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Commonwealth Health Partnerships 2015

C ommo nwe a l t h memb e r c o u n t r i e s drugs subject to government price controls. Regulation is carried out by the Drug Controller General of India. A mental health bill put forward in 2013 sought to improve treatment, protect rights and, significantly, to decriminalise suicide. This was passed in October 2014 and was reinforced by the creation of a National Mental Health Day. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For India to achieve its targets for the reduction of child mortality, which form MDG 4, it would need to have reduced under-five deaths per 1,000 live births to 42 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 53 deaths per 1,000 live births and measles immunisation at 74 per cent, making the achievement of these goals unlikely. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For India, maternal mortality should fall to 150 cases per 100,000 live births. In 2013 India had an adjusted maternal mortality ratio of 190 deaths per 100,000 live births (this figure was estimated at 200 deaths per 100,000 by UN agencies/World Bank in 2010). Although significant progress has been made since 1990, India is unlikely to achieve this target. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2011 this figure stood at 67 per cent, so this target is unlikely to be met. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. India must reduce the high levels of malaria, TB and leprosy if this goal is to be achieved. There is insufficient information from international agencies to confirm the country’s progress on this goal with regard to HIV/AIDS. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Only a third of health care in India (33 per cent) was government funded in 2012. The remaining 67 per cent was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 4.0 per cent of GDP in 2012. Expenditure by government amounts to US$20 per capita. Following a series of consultations among Indian civil society activists and development specialists, a number of issues have been identified that should be addressed in India’s post-2015 health agenda. One of the main ones is equitable access to basic public health care, clean water and safe sanitation. At the time of writing, access to health care was of significant concern in India, with many people in remote areas unable to access primary health care. In the long term, access to primary health centres needs to be made universal, even in remote parts of the country. Furthermore, benchmarks for the financing of health services through domestic resources and donor aid must be established. India needs to work towards ensuring five per cent of its GDP is spent on health (as per World Health Organization recommendations) – its spending on health in 2013 was just 1.3 per cent of GDP. At the start of the period covered by India’s 12th five-year plan (2012–17) the government of India announced aims to achieve universal health coverage by the end of 2017. As part of the plans for universal health coverage all citizens will be entitled to comprehensive health security in the country. It will also be obligatory for the state to provide adequate food, safe drinking water, proper sanitation, education and health-related information for all citizens. India was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1979 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around 66 million people in India are over the age of 65 – five per cent of the total population (2013). At the age of 60 a person living in India can be expected to live for an additional 17 years, on average (2013). The Indira Gandhi National Old Age Pension Scheme dates back to 1995 and was updated in 2007. Monthly pension credits are paid by the state at a rate of US$3 per person (2007–12) on a means-tested basis. Overall, public pension spending is equivalent to one per cent of the country’s total economic output (2012). The elderly are held in high esteem in traditional Indian cultures, and are typically cared for by their children or the community. There are also several private elderly care homes and companies offering home care services. However, with the population of India rapidly ageing, the government is beginning to take steps to ensure that elderly citizens receive the care that they need. The population over the age of 60 years in India has tripled in last 50 years and is expected to continue increasing at a high level in the near future. To this end, the government is currently engaged in implementing the National Program for the Health-Care for the Elderly (NPHCE), which is due to come into force in 2016–17. The programme assesses the international and national commitments of the government as envisaged under the UN Convention on the Rights of Persons with Disabilities and other acts, and deals with provisions for medical care of senior citizens. The NPHCE aims to, among other things, provide accessible, affordable and high-quality long-term, comprehensive and dedicated care services for the elderly. Further information Ministry of Health and Family Welfare: www.mohfw.nic.in Commonwealth Health Online: www.commonwealthhealth.org/health/asia/india 186 Commonwealth Health Partnerships 2015 Population over 65 5%


Commonwealth Health Partnerships 2015
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