Session 11 Health Problems and Challenges Poverty and

Session 11: Health: Problems and Challenges Poverty and Health Inequality § Gaps in health between rich and poor have widened both between and within many countries. § The international debt crisis which currently affects Sub-Saharan Africa. - For example in Mozambique, 33% of total annual public expenditure was on debt repayment and 3. 3% on health. § Increase in health inequality has also occurred in UK, USA and in Eastern Europe. § Structural economic policy changes had adverse affect on health.

Session 11: Health: Problems and Challenges Impact of health on livelihood § Ill health of wage earners can cause families to sync into debt. - Privatization of health facilities increases the cost of health care. § Cut in aid from industrialized nations also affect the poorest of the poor. - It increases the gap between rich and poor. § Excessive population growth in less developed countries and unsustainable patterns of resource use by industrialized countries lead to problems such as climate change. - It affects specifically agro based community and creates health hazards for all. - Women and children are the most vulnerable sections of the society affected by the health hazards.

Session 11: Health: Problems and Challenges Health Situation / awareness in India Children Immunization gap is high-- no public debate to address this issue Measles mortality growth rate has increased to 47% in 2010. Major problems in health care: - inadequate services and - absence of public discussion of this inadequacies. - not at all addressed by the Social Media

Session 11: Health: Problems and Challenges Public Health Expenditure Public health expenditure as a part of GDP is declining • • • 1. 2% -India 2. 7% -China 3. 8% - Latin America 6. 5% -World's average 8% -European Countries

Session 11: Health: Problems and Challenges Problems in Primary health care Lack of resources in PHCs-- bed, instruments, electricity etc. Absenteeism of staff at the PHC- some times it is more 50 percent Result- Morbidity is high in case of diseases / symptoms like anaemia, cold, chest pain, body ache etc. - difficulties in daily work like fetching water, standing in a que for long time etc. General health condition is suffered.

Session 11: Health: Problems and Challenges Is there no problem in the private health care? To get the affordable health care facilities is a problem Private facilities are unregulated---leaving patients at their mercy Fraud, Over medication, exploitative pricing, unnecessary surgery are the common problems in the private sector Reform is required for whole health sector

Session 11: Health: Problems and Challenges Private Health Insurance and its consequences Two major policies in Health Sector: National Rural Health Mission, 2005 -06 Rashtriya Swasthya Bhima Yojana or National Health Insurance Scheme-PPP model-- Product is delivered by the Private Health Insurance Companies and premium is paid by the Government It is a good step for the fastest growing sector in India It is an improvement over the current 'out of pocket system'. Interpretation of such policies: Private sector is the backbone of India's future health care system It is apparently good that hospitals will be paid and people will have access to the health care.

Session 11: Health: Problems and Challenges Issues related to private Insurance Efficiency issues: adverse selection moral hazard insurers and the company have little incentives to contain the costs. service providers have more incentives to use the cheapest possible method for each procedure. strong regulation is required which is difficult in India.

Session 11: Health: Problems and Challenges Distortion issues: - commercial health care is likely to be biased against preventive health services. -India has more burden of communicable diseases and some non communicable diseases like diabetes, cancer etc. which does not require hospitalization. -This private health insurance further promotes privatization of health services -it affects the resource, time, energy and commitment available to strengthen public health services

Session 11: Health: Problems and Challenges Targeting issues: - problems with BPL targeting. -even health contingencies can push people into poverty. -people's health status creates problems for the entire logic of the BPL and proxy indicators of the health subsidy. So service is inadequate. - - - Equity issues: System based on targeted insurance subsidies has a little chance to meet basic norms of equity in health sector Powerlessness, low education, social discrimination create obstacle for poor people to access to this health facilities Large component of health insurance is unsubsidized. Affordability is a major concern.

Session 11: Health: Problems and Challenges Irreversibility Issues: -Health insurance lobby became powerful and establish a strong hold on policy -without a base of public health care, private health insurance has problematic feature. -USA-most ineffective health care services. Health expenditure is high but outcome is poorer. -USA vs Canada– idea of social medicine -present regulations is inadequate to tame a profit seeking health industry to serve the purpose of universalism and equity.

Session 11: Health: Problems and Challenges Nutritional features • Malnutrition still prevails • Malnutrition situation is worse than Sub-Saharan Africa though it is closer to Asian average. • Children are also facing the deficiency of micro nutrients • Low weight and height of children is closely related to the nutrition of adult women. • In Asia, the South Asian Enigma occurs due to low nutritional status of women

Session 11: Health: Problems and Challenges Child Care - Social Responsibility In India, Child care totally depends on the Households • -lack of awareness about nutrition • -lack of resources like energy, power etc. • -care is inadequate ICDS is the best example of States’ responsibility of child care • -some States showed good result of this scheme • -the failure of this scheme in some States is because of • -Anganwadi workers are not providing supplements • -ready to eat food is provided instead of cooked food

Session 11: Health: Problems and Challenges • ANM workers do not have regular schedule to visit the Anganwadi centres for health check up • Safe drinking water facility, sanitation, crèche are missing in the villages • It is possible to deliver ICDS properly– example Tamil Nadu

Session 11: Health: Problems and Challenges Importance of Mid day meals in primary schools: A case of India § In terms of health indicators India has worst indicators of child well being in the world. - Half of all Indian children are under nourished. - It affects not only health but educational indicators. § Govt. of India has taken some steps to address this problem. - The launch of ‘Sarva Siksha Abhiyan’ , mid day meal scheme (MDMS) in 1995. § MDMS aims at facilitating in the universalization of elementary education by mitigating classroom hunger. § It is an opportunity to overcome common micronutrient deficiencies and to facilitate related health interventions. § Sharing a meal with children from diverse backgrounds can help children to overcome traditional social prejudices – improvement of mental health.

Session 11: Health: Problems and Challenges § According to the Supreme Court directives, 28 th Nov, 2001, all state government schools have to prepare mid day meal with a minimum content of 300 calories and 8 -12 grams of proteins each day for a minimum of 200 days. - State authorities started to work with grassroot activists for public mobilization. - The coverage of the MDMS has been extended. - According to Supreme Court order 20 th April, 2004, schools have to provide meals during the summer vacations in drought affected areas.

Session 11: Health: Problems and Challenges Impact of MDMS § 91% parents and 84% teachers want MDMS to continue. § Quality of meal is satisfactory – 86% parents felt. § 96% children like the school food. § 13% parents reported that child had a stomach ache after consuming the meal. § 37% report caste discrimination in MDMS. Source: Different grassroot organizations and research organizations

Session 11: Health: Problems and Challenges Nutritional and health impact § The amount of food provided by schools does not meet Supreme Court norms. § There is a mixed reaction from states about the quality and quantity of the food. § Nutritive value of the meal is not monitored properly. § Change in the menu is not attended by majority of the states. Sometimes monotonous and unappetising meals are provided. § There is a lack of adequate staffs for preparing meals and lack of adequate funds. § The net impact of MDMS on the child’s health is determined by whether the meal is a supplement or a substitute for home food intake. - If it is a substitute the nutritional impact may not be large, it might be negative. Quality of food matters. - The supplement element is likely to be larger for poorer families. If the quality of supplement element goes down, nutritional impact would be less.

Session 11: Health: Problems and Challenges of MDMS § Delay in fund disbursement for MDMS. § Politics of school meals § Lack of monitoring in data collection of nutritional value creation. § Lack of public participation and continuous practice of social discrimination.