Research Area : Health Services and Financing
The background paper on Health and Nutrition in Maharashtra was prepared for Human Development Report 2002, Maharashtra, brought out by the Government of Maharashtra/Planning Commission/ United Nations Development Programme. This paper made a critical appraisal of the achievements made by Maharashtra in terms of health and nutritional outcomes. It contains sections on mortality, morbidity, nutrition, disease control programmes, family welfare programme, health care delivery and utilisation, water supply and sanitation, public expenditure on health and health sector reforms in the state. The report indicated a notable improvement in levels of life expectancy and infant mortality in the state. However, the rural-urban differentials had increased over time. Analysis of availability of health care services showed a strong urban bias in the location of both public and private health care facilities. The rural urban differentials in health status indicators might be attributed to this.
Apart from leprosy, there was no evidence to show a decline in malaria, tuberculosis, and blindness. AIDS has become a major threat. Maharashtra has the highest prevalence of HIV among all Indian states, accounting for 50 per cent of the cases in India.
The public sector was found to be dominating only in delivering contraceptive and immunization services, while the private sector, which is better developed here than in the rest of the country, was found to be the major provider of other health care services. Because of higher treatment costs, the private sector was found to be relatively inaccessible to the poor. Not only is the share of health expenditure in the government budget lower than most of the other states in India, there has been a deceleration in public spending on health care since the early 1990s.
Despite having the highest per capita income in the country, the nutrition status in Maharashtra was not encouraging. As much as 57 per cent of the households in rural areas and 55 per cent in urban areas consumed less than the standard 2,700 calories per day. The impact of this low level of nutritional intake was observed while analyzing the nutritional status of women and children, which was lower than the national average. The report advocates the need to improve coverage of the ICDS schemes, strengthening of rural health infrastructure, strengthening the monitoring of private health care system, focusing more attention on HIV/AIDS, and to raise public spending on health care to 5 percent of the total public expenditure.
Supported by:Government of Maharashtra
Team: Ravi Duggal, T. R. Dilip, Rajshri Kamath