HEALTH IN INDIA

Great improvements have taken place in public health since independence, but the general health picture remains far from satisfactory. The government is paying increasing attention to integrated health, maternity, and child care in rural areas. An increasing number of community health workers and doctors are being sent to rural health centers. Primary health care is provided to the rural population through a network of over 150,000 primary health centers and sub-centers that are staffed by trained midwives and health guides. In the mid-1990s, India had nearly 400,000 physicians and almost 700,000 hospital beds. The government’s eighth five-year plan, from 1990 to 1995, included eradication of malaria and control of leprosy, tuberculosis, and cataracts. India also wants to achieve a goal of one hospital bed per 1,000 people. (As of 1999, there were an estimated 0.4 physicians and 0.8 hospital beds per 1,000 people.) In the mid-1990s, there were nearly 40,000 hospitals and dispensaries. In addition, the rural population was served by more than 130,000 subcenters, over 20,350 primary health centers, and nearly 2,000 community health centers. There are also numerous herb compounders, along with thousands of registered practitioners following the Ayurvedic (ancient Hindu) and Unani systems. India has modern medical colleges, dental colleges, colleges of nursing, and nursing schools. More than 100 colleges and schools teach the indigenous Ayurvedic and Unani systems of medicine and 74 teach homeopathy. New drugs and pharmaceutical plants, some assisted by the UN and some established by European and American firms, manufacture antibiotics, vaccines, germicides, and fungicides. However, patent medicines and other reputed curatives of dubious value are still widely marketed; medical advisors of the indigenous systems and their curatives probably are more widely followed than Western doctors, drugs, and medical practices. As of 1999, total health care expenditure was estimated at 5.4% of GDP. Average life expectancy increased from 48 years in 1971 to 63 years in 2000. Infant mortality declined from 135 per 1,000 live births in the mid-1970s to 69 in 2000. The high mortality rate among infants and children is directly linked to size of family, which is being reduced through the small family norm (National Family Planning Program). The overall mortality rate in 2002 was an estimated 8.6 per 1,000 people. The government’s goal is to raise the life expectancy to 64 years. The government of India took stringent measures to prevent plague following outbreaks during 1994. Mandatory screenings at airports and inspections of passengers were instituted. A shortterm multi-drug therapy launched in India in 1995 led to a dramatic fall in the leprosy prevalence. The incidence of malaria was reduced by 98% between 1953 and 1965, but the number of reported cases increased from 14.8 million in 1966 to 64.7 million in 1976 because DDT-resistant strains of mosquitoes had developed. The incidence of malaria in 1995 was 295 cases per 100,000 people. The death toll from smallpox was reduced to zero by 1977 through a massive vaccination program and plague has not been reported since 1967. Between 1948 and 1980, 254 million people were tested for tuberculosis and 252 million received BCG, an anti-tuberculosis vaccine. In 1999, there were 185 reported cases of tuberculosis per 100,000 people. In 994, there was a serious outbreak of pneumonic plague in western India, which spread to others parts of the country, killing thousands. Many diseases remain, especially deficiency diseases such as goiter, kwashiorkor, rickets, and beriberi. However, India’s immunization rates for children up to one year old are high. Data from 1997 shows vaccinations against tuberculosis, 96%; diphtheria, pertussis, and tetanus, 90%; polio, 91%; and measles, 81%. There is also a national system to distribute vitamin A capsules to children because a lack of this vitamin contributes to blindness and malnutrition. As of the mid-1990s, nearly 25% of the country’s children had been reached. Hypertension is a major health problem in India. Between 3.5% and 6.5% of adults have high blood pressure. UN data shows that India is currently the country with the most HIV-infected people. As of 1999 the number of people living with HIV/AIDS was estimated at 3.7 million and deaths from AIDS that year were estimated at 310,000. HIV prevalence was 0.7 per 100 adults.