7 ways public health in India has changed over the last decade

August 23, 2018 by Neeraj Jain

A national strategy focused on digital health, nutrition, and other high-impact interventions has dramatically improved health outcomes across India—but more work remains to be done.

Neeraj Jain

Neeraj Jain (right), PATH’s country director for India since 2016, has helped to lead health improvements across the country and strengthen organizations for more than 27 years. Photo: Katherine De Bruyn.

India has entered a new era in public health during the past ten years. Thanks to improvements across the spectrum of health and development, average life expectancy has risen steadily from 64 to 68 years between 2005 and 2015.

But we must continue to build on this progress. India still ranks 154th out of 195 countries in terms of quality and accessibility of health care, according to a recent Lancet study.

While plenty of work remains ahead of us, together we have achieved tremendous positive change. Neeraj Jain, PATH’s country director for India, shares seven major trends over the last decade that have brought us this far:

1. A downtrend in communicable diseases

India has been polio-free since 2014. In a country of 1.2 billion people, this is a big deal. We have also been free of tetanus since 2015 and have set strict targets for the elimination of malaria, tuberculosis (TB), and lymphatic filariasis in the coming years. While we still represent a large percentage of the global burden for these diseases, we’ve made significant progress.

The Swachh Bharat Abhiyan, or Clean India Movement, has provided a big push in the right direction to reduce the spread of communicable diseases. As recently as 2014, 65 percent of our population defecated in the open—and now that number is down to 20 percent. This shows how quickly progress can take root when communities and government leaders work together and how it will have a huge impact on health going forward.

08326_hr.jpg Vaccine vials in India with a hand and tray

With its last case of polio in 2014 and tetanus in 2015, India has set its sights on eliminating malaria, tuberculosis, and lymphatic filariasis. Photo: PATH/Gabe Bienczycki.

2. A focus on prevention

As communicable diseases trend downward, we’ve seen new challenges emerge around noncommunicable diseases like hypertension, diabetes, cardiovascular diseases, stroke, and cancer. These diseases impact the rich in India as much as they impact the poor, but most poor people don’t have the resources to combat diseases like cancer. Our public health system isn’t geared toward noncommunicable diseases. So for India as a country, the challenge going forward is to focus on prevention, support, and awareness.

In an encouraging sign of progress, we’ve seen a big increase in health and wellness centers in the past decade. We are now starting to think beyond primary health and toward universal health coverage. Coupled with an emphasis on preventive care, this shift will increase all-around wellness. The National Health Mission (NHM)—the result of a 2013 merger between the National Urban Health Mission and the National Rural Health Mission—is a prominent example. The program’s primary focus is on disease control, prevention, and surveillance, and it has already made a huge impact on our health care system.

Providing breastfeeding support to new mothers

Widespread improvements in sanitation, immunization coverage, and institutional birthing have led to more infants surviving across India. Photo: PATH/Tom Furtwangler.

3. Reduced neonatal mortality rates

Neonatal mortality rates have improved markedly, dropping from 57 deaths per 1,000 live births to 37 between 2005 and 2015. In the past decade, India has saved a huge number of infants through multiple interventions—including an increase in institutional birthing, immunization coverage, and improved sanitation.

Is it enough? Absolutely not. Have we done well? Yes. Do we still have work to do? Absolutely.

4. Tackling antimicrobial resistance

Like several other low- and middle-income countries, India has room to improve in how we handle antibiotics. Production and distribution are not regulated, and retailers sell antibiotics to pretty much anyone—no prescription needed. Most people don’t complete their full course of antibiotic doses, so while they may feel better, the remaining bacteria can develop resistance and make them sick again. Many new kinds of resistance are cropping up, and drugs aren’t working quite as well as they used to.

The 2017 National Action Plan on Antimicrobial Resistance and Red Line campaign—which demands that prescription-only antibiotics be marked with a red line to discourage the over-the-counter sale of antibiotics—are both steps in the right direction. But these efforts need firm legal backing and sustained financial support. Growing antimicrobial resistance is a challenge that India and the world will increasingly face in the coming decade.

05433_hr . Workers cooking rice in a food preparation facility School Lunch Program. Hyderabad, Andhra Pradesh.

Cooking micronutrient-fortified rice for a school lunch program in India. 70 percent of India’s population now has access to subsidized food. Photo: PATH/Satvir Malhotra.

5. Improved nutrition

After significant progress in the last few years, 70 percent of India’s population now has access to subsidized food. PATH has been looking into the massive potential offered by rice fortification and is currently working with the state government to reach 450,000 schoolchildren each day in Karnataka State. Over the coming decade, India plans to introduce fortified food to two-thirds of the country via the National Food Security Act, which will dramatically reduce anemia and childhood stunting.

6. Using digital health and artificial intelligence for social impact

India’s government and our health minister led the conversation around digital health at the recent World Health Assembly in May. India is a digital powerhouse that still faces challenges with our health infrastructure, and it was exciting and inspiring to see India leading strategic discussions around how to best leverage digital health and artificial intelligence (AI) to improve public health.

In the past decade, India has implemented a digital health program called eVIN to track immunization. The program is critically important for the country because of the size of our population. ANMOL is another important digital health tool, providing better health care services to pregnant women, mothers, and newborns. India continues to struggle with high maternal and neonatal mortality rates, so tracking and providing services to new moms is important—especially for the country’s poorest and most vulnerable people.

India is taking the lead on using AI to drive social impact. We are concentrating our efforts where the need is greatest, starting with a focus on some of the most infectious diseases—especially TB. By using AI to improve diagnostics and ensure higher treatment adherence rates, we can accelerate the elimination of TB in every state.

7. Stronger government accountability

As a country, India allocates only 1.15 percent of our gross domestic product (GDP) to health care—one of the world’s lowest rates considering the size of our population. Much of the funding that is allocated to health care is not being used, and a major lack of staff further leads to the underutilization of budgets. Indian health care organizations often have trouble recruiting, as we don’t have enough trained professionals who want to work in rural villages or health centers. Without reliable health services, people living outside of major cities suffer from a growing economic disadvantage.

Recently, largely due to pressure from the public and the media, the Indian government is beginning to vocalize firm timelines and budgets for new health programs. The government has committed to dedicate 2.5 percent of our GDP to health care by 2025. More and more programs are using 100 percent of their health care budgets. New programs are bringing medical insurance to the poor, allowing access to both government facilities and private facilities.

When you look at India’s history, this is a great place to be. Of course, as we drive to fully utilize health budgets, we need to keep working with the government to increase funding—but we are moving by leaps and bounds in the right direction.

Moving forward

So where do we go from here? In the next ten years, a lot still needs to change in India. The public must come to trust the public health system if it is to serve them. Seventy percent of the Indian population still chooses to see a private and likely unqualified health care provider for their health needs. Indians also face some of the highest out-of-pocket costs for health services, driving many struggling households back into poverty and debt.

But perceptions have started to shift. People are demanding better public services, and they expect that health services are going to improve in the coming years. In the next decade, however, it’s not just the public health care system that needs to be strengthened to solve this problem of public perception. We must also strengthen the link between health insurance, private health care providers, and the public, whether they live in cities or far beyond them.

As these forces come together, we’re going to see real progress in health for all Indians—especially those who need it most. That means a healthier, happier world, where people can live up to their full potential.

That’s where we are headed, and you can help to get us there.