Health has always been a high priority area in any country.
It has been recognised as an important component in the process of economic
and social development. It does not simply mean absence of diseases, rather
it is a state of complete physical, mental and social well-being. Sanitation
and hygiene, nutrition as well as safe drinking water are the basic determinants
of good health. The indicators like infant mortality and maternal mortality
rates, life expectancy and nutrition levels, birth rate and death rate,
along with the incidence of communicable and non-communicable diseases
reflects the health status in an economy. The existence of proper and
well-defined health care facilities are vital not only for having a healthy
productive workforce and promoting general welfare, but also for attaining
the goal of population stabilisation as well as enhancing the overall
quality of life of people.
Over the years, India has built up a vast health infrastructure
and manpower, with a wide variety of hospitals and dispensaries being
set up at different levels and run both by public and private sectors.
They are being managed by qualified doctors and trained nurses. Expansion
in access to healthcare services combined with technological advancements
in this field has resulted in substantial improvement in health indices
of the population and a steep decline in mortality rates. Under the mandate
of National Common Minimum Programme (NCMP) of the Government of India,
health is one of the major thrust areas with special focus on primary
The health sector in India has been fragmented between the
Centre and the States. Items like public health, hospitals, sanitation,
etc. comes under the State list of the Constitution, while the items having
wider ramification at the national level like population control and family
welfare, medical education, prevention of food adulteration, quality control
in manufacture of drugs etc. have been included in the Concurrent list.
At the Central level, the Ministry
of Health and Family Welfare is a nodal authority for the growth and
development of health care sector in the country. It is instrumental and
responsible for implementation of various programmes on a national scale
in the areas of health and family welfare, prevention and control of major
communicable diseases as well as promotion of traditional and indigenous
systems of medicines. It also assists States in preventing and controlling
the spread of seasonal disease outbreaks and epidemics through financial
and technical support. The Ministry comprises of the following departments:-
of Health and Family Welfare; and (ii) Department
of Ayurveda,Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) and (iii) Department of Health Research.
The Department of Health and Family Welfare aims to provide
high-quality and superior health care facilities in an effective and time-bound
manner as well as tackle the menace of communicable and non-communicable
diseases, especially in rural areas and in those areas where incidence
of diseases is high. It is looking after all the activities, programmes
and policies relating to promotion of family welfare in the country, which
includes various measures in regard to population stabilisation, mother
and child care, education for family planning, etc. The Directorate
General of Health Services (DGHS) is an attached office of the Department
and renders technical advice on all medical and public health related
matters as well as is involved in the implementation of various health
While, the Department of Ayurveda,Yoga and Naturopathy,
Unani, Siddha and Homoeopathy (AYUSH) is responsible for designing, formulating
and implementing policy in order to promote and propagate Indian systems
of medicine, both within India and abroad. There are six systems of medicine
and health care in the country. These are:- Ayurveda, Unani, Siddha, Yoga,
Naturopathy and Homoeopathy. The main objectives of the Department are
- Attain global leadership for country in the field of
- Upgrade the educational standards in the Indian systems
of medicines and Homoeopathy colleges in the country
- Evolve pharmacopoeial standards for Indian systems of
medicine and Homoeopathy drugs
- Draw up schemes for promotion, cultivation and regeneration
of medicinal plants used in these systems
- Promote good health and expand the outreach of health
- Improve the quality of teachers and clinicians;
- Ensure affordable AYUSH services and drugs which are
safe and efficacious
- Facilitate availability of raw drugs which are authentic
and contain essential components
- Integrate AYUSH in health care delivery system and national
- Re-orient and prioritise research in AYUSH.
Besides, a new department called 'Department of Health Research' has been created in the Ministry in the year 2007, with the following work allocation:-
- Promotion and co-ordination of the basic, applied and clinical research including clinical trials and operational research in areas related to medical, health, biomedical and medical profession and education through development of infrastructure, manpower and skills in cutting edge areas and management of related information thereto;
- Promotion and providing guidance on research governance issues, including ethical issues in medical and health research;
- Inter-sectoral coordination and promotion of public private partnership in medical, biomedical and health research related areas;
- Advanced training in research areas concerning medicine and health, including grant of fellowships for such training in India and abroad;
- International co-operation in medical and health research, including work related to international conferences in related areas in India and abroad;
- Technical support for dealing with epidemics and natural calamities;
- Investigation of outbreaks due to new and exotic agents and development of tools for prevention;
- Matters relating to Scientific societies and associations, Charitable and religious endowments in medicine and health research areas;
- Coordination between organizations and institutes under the Central and State Governments in areas related to the subjects entrusted to the Department and for the promotion of special studies in medicine and health;
- Indian Council of Medical Research (apex body for planning, organization, implementation and coordination of medical research in the country).
The Ministry has been implementing various National
in the country, namely:-
- National Vector Borne Disease Control Programme (NVBDCP)
- National Filaria Control Programme
- National Leprosy Eradication Programme
- Revised National TB Control Programme
- National Programme for control of Blindness
- National Iodine Deficiency Disorders Control Programme
- National Mental Health Programme
- National Aids Control Programme
- National Cancer Control Programme
- Universal Immunization Programme
- National Programme for Prevention and Control of Deafness
- Pilot Programme on Prevention and Control of Diabetes, CVD and Stroke
- National Tobacco Control Programme
In order to build a healthy nation as well as to provide
preventive, promotive and curative care services to its people, the Ministry
has been undertaking several policy measures and initiatives. The most
important being the formulation of National
Health Policy (NHP) in 2002, which aims to achieve an acceptable standard
of good health amongst the general population of the country. The policy
document envisages certain targets for scaling-up health investments to
control all communicable diseases and expanding as well as strengthening
secondary and tertiary health care for the benefit of common man. It covers
all aspects of health care and focuses on the need for enhanced funding
and organisational restructuring of the public health initiatives at the
national level in order to facilitate more equitable access to the health
facilities; efficient delivery of public health infrastructure; education
of health care professionals; health research; enforcement of quality
standards for food and drugs; women's health; etc.
The policy involves
following strategies for achievement of its goals, such as:-
management including early case detection and complete treatment, strengthening
of referral services, epidemic preparedness and rapid response
vector management (for transmission risk reduction) including indoor residual
spraying in selected high areas, use of insecticide treated bed nets,
use of larvivorous fish, anti larval measures in urban areas including
bio-larvicides and minor environmental engineering
- Supportive interventions
including behaviour change communication, public-private partnership (PPP)
and inter-sectoral convergence, human resource development through capacity
building, operational research including studies on drug resistance and
Another major step in this direction has been the launching
of National Rural
Health Mission (NRHM) for the period 2005-12 in order to make substantial improvement in the basic health care delivery system in the country. The main objective of NRHM is to provide accessible, affordable, effective and reliable primary health care facilities, especially to the poor and vulnerable sections of population as well as poorest households in the remotest rural regions. It aims at bridging the gap in rural health care services through creation of a cadre of Accredited Social Health Activists (ASHA); increasing public expenditure on healthcare (from current 0.9% of GDP to 2-3% of GDP); reduction of regional imbalance in health infrastructure; decentralisation of programme to the district level to improve intra and inter-sectoral convergence and promote effective utilisation of resources; induction of management and financial personnel into district health system; as well as operationalisation of community health centers into functional hospitals in order to meet Indian Public Health Standards in each block of the country. The broad goals of the Mission are:-
- Reduction in Infant Mortality Rate (IMR) and Maternal
Mortality Ratio (MMR).
- Universal access to public health services such as womens
health, child health, water, sanitation and hygiene, immunization and
- Prevention and control of communicable and non-communicable
diseases, including locally endemic diseases.
- Access to integrated comprehensive primary health care.
- Population stabilization, gender and demographic balance.
- Revitalize local health traditions and mainstream AYUSH.
- Promotion of healthy life styles.
- Implementation of existing programmes of the Ministry.
NRHM is being operationalised throughout the country, with special focus on 18 states which have weak public health indicators and/or weak infrastructure. These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Odisha, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh. NRHM has received huge success over the years. More than 5.5 lakh ASHA or link workers are connecting households to health facilities. 1.75 lakh Village Health and Sanitation Committees have been made functional to bring about community ownership and planning in the health sector. Rogi Kalyan Samitis set at various levels have been made the custodian of the untied funds and annual maintenance grant for health facilities.
While, in order to address health needs of the urban poor, the Mission document on National Urban Health Mission (NUHM) has been approved in January 2008. The proposed Mission aims to address primary health needs of marginalized urban poor in 429 cities with a population of 1.00 lakh and above. This includes six capital cities with less than 1 lakh population. This is proposed to be initiated in 100 cities in the first year commencing from 2008-09 and would complement the activities undertaken by NRHM in rural areas. The objectives of the programme would be achieved through rationalizing extant public systems, public private partnership for expanding reach and community based health insurance measures.
Besides, the Ministry has been conducting periodic surveys,
like the National
Family Health Surveys (NFHS) and the District Level Household Surveys
(DLHS), to assess the impact and outcomes of its various health and welfare
programmes. For instance, NFHS is a large-scale multi-round survey conducted
in a representative sample of households throughout India. It provides
State and National information for India on fertility, infant and child
mortality, practice of family planning, maternal and child health, reproductive
health, nutrition, anaemia, utilization and quality of health and family
planning services. Three rounds of the survey have been conducted so far
with a view to create a comprehensive demographic and health database
in India. Each successive round of NFHS have two specific goals:-
- To provide essential data on health and family welfare needed by the Ministry
and other agencies for policy and programme purposes and
- To provide
information on important emerging health and family welfare issues.
The first NHFS (NFHS-1) was conducted during the year 1992-93, followed by NHFS-2 during 1998-99 and NFHS-3 during 2005-06. NFHS-3 is being conducted by Ministry with International Institute for Population Sciences (IIPS), Mumbai, as the nodal agency. It not only covers the aspects like maternal and child health, family planning, immunization, fertility and child mortality, but also provide information on several new and emerging issues including:-
- Perinatal mortality, male involvement in family welfare,
adolescent reproductive health, high-risk sexual behaviour, family life
education, safe injections, tuberculosis and malaria
- Family welfare and health conditions among slum and non-slum
dwellers in eight cities (Chennai, Delhi, Hyderabad, Indore, Kolkata,
Meerut, Mumbai and Nagpur)
- HIV prevalence for adult women and men at the national
level and for each of the six high HIV prevalence States, namely, Andhra
Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu.
The survey has been conducted in all 29 States and key survey
indicators have been estimated at the national level, for each State,
for major metropolitan areas, and for slum and non-slum areas in selected
Also, the Ministry has developed a broad institutional framework
to carry out the regulatory and developmental activities in the field
- The regulatory framework consists of two statutory bodies,
namely, the Central Council of Indian Medicine (for Ayurveda, Siddha
and Unani) and the Central Council of Homoeopathy (CCH) for laying down
minimum standards of education, recommending recognition of medical
qualifications, registration of practitioners and the laying down of
- There are National educational institutions such as the National Institute of Ayurveda at Jaipur, the National Institute of Homoeopathy at Kolkata, the National Institute of Naturopathy at Pune, the National Institute of Unani System of Medicine at Bangalore; the Morarji Desai National Institute of Yoga at Delhi; and Rashtriya Ayurveda Vidyapeeth at New Delhi. These institutions aim to regulate and develop high standards of education, teaching, training and research in all aspects of Indian medicine systems.
- The Department of AYUSH operates two apex laboratories, namely, the Pharmacopoeial Laboratory for Indian Medicine (PLIM) and the Homoeopathic Pharmacopoeial Laboratory (HPL), both at Ghaziabad to carry out the research work in the field of medicines.
- The Indian Medicines Pharmaceutical Corporation Ltd.
(IMPCL), a Public Sector Undertaking under the Department, manufactures
classical Ayurveda and Unani drugs.
- The National Medicinal Plants Board coordinates all
the matters relating to medicinal plants, including drawing up policies
and strategies for conservation, proper harvesting, cost-effective cultivation,
research and development, processing, marketing of raw material in order
to protect, sustain and develop this sector. Its main functions are:-
- Assessment of demand/supply position relating to medicinal plants
both within the country and abroad
- Advise concerned Ministries/
Departments/ Organizations/ State/ UT Governments on policy matters
relating to schemes and programmes for development of medicinal plants
- Identification, inventorisation and quantification of medicinal
- Promotion of ex-situ/in-situ cultivation and conservation
of medicinal plants
- Promotion of co-operative efforts among collectors
and growers as well as assisting them to store, transport and market
their produce effectively
- Undertaking and awarding scientific,
technological research and cost-effectiveness studies
the protection of patent rights and other intellectual property rights
concerned with it etc.
- There is a 'Drug Control Cell' which deals with matters
pertaining to licensing and regulation of drugs and the control of misbranded/adulterated
and spurious Ayurvedic, Unani and Siddha Drugs and other related matters.
It is also concerned with the Traditional Knowledge Digital Library
(TKDL) and matters relating to Intellectual Property Rights (IPR).
- There are four Research Councils, namely:-
These Councils are the apex bodies
for research in the concerned systems of medicine and are fully financed
by the Government of India. They continue to initiate and guide, develop
and coordinate scientific research in different aspects of respective
systems, both fundamental and allied. Their research activities have
been reviewed to ensure that they undertake meaningful research under
fixed parameters within specified period and disseminate research findings
for the benefit of educationists, researchers, physicians, manufacturers
and common man.
Council for Research in Ayurveda & Siddha (CCRAS)
Council for Research in Unani Medicine (CCRUM)
- Central Council
for Research in Homoeopathy (CCRH)and
- Central Council for Research
in Yoga & Naturopathy (CCRYN)
As a result of all such measures, India has achieved impressive demographic transition owing to the decline of crude birth rate, crude death rate, total fertility rate and infant mortality rate. As per the available information, the crude birth rate (CBR) declined from 40.8 births per thousand population in 1951 to 29.5 in 1991 and further to 23.5 in 2006. Similarly, there has been a sharp decline in crude death rate (CDR) from 25.1 deaths per thousand population in 1951 to 9.8 in 1991 and further to 7.5 in 2006. The total fertility rate (average number of children likely to be born to a woman between 15-40 years of age) has decreased from 6.0 in 1981 to 2.9 in 2005. The maternal mortality rate has also declined from 437 per one lakh live births in 1992– 93 to 301 in 2001-03. The infant mortality rate, which was 110 in 1981, has declined to 57 per 1000 live births in 2006. While, the child mortality rate has decreased from 57.3 in 1972 to 17.3 in 2005. As far as family planning is concerned, the District Level Household Survey (DLHS) conducted in 2002-04, has revealed that 45.7% eligible couples are currently using any one of the family planning methods as against 22.8% in 1981. The total number of acceptors of different family planning methods enrolled in the country during the year 2006-07 was 46.19 million. As on 1.4.2007, there were approximately 7.25 lakh registered practitioners, 3204 hospitals and 21437 AYUSH dispensaries all over the country. But, since health is a key social services sector in India, lot more efforts and incentives are needed to improve the health care delivery system in the country and promote general well-being of the people.