life expectancy, maternal & child mortality Vs SDGs
Life expectancy in india
LIFE EXPECTANCY IN INDIA :
- Male 69.5,
- female 72.2 and
- total life expectancy is 70.8
- World Life Expectancy ranking of 117
The important achievements of India’s healthcare system in the last 75 years:
In the last 75 years, India has improved tremendously with respect to life expectancy. In 1947, the expectancy of an average Indian citizen was around 32 years and it has increased to 70.19 years in 2022. The increase in life expectancy in the last 75 years has been over 100 percent.
Background note on Immunization :-
- Expanded Programme on Immunization was launched in 1978. It was renamed as Universal Immunization Programme in 1985 when its reach was expanded beyond urban areas. In 1992, it became part of Child Survival and Safe Motherhood Programme and in 1997 it was included in the ambit of National Reproductive and Child Health Programme. Since the launch of National Rural Health Mission in 2005, Universal Immunization Programme has always been an integral part of it.
- Universal Immunization Programme (UIP) is one of the largest public health programmes targeting close of 2.67 crore newborns and 2.9 crore pregnant women annually.
- It is one of the most cost-effective public health interventions and largely responsible for reduction of vaccine preventable under-5 mortality rate.
- Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases:
- Nationally against 9 diseases - Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenza type B
- Sub-nationally against 3 diseases - Rotavirus diarrhoea, Pneumococcal Pneumonia and Japanese Encephalitis; of which Rotavirus vaccine and Pneumococcal Conjugate vaccine are in process of expansion while JE vaccine is provided only in endemic districts.
- A child is said to be fully immunized if child receives all due vaccine as per national immunization schedule within 1st year age of child.
- The two major milestones of UIP have been the elimination of polio in 2014 and maternal and neonatal tetanus elimination in 2015.
- Inactivated Polio Vaccine (IPV): IPV has been introduced in UIP as part of Global Polio end-game strategy, to mitigate the risk associated with tOPV to bOPV switch. IPV was introduced in November 2015 initially in 6 states, which was expanded across the country by April 2016.
- Rotavirus vaccine (RVV): RVV has been introduced to reduce mortality and morbidity caused by Rotavirus diarrhoea in March 2016. It has been introduced in 11 states (Andhra Pradesh, Haryana, Himachal Pradesh, Jharkhand, Odisha, Assam, Tripura, Rajasthan, Tamil Nadu, Madhya Pradesh and Uttar Pradesh). The vaccine will be expanded across the country in 2019-20.
- Measles Rubella (MR) vaccine: India is committed to the goal of measles elimination and rubella control and to achieve the goal MR vaccine was introduced in the country through a campaign mode in a phased manner in 2017. MR campaign target around 41 crore children in the age group of 9 months to 15 years (covering ⅓ of the total population of the country) followed by 2 doses in routine immunization at 9-12 months and 16-24 months. Rubella component is now under routine immunization as MR vaccine.
- Pneumococcal Conjugate Vaccine (PCV): PCV has been launched in May 2017 for reducing Infant mortality and morbidity caused by pneumococcal pneumonia. It has been introduced in Bihar, Himachal Pradesh, Madhya Pradesh, 19 districts of Uttar Pradesh and 18 districts of Rajasthan.
- Tetanus and adult diphtheria (Td) vaccine: TT vaccine has been replaced with Td vaccine in UIP to limit the waning immunity against diphtheria in older age groups. Td vaccine to be administered to adolescents at 10 and 16 years of age and to pregnant women.
- Mission Indradhanush (MI) was launched in December 2014 and aims at increasing the full immunization coverage to children to 90%.
- Under this drive focus is given on pockets of low immunization coverage and hard to reach areas where the proportion of unvaccinated and partially vaccinated children is highest.
- A total of six phases of Mission Indradhanush have been completed covering 554 districts across the country.
- It was also identified as one of the flagship schemes under Gram Swaraj Abhiyan (16,850 villages across 541 districts) and Extended Gram Swaraj Abhiyan (48,929 villages across 117 aspirational districts).
- While the first two phases of Mission Indradhanush resulted in 6.7% increase in full immunization coverage in a year, a recent survey carried out in 190 districts covered in Intensified Mission Indradhanush (5th phase of Mission Indradhanush) shows 18.5% points increase in full immunization coverage as compared to NFHS-4 survey carried out in 2015-16.
New Initiatives in Vaccine Logistics & Cold Chain Management
- Capacity building
- National Cold Chain Training Centre (NCCTE), Pune and National Cold Chain & Vaccine Management Resource Centre (NCCVMRC) -NIHFW, New Delhi have been established to provide technical training to cold chain technicians in repair & maintenance of cold chain equipment
- System strengthening
- Electronic Vaccine Intelligence Network (eVIN) rollout:
- The Government of India has rolled out an Electronic Vaccine Intelligence Network (eVIN)system that digitizes the entire vaccine stock management, their logistics and temperature tracking at all levels of vaccine storage – from national to the sub-district.
- This enables program managers to have real time view of the vaccine stock position and their storage temperature across all the cold chain points providing a detailed overview of the vaccine cold chain logistics system across the entire country.
- eVIN system has been completed in 12 states in the first phase – Assam, Bihar, Chhattisgarh, Himachal Pradesh Gujarat, Jharkhand, Madhya Pradesh, Manipur, Nagaland, Odisha, Rajasthan, and Uttar Pradesh.
- Second phase is ongoing in 9 states – Andhra Pradesh, Daman & Diu, Dadra & Nagar Haveli, Goa, Karnataka, Maharashtra, Telangana, Tripura and Uttarakhand.
- eVIN is to be scaled up to entire country.
- National Cold Chain Management Information System (NCCMIS)to track the cold chain equipment inventory, availability and functionality.
CONTROL OF CONTROLLABLE DISEASES
CONTROL OF COMMUNICABLE DISEASES:
Since gaining independence, India has launched several national programmes to curb the menace of communicable diseases like Malaria, Tuberculosis, and AIDS, among others. According to a study published in the American Journal of Tropical Medicine and Hygiene, in 1947, 75 million malaria cases in a population of 330 million were estimated in India. During the eradication era in the late 1950s and early 1960s, a spectacular achievement was witnessed on the malaria eradication front because malaria cases significantly declined to just 100,000 in 1964. Despite the reversal which led to around 6.4 million cases in 1976, the cases of malaria have declined significantly over the year. According to the WHO’s latest World Malaria Report 2021, of the world’s 11 highest burden countries, only India registered progress against malaria.
- POLIO -Meanwhile, India’s success in Polio has been acclaimed around the globe. Until the early 1990s, Polio was hyperendemic in India, with an average of 500 to 1000 children getting paralysed daily. India was declared Polio free in 2014 and no new case of Polio has been reported in the country since January 2011.
- LEPROSY - With respect to Leprosy, India is running one of the largest leprosy eradication programme in the world, the National Leprosy Eradication Program (NLEP). India’s performance in smallpox eradication has been commendable too. After years of being one of the countries with the highest number of smallpox cases, the country declared itself smallpox free in 1979. Similarly, India has made significant progress in controlling diseases like Tuberculosis, Cholera, Kala Azhar, and HIV.
STATE OF HEALTHCARE FINANCE.
Healthcare policies and government schemes:
Since India became independent in 1947, the government has launched various policies and schemes to improve healthcare facilities in the country. Over the decades, the government has launched schemes like National Health Mission (NHM) and National Rural Health Mission (NRHM) to improve child and maternal health. Meanwhile, there are schemes that are launched as a part of these missions including Janani Suraksha Yojana (JSY) enables direct cash transfer to pregnant mothers, Janani Shishu Suraksha Karyakram (JSSK)allows pregnant mothers to deliver in government hospitals for free, Pradhan Mantri Surakshit Matrutva Abhiyan (PMSMA) focuses on providing good antenatal care and specifically identifying and managing high-risk pregnant mothers. In 2018, a centrally-sponsored Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) was launched which is the largest Government funded health assurance/insurance scheme in the world. In this scheme, financial risk protection is provided by the government against catastrophic health expenditure that impoverishes an estimated 6 crore people every year. Moreover, the government has launched several other schemes like Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), enhanced the quality of medical education in the country and the extensive improvement in healthcare infrastructure since independence. With over 92,000 seats, there are now 612 medical colleges in India as compared to 28 in the 1950s.
Out-of-pocket health spending still high, despite hike in government expenditure
In 2018-19, 40.6% of health spending came from the government, while 48.2% came from patients paying directly to healthcare providers; in UP, patients’ out-of-pocket expenses were 71.3% of the total
Almost half of all health spending in India is still paid by patients themselves directly at the point of treatment, although this has dropped as the government’s share of spending on health went up significantly after 2013-14, according to the Economic Survey 2022-23.
The share of government health expenditure in total health expenditure was just 28.6% in the financial year 2013-14, but rose to 40.6% by 2018-19, the latest year for which data is available. There was a concomitant decline in out-of-pocket expenditure as a percentage of total health expenditure from 64.2% in 2013-14 to 48.2% in 2018-19.