Strategies to cope up with Disparities in Health Services in India


Ms. Jhilam Rudra De
George College of Management and Science

India is a country with a vast range of population divided into several social classes depending on religion, caste, culture, academic and socio-economic background etc.

Till now, there are various aspects of heath care delivery system prevailing in the country. Besides two exclusive national health policies, there were nine expert committees, 11 Plan documents, 60 budgets and numerous Govt. orders that pronounced policies pertaining to health in India in the post independence era. But the healthcare experts and the health care providers are still increasingly concerned abut the growing incidence of significant health inequalities between different social groups.

For e.g.

Rural-Urban Disparities India

* RURAL (per 1000 population)

*  Hospital Beds = 0.2
*  Doctors = 0.6
*  Public Expenditures = Rs.80,000
*  Out of pocket = Rs.750,000
*  IMR = 74/1000 LB
*  U5MR = 133/1000 LB
*  Births Attended = 33.5%
*  Full Immunization.=37%

- URBAN (per 1000 population)
- Hospital Beds = 3.0
- Doctors = 3.4
- Public Expenditures = Rs.560,000
- Out of Pocket = Rs.1,150,000
- IMR = 44/1000 LB
- U5MR = 87/1000 LB
- Births Attended = 73.3%
- Full Immunization= 61%

There are many internal and external influences on an individual's health, often categorized into biological factors, the physical and social environment, personal lifestyle and availability of health services. The standard of living achieved in a society can influence an individual's choice of housing, work and social interactions as well as eating and drinking habits, leading to good or bad health status.

Inequalities in health can be tackled according to any one of the following strategies or combination of more than one ----

* Strengthening individuals In disadvantaged circumstances, it means to employ simple person-based strategies i.e. to enhance the knowledge level, motivation, skill and competencies of the people which enable them to alter their behaviour and attitude in relation to personal risk factors as well as to cope better with the stresses and strains imposed by external health hazards from other layers of influence.

* Strengthening communities This strategy focuses on how people from disadvantaged communities can join together for mutual support and can defend the health hazards collectively, by strengthening themselves.

* Improving access to essential facilities This policy ensures improved access to essential facilities and services like clean water supply, sanitation facility, adequate housing, safe and fulfilling employment, supply of safe and nutritious food, provision for educational services and welfare in times of need to tackle the physical and psychological conditions more effectively in which people can live and deliver work more efficiently.

* Encouraging economic and cultural change This strategy aims to encourage cultural values, promote equal opportunities and environmental hazard control policies on a national and international scale by encouraging economic and cultural changes to reduce poverty and the other various adverse effects of inequality on society.

The strategic approaches should focus on certain age groups, specific diseases and particularly determinants of health like living and working conditions.

Though the association between poverty and ill health has long been recognized, but still inequalities in health are avoidable and judged to be unjust and unfair. Equity is mostly concerned with creating more equal opportunities for health and reducing differentials to the minimum. Societies which have less inequality in income, less variations in the housing standards and food habits and better working conditions seem to have less health inequalities between different socio-economic groups.


* Text book on Preventive and Social Medicine by Gupta and Mahajan
* Hospital and Health Services administration, Principles and Practice by Syed Amin Tabish
* Paper on  Operationalising Right to Healthcare in India by Ravi Duggal

Ms. Jhilam Rudra De
George College of Management and Science

Source: E-mail June 04, 2008


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