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Year : 2013  |  Volume : 57  |  Issue : 3  |  Page : 133-137  

Role of public health systems in the present health scenario: Key challenges

Professor and HOD, Vice Principal, Department of Community Medicine, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India

Date of Web Publication14-Oct-2013

Correspondence Address:
J Ravi Kumar
Professor and HOD, Vice Principal, Department of Community Medicine, Siddhartha Medical College, Vijayawada, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-557X.119808

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The health scenario in our country is rapidly changing, both in terms of the public health challenges that we face as well as our response to these challenges. As India becomes more and more developed and we have greater means at our disposal, our response to our health challenges must reflect our changing health and socio-economic status. India faces enormous challenges in the area of women's and children's health. India is one of the few countries that have recorded substantial decline in maternal mortality. India is still far from achieving the target set in the millennium development goals. Despite several growth-orientated policies adopted by the government, the widening economic, regional, and gender disparities are posing challenges for the health sector. About 75% of health infrastructure, medical manpower, and other health resources are concentrated in urban areas where 27% of the populations live. To reduce this double burden of diseases, public health has to focus on health promotion, and disease prevention and control, while taking into consideration the social determinant of health. The focus of public health is to bring about change at the policy level not only for preventing disease but also for the health promotion through organized action at societal level.

Keywords: Demographic profile, Goals, Healthcare delivery system, India, Key challenges, Policy interventions, Public health

How to cite this article:
Kumar J R. Role of public health systems in the present health scenario: Key challenges. Indian J Public Health 2013;57:133-7

How to cite this URL:
Kumar J R. Role of public health systems in the present health scenario: Key challenges. Indian J Public Health [serial online] 2013 [cited 2022 Oct 2];57:133-7. Available from:

FNx01This article is based on the Dr. G. Anjaneyulu Oration delivered at the 56th All India Annual Conference of Indian Public Health Association (IPHA) at Kochi, Kerala in 2012.

   Introduction Top

We actually have a disease-oriented cure system rather than a health-oriented care system in this country today. When health improves, life improves by every measure. We have to take the responsibility of the future in terms of making the world a 'Better place' health wise and other wise. India being the second largest populated country in the world and with a multitude of health problems encompassing both communicable and noncommunicable diseases and other public health-related problems. India's burden in terms of maternal, new born, and child mortality is one the highest in the world. India has witnessed significant changes in public health, despite significant achievements in some areas. There remain many public health issues that are of immediate concern.

To date, it is estimated that 30% of all Indians still die without seeing a doctor. The universal access to basic services must be ensured. Preventive and promotive health will be pursued to bring down expenses on curative care. This emphasizes better access to health services for the poor, underserved, and marginalized.

India: Health Goals and Objectives

Aim: Improved access to quality healthcare, particularly women, children, and the poor by promoting integration, decentralization, and encouraging community participation.

Goals by March 31, 2012

  • Reduce infant mortality rate (IMR) to 28/1000 live births
  • Reduce maternal mortality ratio (MMR) to 100/100,000 live births
  • Reduce total fertility rate (TFR) to 2.1
  • Reduce malnutrition among children of 0-3 years to half its present level
  • Reduce anemia among women and girls by 50%
  • Raising the sex ratio for the age group of 0-6 years to 935 by 2011-12 and to 950 by 2016-17
  • Provide clean drinking water to all by 2009 and ensuring no slip backs
India has 28 states and 7 union territories. There are 593 districts, 5470 sub-districts, 5161 towns, and 638,588 villages. India is the second most populous country of the world after China and has changing socio-political - demographic and morbidity patterns that have been drawing global attention in recent years [Table 1]. Despite several growth-orientation polices adopted by the government, the widening economic, regional, and gender disparities are posing challenges for the health sector. About 75% of the health infrastructures are concentrated in urban areas where most of the population live.
Table-1: India — demographic profi le

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Health - key challenges

  • Significant inter-state, regional, social, gender disparities
  • Sub-optimal health outcomes given level of income growth (GDP per capita)
  • High financial burden on poor and "vulnerable" (40% remain poor or lapse into poverty every year)
  • Sub-optimal spending by public sector
  • Inadequate accountability of both public and private health service delivery
  • Unregulated private supply; unmonitored and unknown quality; concentration in urban areas
  • Double Jeopardy - increasing burden of noncommunicable diseases, while communicable disease burden remains high

   India Faces the Greatest Challenge of Workforce Top

Most of the states in India face severe health workforce shortage. Health service providers, management, and support workers are needed to fill the gap. These states are unable to provide basic, lifesaving services in consistent manner, for example, they generally fail to achieve an 80% coverage rate for measles immunization and other vaccine preventable diseases, without prompt action, the shortage will worsen.

Health workers - the people who provide healthcare to those who need it - are the heart of health systems. There is a chronic national shortage of health workers. There is no single solution to such a complex problems but ways forward do exist and must now be implemented. Action must be taken now for results to show in the coming years. In India, a rise in chronic health problems among the aging population and the aging of their own workforce has led to an even growing demand for health workers. The hour of need is to make the workforce a priority and put in place a national plan for managing it. Government also needs to invest in training existing health workers to keep them up to date to the changing priorities.

   Challenges in MCH Top

The challenges include lack of universalization of services, rural urban differential poor states of women in society, and lack of political will and acceptance of the issues as a social priority. There is need to ensure essential services for mothers and children during pregnancy, childbirth, the postpartum period, infancy, and childhood [Figure 1], [Figure 2], [Figure 3], [Figure 4]. The maternal mortality continues to be a problem in rural, remote, inaccessible, and tribal areas where there is hardly any health services available, even if available it is inadequate. The latest MMR estimates show an encouraging trend in India. However, we still need to reaffirm our commitment and redouble our effort, and focus on readdressing inequities in particular.
Figure 1: Neonatal death compared to infant death

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Figure 2: Trend of infant mortality rate and Maternal Mortality Ratio

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Figure 3: Trend of Maternal Mortality Ratio in India

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Figure 4: Trend of Infant Mortality Rate in India

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   Sex Ratio Top

The country has a falling low sex ratio of 940 female per 1000 male; early marriage in women and universality of marriage are important social issues. The health of women and children has always been an important social goal of all societies. The realization that improved maternal and child health is the key to the ultimate objective of interest and global focus toward this very important social health issue. Health of the child and mother are closely linked; each has the capacity to influence the other. Most of the deaths and illness in these groups are avoidable by cost effective interventions, which are available to tackle them.

In India, the health needs of general population are far from met, still half of the population is not assured of safe drinking water and the immunization status of the children is not increasing beyond. The public health fraternity should offer ways of delivering healthcare more effectively and equitability. The academics and researchers need to discover a new solution to all these challenges to prevent disease and save lives. Over and above, the healthcare in the country emphasis more on curative services and with inadequate laboratory capacity in the system, and poor participation of preventive sector in public health activities. According to estimates, in India, the total health expenditure is around 6% of the GDP but the government expenditure on healthcare is around 1% of the GDP. Due to this low public expenditure, the reach and quality of public health services are below the desired level.

India accounts for a meager 2.4% of the total world surface area, yet it supports and sustains 16.7% of the world population Emerging infectious diseases are a major public health problem in developing countries like India. Burden of now-communicable diseases are the leading causes of death in the country. Constituting cases of death in the country constitute 42% of all deaths of sanitation, increasing communicable and noncommunicable diseases, etc.

India is passing through demographic and environmental transition, which is adding to burden of diseases. There is triple burden of diseases of communicable and noncommunicable and emerging infectious diseases. There is persisting inequality in health status due to varying economic, social, and political causes.

   Conclusions Top

However, many initiatives have been taken recently for the growth of public health in India, which include National Rural Health Mission (NRHM). The priority is to ensure access, availability and utilization of primary healthcare to all including urban slums population for which there is a need to strengthen the healthcare infrastructure, increase public health work force with a dedicated public health cadre, enhancing public-private partnership.

The challenges faced now in the health sector are much more complex. The complexities of culture and customs, economic situations, geography, ethnicity, and political situations make the challenges related to public health specific, for every state of the nation. The problems faced by Indians like high incidence of communicable diseases, low performance of maternal and child health indicators, and nutritional problems, especially that of women and children, are the issues that persist in almost all parts of the country even today apart from the burden of chronic noncommunicable diseases and other economic and social factors.


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1]

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