India@75: On health, a long way come, a long way to go
Vitamin Angels India
Let's create a healthier, equitable world for mothers and children in India
A lot has improved in the health status of India since the country became independent 75 years ago.
Infant mortality rate (IMR) has dropped from 146 per 1,000 live births in 1951 to 27 per 1,000 births in 2020, according to Government of India and United Nations data. That’s a decline of over 80%.
Neonatal mortality – deaths in the first 28 days of life – has also significantly reduced from 89 in 1969 to 20 per 1,000 births in 2020.
People have started living longer too, with life expectancy increasing from nearly 35 years in 1951 to double of that at 70 in 2021. This is directly related to improving health facilities in the country.
The number of doctors also saw staggering 2015% growth from 61,840 in 1951 to 1,308,009 in 2022. The present ratio of doctors to patients is 1:834 in India, better than the 1:1000 ratio set by the World Health Organization (WHO). The number of nurses has also swelled from 61,840 in 1951 to 3,496,000 in 2022.
Primary health Centers (PHC) in the country have shot up to 30,563 in 2021, against just 725 in 1951, according to the Rural Health Statistics 2020-21.
Significantly, the first year of the National Sample Survey in 1951-52 showed 45% of Indians were living in poverty. That has come down to 7% in 2021, according a NITI Aayog report. India classifies extreme poverty as those earning less than $1.90 per day, where they struggle to meet basic needs like clothing, food, healthcare and housing.
A lot of these number, however, can paint a starkly different picture from ground realities.
Around 45% of the population was living in poverty in India in 1951. That has come down to 7% in 2021, according a NITI Aayog report.
LOOKING BEYOND THE NUMBERS
India may have improved its infant mortality rate, but it is far behind its immediate neighbors. For instance, six children per 1,000 births die before the age of one in Sri Lanka and China, 23 in Bhutan, and 24 in Nepal and Bangladesh each.
In China and Sri Lanka, only four infants die in the first 28 days of life per 1,000 live births, while the neonatal mortality rate is 15 in Bhutan, 17 in Nepal, and 18 in Bangladesh.
India is ahead only when compared to Pakistan and Afghanistan.
The causes for infant mortality include poor sanitation and water quality, malnourishment of the mother and infant, and inadequate prenatal and medical care. It should come as no surprise then that 52.2% pregnant women in India are anemic, while among children under five years, 35.5% are stunted, 19.3% wasted, 32.1% underweight, and 67.1% are anemic, according to the National Family Health Survey-5.
With this, India also has highest share in disease burden in the world, with 21% of all cases globally, according to the WHO.
The healthcare problem is more pronounced in rural India.
Around 22% of PHCs and Sub Centers – the first point of contact between the people and the healthcare system – functioned without doctors in rural India, according to the Rural Health Statistics 2020-21. That’s an increase from 17.5% seen in 2005.
At the Community Health Center-level, a whopping 67.96% had no specialist doctors to see patients.
At the PHC and Sub-Centre level, there was a 27.2% shortfall in Auxiliary Nursing Midwives (ANMs) – critical to the health of pregnant women, new mothers, and children – in 2021.
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The non-availability of staff has proven to be a big discouragement to health-seeking behavior among individuals who make long journeys only to be met with a lack of qualified personnel at the health facility.
At the Community Health Center-level, a whopping 67.96% centers did not have specialist doctors to see patients, data from the Rural Health Statistics 2020-21 shows
There’s inequality in hospital beds too. Around 65% of hospital beds in the country cater to almost 50% of the population, according to a NITI Aayog report.
The report also pointed out that India's healthcare expenditure to GDP is the lowest among the BRICS (Brazil, Russia, India, China, and South Africa) nations. The combined expenditure by the Central and State governments in India is 1.29% of the GDP. Brazil spends 9.2% of the GDP on healthcare, followed by South Africa at 8.1%, Russia at 5.3% and China at 5%.
It is also lower than some of its neighboring countries such as Bhutan (2.5%) and Sri Lanka (1.6%).
India also ranked the lowest in the number of hospital beds per thousand population. It had just 0.5 beds per 1,000 population— or one bed for every 2,000 people – in 2017, when figures were last available. Russia had 8.1 beds, Brazil had 2.1 beds, and China had 4.3 beds per 1,000 population.
Even if 100% of their income were to be spent on food, the recommended diet would be unaffordable for over 44.9% people in rural India, according IFPRI.
Adding to the woes is unaffordability of nutritious diets to stay healthy. The National Institute of Nutrition (NIN) recommends at least eight food groups per day with vegetables, fruits, green leafy vegetables, and tubers forming half the plate of recommended food per day. The other half should consist of cereals, millets, pulses, and milk/curd.
However, studies estimate that three out of four rural Indians cannot afford this recommended diet. Even if 100% of their income were to be spent on food, the recommended diet would be unaffordable for over 44.9% people in rural India, according to the International Food Policy Research Institute.
THE WAY FORWARD
Reaching vulnerable populations at the last mile remains one of the biggest challenges for low- and middle-income countries in successfully implementing healthcare services to those most affected. The priority of the government, change-makers and leaders must be to make these services accessible to all. And they should address the problem right at the very start – malnutrition.
Malnutrition threatens the health and future of millions of women and children every year across the world. Improving nutrition from the beginning is a proven way to break the intergenerational cycle of poverty and poor health.
Evidence based approaches and nutrition interventions are a powerful way to enable children to thrive through each stage of their development and improve overall health outcomes of the country.
Improving nutrition from the very start is a proven way to break the intergenerational cycle of poverty and poor health.
HOW VITAMIN ANGELS IS HELPING
Vitamin Angels in India is working to address the problem of nutritional inequity among the most vulnerable, hard-to-reach, and marginalized populations – women, infants, and children. Since 2010, VA has been working with 1,800 field partners to provide life-saving vitamins and minerals to millions of children and women across India.
In our experience of working in the last mile, we believe that the trick to sustain impact is for civil society partnering with government health functionaries and making communities more aware of seeking nutrition and health services from local governments.