A Look at Mortality Statistics
Positive achievements
During the last few decades, there has been a notable improvement in the health status of the population. The death rate has steadily declined. The life expectancy at birth has gone up considerably since 1951, recording an estimated 62 years during 1995. Many of the infectious diseases have shown a decline, e.g. plague and malaria.

Some drawbacks
There is still a lot that needs to be done. India’s health standards are still low compared to those in developed countries. The infant mortality rate (IMR) India is still high (about 74) as compared to a low of about 6 in developed countries. It does not compare even favorably to some countries in the African continent. Even among underdeveloped countries the IMR is considerably higher. The life expectancy rate in India is at least 10–15 years behind the western life expectancy.

A look at some morbidity profiles
Although some diseases have been brought under control many diseases like tuberculosis, filariasis, leprosy, malaria, diarrhea diseases continues to be a major health problem. Small pox has been eradicated. But measles and polio are still widely prevalent. Bacterial meningococccal meningitis has been on the increase. We still have not controlled viral hepatitis infections. AIDS may become one of the most deadly diseases in the near future. Diarrheal diseases still are a major cause of morbidity and mortality in children. Malnutrition occurs very commonly in children, especially in the rural areas.

About 30 per cent of babies are born with a birth weight of less than 2.5. kg. Vitamin A deficiency is a major cause of preventable blindness. India is home to almost half the cases of tuberculosis in the world. Not so encouraging is the widespread occurrence of leprosy. People continue to be afflicted by malaria. Many deaths occur due to Paramoecium falciparum infections. Kala–azar has made a resurgence. An estimated 20,000 cases occur annually. Lastly sexually transmitted diseases are widely prevalent.

In addition to the above the so called slow epidemics of diseases such as diabetes, cancer, heart diseases also affect people in third world countries. Smoking is decreasing in many developed countries due to health fears, but it is on the rise in developing countries. It is estimated that in certain developed countries as high as 60% of the men smoke. Heart attacks occur at a younger age in South Asia as compared to the rest of the world. With the adoption of western lifestyle, diabetes is increasingly seen in India.

What has been done so far to tackle these health problems?
1. Establishment of primary health care centers:
The establishment of primary health care centers started earnestly after independence in 1952. Over the years, a network of primary health centers and sub–centers have been established. The primary health centers are the major health care providers in the rural areas. At the village level, a band of voluntary health workers (e.g. village health guides and trained dais) has been created. They are selected by the local community and trained to deliver primary health care. Secondary health care is provided by the district hospitals and newly created community health care.

Tertiary health care is provided by the teaching hospitals and institutions and other apex hospitals. Both in the rural and urban areas, the public and private sectors exist side by side. A large number of voluntary organizations are also involved in providing health care to the people.

2. Establishing a health care work force
Major requirement in developing an adequate health infrastructure is health manpower which must be adequate both as regards quality and quantity. Many medical colleges (allopathic) and nursing schools were started soon after independence. There are about 400,000 allopathic doctors. In addition the alternative forms of medicine also contribute to the workforce e.g. Ayurvedic system, Homeopaths, Unani system, they number approximately 6 lakhs and are actually more than the existing allopaths. When all doctors are included the ratio of doctor: patient population is roughly 1:2100.

3. Health care and insurance
As compared to the West, health care insurance does not exist in a big way. As part of the public sector health services, there are a number of schemes such as Central Govt. Health scheme (CGHS) and the Employees State Insurance Scheme (ESIS) under which comprehensive health care services are provided to the families of employees. The beneficiaries covered by these schemes work out to a little less than 6 per cent of the Indian population. Some private sectors provide insurance to their employees. With the government opening up the insurance sector to international competitors the insurance scenario will undergo a dramatic change in the coming years.