HEALTH AND HEALTHCARE IN MAHARASHTRA – A STATUS REPORT

Ravi Duggal, T.R. Dilip and Prashant Raymus




Maharashtra has been at the forefront of healthcare development in India. It was one of the first states to achieve the norms mandated for primary health centres, sub-centres and Rural Hospitals, under the Minimum Needs Programme. The state also has the largest private health sector in India whose reach is quite extensive.

Although Maharashtra is one of the affluent states in India with the highest per capita income, and contributes over 15% of the country's national income and 40% of the tax revenues, having one of the largest industrial economies, post-SAP Maharashtra's position has faced a reversal. In terms of the social infrastructure too (schools, health care facilities, water supply, housing etc.) it no longer dominates the country. There are two areas of concern which plague Maharashtra, one is food availability (rather access) which is the cause of unacceptable levels of malnourishment, and the other, the declining sex-ratio, especially in the 0-6 year age-group, which has clear linkages with sex-selective abortions linked to sex-determination. Further, there is a decline in public expenditure on health care from 1 per cent of NSDP in the eighties to 0.7 percent in 2001-02, and as a proportion to total government spending from over 6 per cent in eighties to a low of 4.6 per cent in 2001-02 and this declining expenditure has contributed to the adversities faced by the public health sector and consequently the health status of the citizens of the state.

The book has six chapters which focus on socio-economic and demographic profile of Maharashtra, the organisational structure and systems of public health care services at various levels in urban as well as rural areas, the physical infrastructure for delivery of health care services and the wide rural-urban disparity in access to these services, review of healthcare facilities available in public sector in the state, analysis of declining public expenditure on health care services including curative care as well as preventive and promotive programmes and some indicators of health status such as infant mortality, child mortality, life expectancy, morbidity and hospitalisation, nutritional status, water supply and sanitation in Maharashtra. The discussion in all chapters is analytic and backed by strong evidence in 46 tables with time-series data on a wide range of health and related issues.

Health and Healthcare in Maharashtra – A Status Report is a comprehensive and analytical compilation of healthcare development of Maharashtra bringing together all available information and data on health and healthcare.

Contents

  1. Contextualising Health Care
  2. Organisation of Public Health Services
  3. Health Care Delivery: Physical Infrastructure
  4. Health Care Facilities in Public Sector
  5. Public Health Expenditure
  6. Some Indicators of Health Status
Highlights of Tables
1. Health Infrastructure in Maharashtra 1981-2001

2. District-wise number of medical institutions and beds per one lakh population, Maharashtra

3. Availability of health care infrastructure facilities in Maharashtra by districts

4. Availability of Primary Health Centres (PHC's), Rural Hospital (RH's) and Sub-centres in Maharashtra , 1991-2001

5. Number of Doctors and Nurses per 1,00, 000 population

6. Rural-Urban availability of Doctors and Nurses in Maharashtra, 2000

7. Availability of selected physical infrastructure facilities in District Hospitals, First Stage Referral Units (FRU's), Community Health Centres (CHC's) and Primary Health Centres (PHC's), Maharashtra, 1999-2000

8. Availability of selected equipment in District Hospitals, First Stage Referral Units (FRU's) and Community Health Centres (CHC's) Maharashtra, 1999-2000

9. Availability of manpower facilities in District Hospitals, First Stage Referral Units (FRU's), Community Health Centres (CHC's) and Primary Health Centres (PHC's) Maharashtra, 1999-2000

10. Availability of some stock of selected items in District Hospitals, First Stage Referral Units (FRU's) Community Health Centres (CHC's) and Primary Health Centres (PHC's) Maharashtra, 1999-2000

11. Availability of at least 60 per cent of critical inputs in District Hospitals, First Stage Referral Units (FRU's) and Community Health Centres (CHC's) Maharashtra, 1999-2000

12. Health Care Facilities in Mumbai, Rural and Urban Maharashtra by Public and Private Sector

13. Utilization of Public and Private Facilities in Rural and Urban Maharashtra

14. Per cent users of public health facilities in Maharashtra

15. Prevalence of selected diseases in Maharashtra

16. HIV/AIDS status in Maharashtra

17. District-wise couples Effectively Protected (CEP) and Fertility Indicators: Maharashtra 2001

18.Percentage receiving selected antenatal care services in Maharashtra

19. District level and regional variations in selected Reproductive and Child Health indicators, 1998-99

20. Public Expenditure on Health Care in Maharashtra

21. Maharashtra Government Expenditure on Health

22.Expenditure on selected diseases programme (as per cent to expenditure on Disease Programmes)

23. Average out of pocket medical expenditure on treatment of an ailment in outpatient care and inpatient care units, Maharashtra 1986-87 and 1995-96

24. Maharashtra 2000-01 Public Health Expenditures: Across Rural and Urban Areas

25.Profile of Utilization and Expenditure in Public Hospitals in Maharashtra, 2000-2001

26.Expenditure on medical education in Maharashtra in 1999-2000 (actuals)

27.Number of students selected in medical colleges in 4½ years MBBS course in 2001-2002

28. Trends in Infant Mortality Rate by residence and sex, Maharashtra

29.Trends in Child Mortality indicators by place of residence Maharashtra (per 1000 live births)

30.District-wise variations in Infant and Under 5 Mortality Indicators, Maharashtra 1991

31. Trends in Life Expectancy at birth by residence and sex,Maharashtra

32. Prevalence of ailments and hospitalisation per thousand persons inMaharashtra, 1995-96

33.Number of persons reporting ailment during a period of 15 days per 1000 persons and number of persons hospitalized per 1000 population by fractile-group of mpce and social group

34. Percentage distribution of deaths by major cause groups in Rural Maharashtra (excluding senility) 1981-1994

35.Percentage distribution of deaths (excluding senility) due to ten major causes in rural Maharashtra, 1997

36. Per thousand distribution of persons by calorie intake level for Maharashtra, 1983-2000

37. Average per capita intake of calorie, protein, and fat per diem for Maharashtra 1972-2000

38. Anemia among women aged 15-49 years and children under three years (6-35 months) in Maharashtra, 1998-99

39. Nutritional status of ever married women aged 15-49 years, 1998-99

40. Nutritional status of children under 3 years Maharashtra, 1998-99

41. Number of beneficiaries under supplementary Nutrition Programme (ICDS) in the month of March 2001, Maharashtra

42. Percentage of households having drinking water and sanitation facilities in Maharashtra

43. Source of drinking water, Maharashtra 1999

44. Type of sanitation facility, Maharashtra 1999

45. Percentage of households having safe drinking water and toilet facilities, Maharashtra 1991

46. Overall Inputs and Outcomes of Health Sector in Maharashtra in Rural and Urban Areas

Figures

1. Organisation Structure of Public Health and Family Welfare

2. Organisation Structure of Medical Education and Drugs Department

3. Organisation Structure of Public Health at District

4. Sources of Utilization of Health Care Services, Maharashtra

5. Percentage Nutritional status of Children

Box Items
1. Private Health Care - Evidence through Utilization Studies

2. Health Sector Reforms ?

Annexure Tables


I) Health care indicators across selected states in India

II) Summary of information on studies covering morbidity and utilization of health care services from private sector and on medical expenditure in Maharashtra

III) Total Public Expenditure on Health (Rs. in Millions) and Health Expenditure as a percentage of NSDP

IV) Expenditure on National Disease Programme and Public Health

V) Expenditure on Malaria Control Programme by Line Items

VI) Expenditure on Leprosy Control Programme by Line Items (in percentage), Maharashtra

VII)Expenditure on National Tuberculosis Control Programme by Line Items (in percentage), Maharashtra

VIII)Per cent Expenditures across Line Items under Family Welfare programme (Rural Family Welfare Services)

IX) Per cent utilizing health care services from private sector for selected RCH services by districts, Maharashtra, 1998-99

X) District wise number of AIDS cases reported and deaths reported in Maharashtra, August 1986-February 2001

XI)Selected district-wise child health indicators, Maharashtra 1998-99

XII)Percentage of males and females having at least one of RTI/STI symptoms, Maharashtra

XIII) Number of beneficiaries under supplementary nutrition programme (ICDS) in the month of March 1996-2000

XIV) Goals and Achievements for Health and Family Welfare Programme,Maharashtra

XV) Per Capita District Domestic Product At constant (1993-94) prices

XVI)Monthly Per Capita Expenditure (MPCE) by group of Item of Consumption

XVII) State Income i.e. Net State Domestic Product (At constant prices) Consumption

Report also published in Marathi

Contribution: Rs.100/-