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.
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.
Better health is central to human happiness and well-being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more. Healthy Citizens are the greatest asset any country can have. Many factors influence health status and a country's ability to provide quality health services for its people.
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.
It has been observed 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.
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.
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.
In recent years India has made ground-breaking progress in reducing the maternal mortality ratio (MMR) by 77% from 556 per 100000 live births in 1990 to 130 per 100000 live births in 2016. The Urban-Rural divide traditionally seen in institutional births has been largely closed. Overall 75% of rural births are now supervised as compared to 89% in urban areas.
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.
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 Indra dhanush’ 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 this Mission. 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. 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 0.02 deaths per lakh population in 2018 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 National Programme for prevention and control of cancers, diabetics, cardiovascular diseases and stroke under National Health Mission was initiated to tackle the raising burden of NCDs. The main focus of the Programme is on health promotion and prevention, strengthening of infrastructure including human resource, early diagnosis, treatment and referral and integration with primary health care systems through NCD cells in the entire the country.
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 1.28% of its GDP (2017-18 BE) 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 1657 in 2017-18. The Centre : State share in total public expenditure on health was 37:63 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. 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. Ayushman Bharat Mission- National Health Protection Mission or Pradhan Mantri Jan Arogya Yojana (PMJAY) world’s largest health scheme announced in the Union Budget 2018-19 is the latest initiative in expanding the health insurance net and targets 10 crore poor and deprived rural population. The Mission aims to provide a cover of Rs.5 lakh per family per year for secondary and tertiary care procedures.
Manpower for health services has been described as the “heart of the health system in any country”. It is one of the most important aspect and critical component of health policies. A health information system with a strong human resource component can help build the evidence base in order to plan for availability and accessibility of needed health workers in right place, at right time and in desired quality. NHP has compiled detailed health manpower availability in public sector. The total number of registered Allopathic Doctors (up to 2018) is 11, 54,686. Number of Dental Surgeons registered with Central/State Dental Councils of India up to 31.12.2018 was 2,54,283.There is an increasing trend in number of Dental Surgeons registered with Central/State Dental Council of India from 2007 to 2018.Total number of registered AYUSH Doctors in India as on 01.01.2018 was 7,99,879.
Health infrastructure 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. Effective public health actions rely upon a well-trained public health workforce and good and sufficient health infrastructure.
Indian healthcare delivery system is categorised into two major components- public and private. The public healthcare system comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas. The private sector provides majority of secondary tertiary and quaternary care institutions with a major concentrations in metros.
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 529 medical colleges, 313 Colleges for BDS courses and 253 colleges which conduct MDS courses. There has been a total admission of 58,756 in Medical Colleges & 26,960 in BDS and 6288 in MDS during 2018-19.
India has 1909 Institutions for ANM with an admission of 55263, 6861 Institutions with an admission of 267564 for Nursing and 1682 Pharmacy Institutions with an admission of 99145 as on 31st March, 2018. There are 4035 hospitals and 27951 dispensaries to provide Medical care facilities under AYUSH by management as on 1.4.2018. To cater the health needs of these rural populations there are 158417 Sub Centers, 25743 Primary Health Centers and 5624 Community Health Centers in India as on 31st March 2018. Total no. of licensed Blood Banks in the Country till December, 2018 is 3108. The country has 469 Eye Banks till January, 2019.
The Central Government Health Scheme (CGHS) was started under the Ministry of Health and Family Welfare in 1954 with the objective of providing comprehensive medical care facilities to Central Government employees, pensioners and their dependents residing in CGHS covered cities. At present, CGHS has health facilities in 37 cities having 288 Allopathic Dispensaries and 85 AYUSH Dispensaries in the Country. There are 1141286 registered cards with total 3395453 number of beneficiaries.
Universal access to health care is a well-articulated goal for both global institutions and national governments. 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. Access to good health and well-being is a human right and that is why SDG offers a new chance to ensure the highest standard of heath and healthcare for all the citizens.
India’s National Health Policy, 2017 envisions the goal of attaining highest possible level of health and well-being for all and 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. 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.
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