National Health Profile (NHP) is an annual publication of the Central Bureau of Health Intelligence (CBHI). The first release of the annual publication was in 2005. It covers all the major information on Demography, Socio-Economic Status, Disease Morbidity & Mortality, Healthcare Finance, Human Resources in Health and Healthcare Infrastructure. NHP is an initiative which is at par with international standards of data publications.
Objective and utility
The objective of NHP is to create a versatile data base of health information of India and making it available to all stakeholders in the healthcare sector. This data base of health information is comprehensive, up-to-date and easy to access. This publication takes into account recent trends in demography, disease profile (communicable and non communicable/lifestyle diseases) and available health resources which define a country's health status. The disease profile has been presented following standard coding from Family of International classification (FIC). This improves interoperability of the data internationally.
The purpose is to provide relevant information for planning and decision making on an informed basis to the planners, policy makers, health administrators, research workers and others engaged in raising the health and socio-economic status of the community. This publication is useful for medical post graduates and trainees of medical and paramedical personnel.
National Health Profile 2018
A healthy population can undoubtedly contribute to economic growth and development of a country. India has made considerable progress in many health indicators. Life expectancy at birth has increased, infant mortality and crude death rates have been greatly reduced, diseases such as small pox, polio and guinea worm have been eradicated, and leprosy has been nearly eliminated. The country strives towards achieving Universal Health Coverage.
India accounts for a relatively large share of the world’s disease burden and is undergoing an epidemiological transition that the non-communicable diseases dominate over communicable in the total disease burden of the country. In a recent report of India Council of Medical Research (ICMR), titled India: Health of the Nation’s States: The India State-Level Disease Burden Initiative (2017), it is observed that the disease burden due to communicable, maternal, neonatal, and nutritional diseases, as measured using Disability-adjusted life years (DALYs), dropped from 61 per cent to 33 per cent between 1990 and 2016. In the same period, disease burden from non-communicable diseases increased from 30 per cent to 55 per cent. The epidemiological transition, however, varies widely among Indian states: 48% to 75% for non-communicable diseases, 14% to 43% for infectious and associated diseases, and 9% to 14% for injuries.
Population Statistics
As per Census 2011, the total population of India is 1210.8 million with a decadal growth rate of 17.7 per cent. While 31.14 per cent of the population lives in urban areas, the rest lives in rural areas. The Sex Ratio (number of females per 1000 males) in the country has improved from 933 in 2001 to 943 in 2011. In rural areas the sex ratio has increased from 946 to 949. The corresponding increase in urban areas has been of 29 points from 900 to 929. Kerala has recorded the highest sex ratio in respect of total population (1084), rural population (1078) and urban (1091). The lowest sex ratio in rural areas has been recorded in Chandigarh (690). While 28.5% population of India lies between 0-14 age group, only 8.3% are above the age of 60 years.
Vital Statistics
Estimated birth rate, death rate and natural growth rate are showing a declining trend. Estimated birth rate declined from 25.8 in 2000 to 20.4 in 2016 while the death rate declined from 8.5 to 6.4 per 1000 population over the same period. The natural growth rate declined from 17.3 in 2000 to 14 in 2016 as per the latest available information.
The SRS (2016) shows that the Total Fertility Rate – the average number of children that will be born to a woman during her lifetime – in 12 States has fallen below two children per woman and 9 States have reached replacements levels of 2.1 and above. Delhi, Tamil Nadu and West Bengal have lowest fertility among other countries. Fertility is declining rapidly, including among the poor and illiterate.
The literacy rate of the country has shown an increase of 8.2% during the decade 2001-2011. Overall literacy rate of India is 73.0% whereas for males it is 80.9% and for females it is 64.6%. Rural literacy rate is 67.8% and urban literacy rate is 84.1%. The highest number of rural literates has been recorded in Uttar Pradesh (85.3 million). Maharashtra (40.1 million) has recorded the highest number of literates in urban areas.
The Maternal Mortality Ratio has shown a decrease of 11 points during 2010-12 to 2011-13. According to the latest data available maternal mortality ratio is highest for Assam i.e. 300 per 1, 00,000 live births and lowest for Kerala i.e. 61 per 1, 00,000 live births in 2011-13. Infant mortality rate (IMR) has declined considerably i.e. 37 per 1000 live births in 2015; however, there is a huge gap between IMR of rural (41 per 1000 live births) and urban (25 per 1000 live births).
There are noteworthy improvements in health indicators such as life expectancy, infant mortality rate (IMR) and maternal mortality rate (MMR) due to increasing penetration of healthcare services across the country, extensive health campaigns, sanitation drives, increase in the number of government and private hospitals in India, improved immunisation, growing literacy etc. Initiatives such as Janani Shishu Suraksha Karyakarm, Janani Suraksha Yojana, Reproductive, Maternal, New-borns, Child and Adolescent Health Services and national programmes to curb incidences of diseases such as polio, HIV, TB, leprosy etc have played pivotal roles in improving India’s health indicators. Yet, a huge disparity in the availability of healthcare resources continues to exist in India. The rural- urban divide is considerable when it comes to healthcare access. Fairly-developed states like Kerala, Maharashtra and Tamil Nadu have brought down their IMR, TFR and MMR rates and states like Assam, Jharkhand continue to grapple with these issues even today.
There are many factors which have an impact on Maternal Mortality Ratio and education level of women is one of the most important factors in reducing maternal mortality. Education enhances women's ability to access existing health care resources, including skilled attendants for childbirth, and directly leads to a reduction in her risk of dying during pregnancy and childbirth.
Immunization
India has attained significant progress in achieving immunization coverage through Universal Immunization Programme (UIP) which provides prevention against six vaccine preventable diseases. In 2013, India along with South East Asia Region, declared commitment towards measles elimination and rubella/ congenital rubella syndrome (CRS) control by 2020. MR vaccine campaign is targeted towards 410 million children across the country. Mission Indradhanush aimed to fully immunize more than 90% of newborns by 2020 through innovative and planned approaches. A total of 528 districts were covered during the various phases of Mission Indradhanush. India has come a long way in immunisation but has to traverse far before achieving its targets.
National health programmes, launched by the Government of India, have been playing crucial roles in tackling several serious health concerns, communicable and non-communicable diseases, over the last two decades. Malaria has been a problem in India for centuries, at one time a rural disease, diversified under the pressure of developments into various ecotypes. Both the cases reported and deaths due to malaria have come down over the years. The malarial death rate in India declined to 0.01 deaths per lakh population in 2016 from 0.10 deaths per lakh population in 2001. To achieve malaria-free country by 2027 and elimination by 2030, National Strategic Plan (NSP) 2017-22 for Malaria Elimination has been developed by National Vector Borne Disease Control Programme. For effective implementation of various elimination strategies, the focus of the programme is laid on district-level rather than State-level.
Revised National TB Control Programme (RNTCP) is another programme implemented under National Health Mission. It has achieved millennium development goals in 2015 by halting and reversing the incidence of TB. The programme was initiated with the objective of ensuring access to quality diagnosis and care for all TB patients. Several notable activities such as notification of TB; case-based, web-based recording and reporting system (NIKSHAY); standards of TB care in India; Composite indicator for monitoring programme performance; scaling up of the programmatic management of drug resistant TB services etc. were implemented in the past. NIKSHAY, the web based reporting for TB programme has enabled to capture and transfer of individual patient data from the remotest health centres of the country. In 2017, National Strategic Plan (NSP) 2017-25 for TB Elimination framework has been adopted, which provides goals and strategies for eliminating TB in India by 2030. The number of patients diagnosed and registered for treatment of TB in India has reported as 1,444,175 patients were registered under RNTCP in 2017.
National Programme for Prevention and Control of NCDs objective is to integrate the non-communicable diseases (NCDs) interventions in the NRHM framework in a bid to optimise scarce resources and make provisions to ensure long term sustainability of these interventions. The NCD cell implements and supervises activities connected to health promotion, early diagnosis, treatment and referral, thereby facilitating partnership with labs for early diagnosis in the private sector. It also seeks to create and sustain a fortified monitoring and evaluation system for public health through convergence with the ongoing interventions of National Health Mission (NHM), National Tobacco Control Programme (NTCP) and National Programme for Health Care of Elderly (NPHCE).
Health Finance
The cost of treatment has been on rise in India and it has led to inequity in access to health care services. India spends only 1.02% of its GDP (2015-16) as public expenditure on health. Per capita public expenditure on health in nominal terms has gone up from Rs 621 in 2009-10 to Rs 1112 in 2015-16. The Centre: State share in total public expenditure on health was 31:69 in 2015-16. The share of Centre in total public expenditure on health has been declining steadily over the years except in 2017-18.
Health insurance in India is a growing segment. Yet, it hasn’t taken off fully and several measures are needed to improve and expand insurance coverage. In the country health insurance pays for only inpatient hospitalization and for treatment at hospitals in India. In 2000 government of India liberalized insurance and allowed private players into the insurance sector. The advent of private insurers in India saw the introduction of many innovative products like family floater plans, top-up plans, critical illness plans, hospital cash and top up policies. Out of 437,457 persons covered under insurance, 79% were covered by public insurance companies, with the remaining being covered by private insurance companies. Manpower for health services has been described as the “heart of the health system in any country”. It is one of the most important aspects of healthcare systems and a critical component of health policies. In India, there is no reliable source giving the number of the members of the health workforce as more than half of the healthcare professionals work in the unorganized private sector. However, NHP has compiled detailed health manpower availability in public sector. The total number of registered Allopathic Doctors (up to 2017) is 1,041,395. There is an increasing trend in the availability of Dental Surgeons and Nurses per lakh population over the years. Number of Dental Surgeons registered with Central/State Dental Councils of India up to 31.12.2017 was 251,207. There is an increasing trend in number of Dental Surgeons registered with Central/State Dental Council of India from 2007 to 2017. Total number of registered AYUSH Doctors in India as on 01.01.2017 was 773,668.
Health infrastructure
It is an important indicator for understanding the health care policy and welfare mechanism in a country. It signifies the investment priority with regards to the creation of health care facilities. Infrastructure has been described as the basic support for the delivery of public health activities. Medical education infrastructure in the country has shown rapid growth during the last 20 years. The country has 476 medical colleges, 313 Colleges for BDS courses and 249 colleges which conduct MDS courses. There has been a total admission of 52,646 in 476 Medical Colleges & 27060 in BDS and 6233 in MDS during 2017-18.
There are 3215 Institutions for General Nurse Midwives with admission capacity of 129,926 and 777 colleges for Pharmacy (Diploma) with an intake capacity of 46,795 as on 31st October, 2017. There are 23,582 government hospitals having 710,761 beds in the country. 19,810 hospitals are in rural area with 279,588 beds and 3,772 hospitals are in urban area with 431,173 beds. 70% of population of India lives in rural area and to cater their need there are 156,231 Sub Centres, 25,650 Primary Health Centres and 5,624 Community Health Centres in India as on 31 st March 2017.
Universal access to health care is a well-articulated goal for both global institutions and national governments. India’s National Health Policy, 2017 envisions the goal of attaining highest possible level of health and well-being for all at for all ages through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without financial hardship to the citizens. Under health related Sustainable Development Goal (SDG) no. 3 (Good Health and Well-Being), a commitment towards global effort to eradicate disease, strengthen treatment and healthcare, and address new and emerging health issues has been pronounced. The gains of India in many health related indicators helped the country to make progress in achieving MDGs. More efforts, however, are required to reach the goals of Universal Health Coverage and those envisioned in SDG. Ayushman Bharat Mission, world’s largest health scheme announced in the Union Budget 2018-19, is the latest initiative for expanding the health insurance net and targets 10 crore poor and deprived rural families.
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