According to data provided in 1989 by the Ministry of Health and Family Welfare, the total number of civilian hospitals for all states and union territories combined was 10,157. In 1991 there was a total of 811,000 hospital and health care facilities beds. The geographical distribution of hospitals varied according to local socio-economic conditions. In India’s most populous state, Uttar Pradesh, with a 1991 population of more than 139 million, there were 735 hospitals as of 1990. In Kerala, with a 1991 population of 29 million occupying an area only one-seventh the size of Uttar Pradesh, there were 2,053 hospitals. In light of the central government’s goal of health care for all by 2000, the uneven distribution of hospitals needs to be re-examined. Private studies of India’s total number of hospitals in the early 1990s were more conservative than official Indian data, estimating that in 1992 there were ^300 hospitals. Of this total, nearly 4,000 were owned a‘1(d managed by central, state, or local governments. Another 2,000, owned and managed by charitable trusts, received
partial support from the government, and the remaining 1,300 hospitals, many of which were relatively small facilities were owned and managed by the private sector. The use of state-of-the-art medical equipment, often imported from Western countries, was primarily limited to urban centres in the early 1990s. A network of regional cancer diagnostic and treatment facilities was being established in the early 1990s in major hospitals that were part of government medical colleges. By 1992 twenty-two such centres were in operation.
Most of the 1,300 private hospitals lacked sophisticated medical facilities, although, in 1992, approximately 12 per cent possessed state-of-the-art equipment for diagnosis and treatment of all major diseases, including cancer. The fast pace of development of the private medical sector and the burgeoning middle class in the 1990s have led to the emergence of the new concept in India of establishing hospitals and health care facilities on a for-profit basis.
By the late 1980s, there were approximately 128 medical colleges—roughly three times more than in 1950. These medical colleges in 1987 accepted a combined annual class of 14,166 students. Data for 1987 show that there were 320,000 registered medical practitioners and 219,300 registered nurses. Various studies have shown that in both urban and rural areas people preferred to pay and seek the more sophisticated services provided by private physicians rather than use free treatment at public health centres. Indigenous or traditional medical practitioners continue to practice throughout the country.
The two main forms of traditional medicine practiced are the ayurvedic (meaning science of life) system, which deals with causes, symptoms, diagnoses, and treatment based on all aspects of well- being (mental, physical, and spiritual), and the unani (so- called Galenic medicine) herbal medical practice. A vaidya is a practitioner of the ayurvedic tradition, and a hakim (Arabic for a Muslim physician) is a practitioner of the unani tradition. These professions are frequently hereditary. A variety of institutions offer training in indigenous medical practice. Only in the late 1970s did official health policy refer to any form of integration between Western-oriented medical personnel and indigenous medical practitioners. In the early 1990s, there were ninety-eight ayurvedic colleges and seventeen unani colleges operating in both the governmental and non-governmental sectors.
The Indian constitution charges the states with ‘the raising of the level of nutrition and the standard of living of its People and the improvement of public health’. However, many critics of India’s National Health Policy, endorsed by Parliament in 1983, point out that the policy lacks specific measures to achieve broad stated goals. Particular Problems include the failure to integrate health services With wider economic and social development, the lack of Nutritional support and sanitation, and the poor participatory involvement at the local level.
Central government efforts at influencing public health have focused on the five-year plans, on coordinated planning with the states, and on sponsoring major health programmes. Government expenditures are jointly shared by the central and state governments. Goals and strategies are set through central-state government consultations of the Central Council of Health and Family Welfare. Central government efforts are administered by the Ministry of Health and Family Welfare, which provides both administrative and technical services and manages medical education. States provide public services and health education.
The 1983 National Health Policy is committed to providing health services to all by 2000. In 1983, health care expenditures varied greatly among the states and union territories, from Rs.13 per capita in Bihar to Rs.60 per capita in Himachal Pradesh, and Indian per capita expenditure was low when compared with other Asian countries outside of South Asia. Although government health care spending progressively grew throughout the 1980s, such spending as a percentage of the gross national product remained fairly constant. In the meantime, health care spending as a share of total government spending decreased. During the same period, private sector spending on health care was about 1.5 times as much as government spending.
In the mid-1990s, spending on health amounts to 6 per cent of GDP, one of the highest levels among developing nations. The established per capita spending is around Rs.320 per year with the major input from private households (75 per cent). State governments contribute 15.2 per cent, the central government 5.2 per cent, third- party insurance and employers 3.3 per cent, and municipal government and foreign donors about 1.3, according to a 1995 World Bank study. Of these proportions, 58.7 per cent goes toward primary health care (curative, preventive, and promotive) and 38.8 per cent is spent on secondary and tertiary inpatient care. The rest goes for non-service costs.