India Infrastructure Report 2013|14
IDFC Foundation
216 x 280 mm
Year of Publishing
Territorial Rights
Orient BlackSwan

The Indian population today has little or no access to good quality healthcare at affordable prices. Not surprisingly, on several of the basic health indicators India ranks amongst the lowest in the world. The health crisis is aggravated by a rising incidence of chronic and non-infectious diseases. The public health system is in jeopardy, due to decades of appallingly low public investments; inadequate and antiquated infrastructure; severe shortage of human resources; and inadequacies in government policies. Failed public health systems have forced people to turn to the private sector, which is costly and unregulated, with services often being provided by unqualified medical practitioners. As a result, people seeking healthcare services have the agonising choice between poor quality public facilities and costly, yet undependable private services. Preventive and primary healthcare have been marginalised, with the focus having shifted to curative tertiary care, higher importance of clinical medicine and extremely high dependence on clinical investigations. Health expenditures can be prohibitively high with the rural population and the urban poor being the worst sufferers. India is thus faced with the daunting challenge of providing Universal Health Coverage (UHC) and ensuring that all people receive good quality healthcare without facing significant financial difficulty. 

Twelfth in the series, India Infrastructure Report 2013|14 looks at the challenges for ensuring availability, accessibility, affordability and quality of comprehensive healthcare to all, and explores strategies to overcome the impediments along the road to UHC. In this process, it also discusses whether initiatives taken to reduce the burden of people’s health expenditure has yielded desirable results, how to leverage the strengths of the private sector in healthcare delivery, role played by the non-state entities in rural healthcare, imperatives of engaging with the community, and the high impact of preventive care at low cost. The report draws the readers’ attention to some of the emerging issues in the health sector such as rising burden of non-communicable diseases (NCDs) and mental health, human resource crisis in health sector and health concerns of informal sector workers, and steps required to attend to them within the UHC framework.

The result of a collaborative effort led by the IDFC Foundation, this Report brings together a range of insightful perceptions of academics, researchers and practitioners committed to improving healthcare practices. It will be an extremely useful resource for policy-makers, academics, researchers and corporates engaged in this sector.

IDFC Limited (formerly Infrastructure Development Finance Company Limited) was incorporated in 1997 as India’s first specialised infrastructure-financing intermediary in order to address the growing requirements of the various infrastructure sectors. IDFC’s mandate was to lead private capital flows to commercially viable infrastructure projects. Having successfully played its role in promoting private investment in infrastructure over the last 16 years, IDFC would now enlarge its footprint in the financial services sector after receiving ‘in-principle’ approval of the Reserve Bank of India (RBI) to set up universal banking operations. In keeping with its mission of ‘being the leading knowledge-driven financial services platform, creating enduring value, promoting infrastructure and nation building, in India and beyond’, IDFC has been carrying out its development agenda under the rubric of the IDFC Foundation. IDFC Foundation is a wholly-owned subsidiary of IDFC Limited and a not-for-profit company within the meaning of Section 8 of the Companies Act, 2013. IDFC Foundation, since its inception, has been involved in policy advocacy and research, programme support, capacity building and community engagement programmes. IDFC Foundation’s activities are aimed at promoting inclusive growth, creating livelihood opportunities for the rural population and executing corporate social responsibility (CSR) initiatives.

List of Tables, Figures, Boxes
List of Abbreviations
Foreword by Rajiv B. Lall

The Road to Universal Health Coverage: An Overview
Sambit Basu and Sourabh Ghosh

Section I
1. Universal Healthcare and Social Responsibility of the Private Sector
Imrana Qadeer
2. Triple Burden of Malnutrition in India: Challenges and Opportunities
Prema Ramachandran
3. Overview of the Regulatory Structure of the Healthcare Sector
M. R. Madhavan and Mandira Kala
4. Scaling Up Health Expenditure for Universal Health Coverage: Prospects and Challenges
Indrani Gupta and Samik Chowdhury
5. Determinants of Private Healthcare Utilisation and Expenditure Patterns in India
Debasis Barik and Sonalde Desai

Section II
Accessibility, Affordability and Quality

6. Private Sector and Public-Private Partnership in Health Service Delivery in India
A. Venkat Raman
7. Innovative Social Enterprise Models for Rural Healthcare Delivery
Poonam Madan
8. Leveraging the Untapped Potential of Non-state Players for Universal Health Coverage
Anil Cherian, Rev. Mathew Abraham, Rev. Tomi Thomas, Priya John, Mercy John, Santhosh Mathew Thomas and Anuvinda Varkey
9. Community Participation in Healthcare Management in India: Need and Potentials
Abhijit Das
10. Rashtriya Swasthya Bima Yojana: A Step towards Universal Health Coverage in India
Nishant Jain
11. Simplifying the Healthcare Ecosystem the TPA Way
Vikram Jit Singh Chhatwal
12. Access to Medicines, Medical Devices and Vaccines in India
Sakthivel Selvaraj and Aashna Mehta
13. Vaccines and Immunisation: An Integral Aspect of Universal Health Coverage
Giridhara R. Babu, Raveesha R. Mugali and Vivek V. Singh
14. Janani Suraksha Yojana, Institutional Deliveries and Maternal Mortality: What Does the Evidence Say?
Ambrish Dongre
15. Positioning Quality in Health Services: A Case Study of Maternal and Child Health Programmes in India
Aradhana Srivastava, Sanghita Bhattacharyya and Bilal Avan

Section III
Emerging Challenges
16. New Models for Public-Private Partnerships in Health Promotion
Jacob Puliyel
17. Non-Communicable Diseases in India: Challenges and Implications for Health Policy
Sailesh Mohan and D. Prabhakaran
18. Improving Access to Mental Healthcare in India: Opportunities and Innovations
Rahul Shidhaye and Vikram Patel
19. Barriers to and Inequities in Coverage and Financing of Health of the Informal Workers in India
Charu C. Garg
20. Human Resources for Health in India: Current Challenges and Policy Options
Krishna D. Rao and Sudha Ramani
21. Capacity Building Exercise for Healthcare Service Workforce for Twenty-first Century India: Challenges and Opportunities for Radical Reforms
Gautam Sen

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