women die especially in remote rural areas because they are not treated immediately for complications during childbirth in the primary health centres. Maternal mortality rate is still high as a result. The NFHS does not give any statistic on it. More institutional births are taking place than before rather than at home. More women are going to a public facility than before for delivery. More Caesarean section births are also taking place and more women are going to private health facility for caesarean sections. It is often alleged that private hospitals go for caesarean operations more frequently in order to make money. Women, however, are breast feeding their children more than before.
For women’s empowerment, the most important factor is education and the NFHS-4 survey reveals that there has been a rise in women’s literacy from 55.1 per cent to 68.4 per cent. But literacy among women often means just being able to sign the name. It is also surprising to learn that women have become more active in the household in decision making (84 per cent versus 76.5 per cent ten years ago). Less violence against women from spouses in 2015-16 than before is also welcome news. Also, more women own a house or land (alone or jointly with others) which is now at 38.4 per cent -- definitely a good sign because owning property gives women status in the household. More women are having a bank account and mobile phones. Women having savings account that they themselves use has increased from 15.1 percent to 53 per cent.
The sex ratio has also improved since 10 years ago which is commendable. But on the whole we know that women are still not getting equal treatment and violence against women in urban areas persists. The labour participation rate is also lower than before for women and the proportion of women is 23 percent of the labour force but this is not covered by the survey and there is no equality in pay for women either.
The Total Fertility Rate has declined but it is strange that there is a decline in family planning practices as well. Sterilization cases, both males and females, have also declined. Only oral contraceptive pills have increased from 3.1 per cent to 4.1 per cent and use of condoms rose from 5.2 percent to 5.6 per cent. It seems people are reluctant to disclose the details of their family planning methods to surveyors and that is why there is a discrepancy between the decline in TFR and a decline in family planning practices.
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On the whole, health is one of the weakest sectors in India. There is a shortage of 5 lakh doctors because every year many doctors leave to work abroad. India has 472 medical colleges and close to one million doctors, yet we are not able to fulfill the WHO norm of having one doctor per 1000 population. There is a huge shortage of doctors in rural areas. The 2017 Budget has proposed that the Centre will create additional 5000 PG medical seats every year and has increased the allocation for the health sector by 28 per cent. There will be two more AIIMS set up –one in Gujarat and the other in Jharkhand.
Even though India has 17 per cent of the world’s population, according to the famed medical journal Lancet (January 11, 2017), it contributes disproportionately to global burden of diseases with more deaths of children aged 5 years and younger than in any other country. It contributes a quarter of the world’s TB population, premature cardiovascular diseases and an ‘epidemic of diabetes’. It also ranks 143 out of 184 countries for health related UN’s Sustainable Development Goals. It seems India has a long way to go in achieving universal healthcare and improving the health of the population in a significant manner.
It should also be mentioned that statistical surveys are important for understanding general trends, but while they present interesting facts, they do not give the complete picture.
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David Rusnok Researcher Strengthening National Climate Policy Implementation (SNAPFI) project DIW Germany
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