Escolar Documentos
Profissional Documentos
Cultura Documentos
Overview
The acceleration of economic growth since 1981 has not translated adequately
into a sustained improvement in Indias human development outcomes
[GDP growth: 1950-80 = 3.5; 1980-2000= 5.5; 2000-2011= 8.0 approx]
MMR and Under five mortality are unacceptably high and the decline has
been slow. This is a cause for concern for both national and global policy
(Subramanian et al :2006).
India offers a complex picture of multiple inequalities. There are regional, sub
regional, social and economic dimensions of inequality along multiple axes of
class, caste, gender and religion
The available macro data sets enable us to examine these relationships and the
patterns
117
120
101
Under 5 M ortality
100
96
Mothers
with no
education
ST
79
80
70
74
59
60
40
30
20
95
34
14
Urban
Kerala
Mothers Highest
with more quintile
than 12
years of
education
Non ST,
SC and
OBC
Male
All India
Female
Lowest
quintile
Rural UP
Source: Baru et al (2010) Inequities in Access to Health Services in India: Caste, Class and Region, Economic &
Political Weekly,September 18, 2010 vol xlv no 38. Pp 49-58
Social Gap in Under-Five Mortality for three periods 19921993*, 1998-99 and 2005-06
140
119
120
101
100
80
74
60
SC-Other
ST-Other
OBC-Other
All India
44
40
38
37
37
29
24
21
20
14
1992-93
1998-99
2005-06
NFHS Years
Source: Baru et al (2010) Inequities in Access to Health Services in India: Caste, Class and Region,
Economic & Political Weekly,September 18, 2010 vol xlv no 38. Pp 49-58
75.3
75.2
80
Kerala
57.6
50
40
39.7
Scheduled caste
43.5
38.6
Rural
60
35.5
31.3
30
24.4
23
20
10
Highest Quintile
Urban
Uttar Pradesh
Scheduled tribe
Lowest Quintile
Source: Baru et al (2010) Inequities in Access to Health Services in India: Caste, Class and
Region, Economic & Political Weekly,September 18, 2010 vol xlv no 38. Pp 49-58
100
100
80
60
51
40
20
38
39
OB C
A ll Ind ia
33
16
18
R ur al U P
ST
SC
N o n ST , SC and
OB C
U r b an Ker ala
Source: IIPS and Macro International (2007): National Health and Family Survey 2005-06 (NFHS 3), Mumbai.
90
84
80
70
58
60
50
39
40
27
30
24
24
23
20
13
10
14
Lo west
Seco nd
M id d le
F o urt h
Hig hest
W ealt h Ind ex
Source: IIPS and Macro International (2007): National Health and Family Survey 2005-06 (NFHS 3), Mumbai.
10
Defining commercialisation
11
12
Lack of regulation
Health sector reforms accelerated commercialisationpublic and private (Qadeer et al: 2002)
16
17
Back and forth linkages between public and private sector; between
formal and informal sector for maternal health services. (Unisa: 1999;
Narayana:2006; Singh:2009; Jeffery & Jeffery: 2010)
18
Summing Up
Selected References
Baru, R (1998): Private Health Care in India: Social Characteristics and Trends (New Delhi: Sage
Publications).
Baru, R and Nundy, M ( 2008) Blurring of Boundaries: Public-Private Partnerships in Health Services in India.
Economic and Political Weekly, January 26th 2008. pp.62-71
Baru,R and Bisht, R (2010) Health service inequities as challenge to health security, IHD and Oxfam
Working Paper Series.
Bonu, S, I Bhushan and D H Peters (2007): Incidence, Intensity and Correlates of Catastrophic Out-ofPocket Health Payments in India, ERD Working Paper No 102, Asian Development Bank, October;
Manila, Philippines.
Garg, C and A K Karan (2005): Health and Millennium Development Goal 1: Reducing Out-of-Pocket
Expenditures to Reduce Income Poverty-evidence for India, EQUITAP Project, Working Paper No 15,
Institute of Health Policy, Colombo
Hart, T J (2000): Commentary-Three Decades of the Inverse Care Law, British Medical Journal, 320
(7226): pp 18-19.
IIPS and Macro International (2007): National Health and Family Survey 2005-06 (NFHS 3), Mumbai
Iyer, A, G Sen and A George (2007): The Dynamics of Gender and Class in Access to Health Care:
Evidence from Rural Karnataka, India, International Journal of Health Services, 37(3): 537-54
Jeffery, P, A Das, J Dasgupta and R Jeffery (2007): Unmonitored Intrapartum Oxytocin Use in Home
Deliveries: Evidence from Uttar Pradesh, India, Reproductive Health Matters, 15(30), 172-78.
Jeffery,P and Jeffery, R (2008) Money itself discriminates obstetric emergencies in the time of
liberalisation Contributions to Indian Sociology, vol 42, no 1. pgs 59-91
Jeffery, P and Jeffery, R (2010) Only when the boat has started sinking: A maternal death in rural
north India Social Science and Medicine. November. 71(10), pp.1711-1718
Muraleedharan, V R (1999): Characteristics and Structure of the Private Hospital Sector in Urban India:
A Study of Madras City, Small Applied Research Paper 5, Partnerships for Health Reform Project, ABT
Associates Inc, Bethesda.
Nandraj, S and R Duggal (1997): Physical Standards in the Private Health Sector: A Case Study of Rural
Maharashtra, Centre for Enquiry into Health and Allied Themes, Mumbai
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Narayana, K V (2006): The Unqualified Medical Practitioners: Methods of Practice and Nexus with
Qualified Doctors, Working Paper No 70, Centre for Economic and Social Studies, Hyderabad.
Nayar, K R (2007): Social Exclusion, Caste and Health A Review Based on Social Determinants
Framework, Indian Journal of Medical Research, (126), October, pp 355-63
Praveen Kumar Pathak, Abhishek Singh, S. V. Subramanian (2010) Economic Inequalities in Maternal
Health Care: Prenatal
Care and Skilled Birth Attendance in India, 19922006. PLOS open access journal
Qadeer, I, K Sen and K R Nayar (2001): Public Health and the Poverty of Reforms: The South Asian
Predicament (New Delhi: Sage Publications).
Rani, M, S Bonu and S Harvey (2007): Differentials in the Quality of Ante Natal Care in India,
International
Journal for Quality in Health, pp 1-10.
Rao, S (2005): Delivery of Services in the Public Sector: Financing and Delivery of Healthcare Services
in India, National Commission on Macroeconomics and Health Background Papers, Ministry of Health
and Family Welfare, Government of India, New Delhi.
Rao, S, M Nundy and A S Dua (2005): Delivery of Health Services in the Private Sector: Financing and
Delivery of Health Care Services in India, National Commission on Macroeconomics and Health
Background Papers, Ministry of Health and Family Welfare, Government of India, New Delhi
Sharma,S, S. Smith, E. Sonnavelett, M.Pine, V. Dayaratna, R. Sanders (2005) Formal and Informal Fees
for Maternal Health Care Services in Five Countries:Policies and Perspectives. Policy Working Paper
Series No. 16, USAID, June.
Singh, K (2009) Practices of unqualitied practitioners in urban slums of south west delhi: an exploratory
study. Unpublished MPhil dissertation, Jawaharlal Nehru University, New Delhi.
Skordis-Worrall et al. Maternal and neonatal health expenditure in mumbai slums (India): A cross
sectional study BMC Public Health 2011, http://www.biomedcentral.com/1471-2458/11/150
Subramanian, S V, S Nandy, M Irving, D Gordon, H Lambert and G D Smith (2006): The Mortality Divide
in India: The Differential Contributions of Gender, Caste and Standard of Living across the Life Course,
American Journal of Public Health, 96, pp 818-25
Unisa, S (1999): Childlessness in Andhra Pradesh: Treatment Seeking and Consequences,
Reproductive Health Matters, 7(13), pp 54-64, May
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