UNIVERSALISATION OF HEALTH CARE IN INDIA: QUESTIONS, METHODS AND ASSESSMENTS
- Bertrand Lefebvre
(Geographer, University of Rouen, Visiting researcher at the school of Tropical Medicine of Bangkok, Mahidol University)
- Abhiroop Mukhopadhyay
(Economist, Indian Statistical Institute, Kolkata)
- Audrey Bochaton
(Geographer, University Paris Quest Nanterre, Paris)
- Venkat Raman
(Management studies, University of Delhi)
- Olivier Telle
(Geographer, Institut Pasteur, CSH, Delhi)
Universalisation of health care is at the heart of health policy in India since Independence in 1947. Since then, the country has experienced different models to improve access to health services and ensure universal care to entire population. During the first decades after 1947, the government has planned and invested in the development of a national and integrated network of care facilities (primary, secondary and hospital).The private sector was later on supported through public-private partnership policies in order to develop and diversify the supply of care. Targeted programs have been implemented for some patients (tuberculosis, HIV / AIDS, mother and child). Programs for health insurance have been developed over the last decade to reduce financial barriers to care for the poor (RSBY, Aarogyasri Scheme).
Despite the proliferation of governmental and private initiatives, the majority of the Indian population still has great difficulty in obtaining appropriate health care services. The lack of health centre near by is cited as the second reason for not using government health services after the low quality of care (NFHS-3). According to the same survey, a quarter of women placed remoteness of care services as the first barrier in access to care. Along these problems of spatial coverage, other barriers stand between patients and health care services. Health expenditures are for example the second cause of indebtedness of rural families. In 2004-05, 39 Million peoples lipped into poverty due to health spending (NSSO 2004-05).
Availability of services, financial, organizational, social and cultural barriers as well as health needs are all components of access to health, and whose evaluation requires a multidisciplinary approach. This workshop will present various approaches and methodologies to assess programs and policies aimed at universal health care in India. From geomatics, mapping and statistical techniques to case-based approaches and health seeking behaviour surveys, the participants will be introduced to a wide array of methodologies. Each of these methods will be mobilized for a final exercise of Local Health Diagnosis applied to a region in India.
Readings and online resources:
Apparicio, P., Abdelmajid, M., Riva, M., and Shearmur, R. (2008), “Comparing Alternative Approaches to Measuring the Geographical Accessibility of Urban Health Services: Distance Types and Aggregation-Error Issues,” In International Journal of Health Geographics, Volume 7, doi:10.1186/1476-072X-7-7. http://www.ij-healthgeographics.com/content/7/1/7/
Batra, A., Gupta I. and Mukhopadhyay, A. (2014), Gender differences in health expenditure of rural cancer patients: Evidence from a public tertiary care facility in India, Indian Statistical Institute, New Delhi: mimeo.
Cromley, E. K., and McLafferty, S. (2012), GIS and Public Health, New York: Guilford Press (2nd ed.).
Krishna, A., and Ananthpur, K. (2013), “Globalization, Distance and Disease: Spatial Health Disparities in Rural India”, in Millennial Asia, Volume 4, no. 1, pp. 3-25. doi:10.1177/0976399613480879. http://mla.sagepub.com/content/4/1/3.short?rss=1&ssource=mfr
National Commission on Macroeconomics and Health (2005), Background Papers – Financing and Delivery of Health Care Services in India, http://www.whoindia.org/en/Section102/Section201_887.htm.
QGIS – Online tutorials
STATA – A preliminary Introduction to STATA by Abhiroop Mukhopadhyay
Case Research Method – IDPAD Project