SDG 3: Good Health and Well Being

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Global Picture
  • The Goal addresses all major health priorities, including reproductive, maternal and child health; communicable, non-communicable and environmental diseases; universal health coverage; and access for all to safe, effective, quality and affordable medicines and vaccines
  • It also calls for more research and development, increased health financing, and strengthened the capacity of all countries in health risk reduction and management
    • Commendable progress has been achieved in several areas – improving child and maternal health and reducing mortality, raising life expectancy, and improving the defense against several major communicable diseases
    • On the flip side, progress has slackened in fighting HIV/ AIDS, malaria, and tuberculosis
    • Maternal mortality has fallen by almost 505 since 1990; measles vaccines have averted nearly 15.6 million deaths since 2000
  • The under-5 mortality rate has significantly come down to 39 deaths per 1,000 live births in 2017, a 6.7 per cent reduction since 2015, and an overall reduction of 49% since 2000
  • The global neonatal mortality rate has also undergone a substantial decline of 41% during the same period
    • On the other hand, the risk of dying from non-communicable diseases (i.e. cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases) remained high at 18%
  • Risks of dying from road traffic injuries and air pollution are on the rise
  • The capacity of the health care system needs to increase
    • For instance, accessing care by trained health professionals remains at a low level (per 10,000 people, 40% of all countries had less than 10 medical doctors and 55% less than 40 paramedics)

Indian Picture
  • The extent of change and improvement in India's healthcare system over the past decade is remarkable; there have been significant shifts in health strategies adopted and new directions set
  • The emphasis on water and sanitation, primarily through the Swachh Bharat Mission, has had a considerable impact on the spread of communicable diseases
  • The focus on preventative care and holistic approaches have massively increased
  • The attack on malnutrition has become comprehensive through increasing the entitlement to food under the National Food Security Act and the well-targeted National Nutrition Mission and Poshan Abhiyaan
  • Technology is leveraged for improving the efficiency of the health management system – eVIN (electronic vaccine intelligence network) to track and improve immunization coverage, ANMOL (ANM online) to extend better maternal and newborn care services, and use of Artificial Intelligence to improve diagnostics and treatment
  • There are significant efforts and initiatives to improve government accountability on health
    • For instance, the government has committed to enhancing public health expenditure to 2.5% of GDP by 2025; the National Health Policy, 2017 recommends State governments' health budget to be more than 8% of their total budget by 2020
    • The government is committed to establishing well equipped 1.5 lakh health and wellness centers by 2022 to ensure access to health services. 
Measures Taken by the Indian Government
  • Reducing Maternity Mortality Ratio
    • India has made groundbreaking progress in recent years in reducing the Maternal Mortality Ratio (MMR)
    • MMR has fallen from 78%, from 556 in 1990 to 122 in 2017 per 1,00, 000 live births
    • Eleven States:
      • Kerala, Tamil Nadu, Maharashtra, Telangana, Gujarat Andhra Pradesh, Jharkhand, Uttarakhand, West Bengal, Karnataka, and Haryana, have already achieved the National Health Policy target of IMR of less than 100 per 1,00,000 live-births in 2015- 17
    • While three States:
      • Kerala, Maharashtra, and Tamil Nadu have already reached the SDG-3 target of MMR of less than 70 per 1,00,000 live births, achieving the same at the national level remains a challenge
    • The implementation of the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy has had a profound impact on the maternal health situation
      • It has recognized the importance of integrating interventions across the life stages and addressed inequitable health care delivery for vulnerable population groups and uneven performance across the country
  • Reducing Under-5 Mortality
    • Under-5 mortality has registered considerable improvement over the years
    • The number of children under-five years of age dying in India has fallen by 37% since 2012, from 1.4 million to 8,82,000
      • Correspondingly, the under-5 mortality rate (under-5 deaths per 1000 live births) has fallen from 56 to 37, as per SRS 2015-17
    • Over the same period, infant deaths (dying before reaching their first birthday) fell by over 34% – from 1.09 million to 7,21,000, with the Infant Mortality Rate coming down from 44 to 30
      • Similarly, over the same period, neonatal deaths (dying in the first 28 days) reduced by over 29% – from 7,79,000 to 5,49,000, with the Neonatal Mortal Rate dwindling from 31 to 23%
    • The gender gap in the under-five mortality rate has narrowed down from 9.3% (54 deaths per 1,000 live births for males and 59 for females) to 2.7% (36 deaths per 1,000 live births for males and 39 for females as per SRS 2015-17)
    • Apart from the RMNCH strategy, the Integrated Child Development Service (ICDS) Scheme, one of the world's most extensive programs providing for an integrated package of services for the holistic development of the child is a critical intervention in this area
    • The initiative of Beti Bachao Beti Padhao has made a considerable impact on correcting the social bias against the girl child
    • Towards universalizing immunization, the Mission Indradhanush aims to immunize by 2020. Arresting malnutrition is an essential part of the measures to improve child survival and wellbeing
    • The multi-ministerial convergence mission of Poshan Abhiyaan focusses on ensuring attainment of malnutrition free India by 2022 and bringing down stunting among under-6 children from 38.4% to 25% by 2022
  • Addressing the Burden of Communicable Diseases
    • The communicable diseases scenario in the country presents a challenge
      • The estimated TB incidence in India stands at 2.7 million.17 India has stepped up its efforts to control TB and achieve the target for ending TB to 2025, five years ahead of the global target year of 2030
      • Focused and sustained government efforts have led to improvements in diagnostics, patient compliance and treatment outcomes
      • Efforts to improve diagnostics has increased the detection of drug-resistant TB by 52%
    • Among other initiatives, drug-resistant TB treatment centers (DR-TB) have been increased from 197 to 509 in the past year. India has the third-largest HIV epidemic in the world, with 2.1 million people living with HIV
      • HIV prevalence in India stood at 0.22% in 2017
      • However, new HIV infections in India have decreased by 46% and AIDS-related deaths by 22% since 2010.19 HIV incidence per 1000 uninfected population stood at 0.07 in 2017
      • The government has recognized the burden of these communicable diseases
    • It has been working to eradicate them through several targeted programs such as the National AIDS Control Programme (NACP), the Revised National Tuberculosis Control Programme (RNTCP), and the National Vector Borne Disease Control Programme (NVBDCP)
  • Adopting a focused approach for Non-Communicable Diseases (NCDs)
    • India is among the first countries to set specific targets and indicators to bring down the burden of NCDs mortality by 25% by the year
    • The government's response to NCDs has been robust, mainly through programs such as
      • The National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS)
      • The National Multisectoral Action Plan for Prevention and Control of NCDs (2017-2022) provides clear directions for tackling the growing burden of NCDs in the Indian socio-economic, cultural and health systems contexts
      • The Mental Healthcare Act, 2017 has an entitlement approach to the delivery of mental healthcare and services
  • Ensuring Universal Health Coverage
    • A recent bold initiative in the area of ensuring universal health coverage has been the launch of Pradhan Mantri Jan Arogya Yojana with its two components of Ayushman Bharat and Health & Wellness Centres, in 2018
    • Ayushman Bharat targets to provide health insurance coverage to over 100 million poor and vulnerable families (approximately five hundred million individuals) up to INR 5,00,000 per family per year for secondary and tertiary institutional care
    • Through 1,50,000 health and wellness centers, comprehensive health care, including maternal and child health services, along with free diagnostic services and essential medicine
    • In the first year of these initiatives, 4.65 million people had already accessed health care services
    • With countrywide portability, one can access the benefits from any public or private impaneled hospital across the country.
  • Affordability and the cost of health care
    • The private sector is the dominant healthcare provider in India, characterized by a lack of regulation and consequent variation in quality and costs of services
    • The public sector offers healthcare at low or no cost but is perceived as being unreliable and of sub-optimal or indifferent quality and, generally is not the first choice, unless one cannot afford private care
    • Public intervention in healthcare delivery needs to include monitoring of both public and private delivery systems and ensuring authentic diagnostic facilities at affordable cost among others
  • A large gap between best performing and least performing states
    • According to the NITI Aayog's State Health Index Report 2019 (Healthy States, Progressive India), the overall health index score of India's best-performing state is more than two and a half times as that of the bottom-most performer
    • There are vast regional disparities that Uttar Pradesh with the highest population ranks the lowest in Health Index with a score of 28.6 while Kerala is on top of the table with a score of 74.01
  • Lack of Health Awareness
    • While health awareness has spread considerably, gaps remain, particularly in the areas of child and adolescent health; food and nutrition; lifestyle aspects; geriatric morbidity and care; and mental health
    • Causes are diverse
      • Lack of focus on preventive care and patient counseling in the health delivery system
      • Lower public priority to health concerns
      • Weaker links between education and health
    • These issues need to be addressed in a system-wide approach both in the education and health sectors
      • 1,50,000 health and wellness centers, comprehensive health care, including maternal and child health services, along with free diagnostic services and essential medicine
    • In the first year of these initiatives, 4.65 million people had already accessed health care services
    • With countrywide portability, one can access the benefits from any public or private impaneled hospital across the country

Best and Worst Performers
  • Best: Kerala and Puducherry
  • Worst: Nagaland and Daman and Diu

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