Healthcare in India

The lack of reliable, cause-specific mortality statistics is considered a major obstacle to the improvement of public health in many low- and middle-income countries. Researchers and government officials in India have set up the Million Death Study to address this situation. First, how the study produces quantitative estimates of the burden of mortality in India is explored by collecting symptomatic data, using that data for diagnostic purposes, and aggregating those diagnoses into an overview of mortality in India. Second, the limitations of the perspective on public health based on discrete and specific diseases that result from this approach are addressed. Numbers alone cannot solve the public health issues India faces, rather cognitive justice towards a broader range of perspectives on major public health problems is required to develop effective political interventions.

The child undernutrition estimates from the Comprehensive National Nutrition Survey, 2016–18 reveal that many Indian states have made substantial decline, reversing their poor past record in wasting, ranging from 7 to 14 percentage points within just 30 months. Is it really possible to make such a large decline in such a short span of time? Or, does this point to an anomaly in data or estimation?

Whether the burden of non-communicable diseases has shifted to older men and women, and whether it varies by marital status and affluence of the household has been examined. The analysis is based on the 60th and 71st rounds of the National Sample Survey for 2004 and 2014. Even though comparisons of prevalence and shares between men and women are relied on in the analysis, some glaring disparities emerge. The growing menace of NCDs in the context of a rapidly increasing older population calls for bold policy initiatives, which are currently either underfunded or limited in coverage and uncoordinated. A drastic overhaul of the health system and behavioural changes are thus emphasised.

Drawing from an ethnographic study conducted in a Karnataka village, the unfavourable differential treatments against Dalit patients in rural public health services are delineated. An analysis of medical interactions shows that as compared to non-Dalits, Dalit patients experienced more apathy, denial, and avoidance behaviours from service providers. Surprisingly, most Dalits did not attribute this to their caste, but to the flaws of the public health delivery system. Caste and allopathic medical practice are embedded in the rural public health delivery system, and both camouflage and normalise discrimination in paternalistic medical interactions. This sustains the favourable environment for caste-based discrimination in rural public health services even in places where Dalit consciousness is strong.

Based on data from the National Sample Survey Office’s surveys on healthcare, this study critically evaluates the impact of the National Health Mission on improving utilisation of maternal healthcare services in Bihar, which had very poor maternal and child health outcomes at the start of the mission. In particular, it investigates factors affecting the utilisation of maternal care services and choice of facilities between the pre- and post-NHM periods; assesses the success of the Janani Suraksha Yojana in enhancing institutional delivery, particularly in public facilities; and estimates the out-of-pocket expenditure on maternal care in the pre- and post-NHM periods and identifies factors affecting such expenditure levels.