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The National Health Policy (NHP), 2002 has sets out the basic objective of achieving good health amongst all population of the country. The National Common Minimum Programme (NCMP) of the present Government has also placed emphasis on raising public health investment with focus on primary health care and increased investment in programmes to improve the reproductive and child health care. It envisages an increase in public spending on health to 2-3 per cent of GDP by increased contributions from the Central and State Governments. Towards this end the Government has launched a National Rural Health Mission (NRHM).
The NRHM be implemented throughout the country with special focus on 18 States with weak public health indicators and/or weak infrastructure; to improve the availability of and access to quality health care in general and to reproductive and child health care and to build synergy between health and determinants of good health like nutrition, sanitation, hygiene and safe drinking water. Accordingly, the targets are to reduce the Maternal Mortality Rate (MMR) to 100 per100, 000 live births by 2012; the Total Fertility Rate (TFR) to be reduced to 2.1 by 2012; and the Infant Mortality Rate (IMR) to be reduced to 30 per1000 live births by 2012. These targets are prominently placed in achieving millennium development Goals (MDGs).
Social Groups
Caste and religion is intertwined with every aspect of life in India. The Hinduism is the largest religion, which is described as majority and followed by the Muslims, Christians and others including Sikhs, Buddhists and Jains, which are described as minorities. The Hindu Religion has further divided into different caste groups broadly termed as the Scheduled Castes, (SCs), the Scheduled Tribes (STs), the Other Backward Classes (OBCs) and Others. According to 2001 Census, the Hindus constitute about 80.5% and within it the SCs representing 16.2 per cent, the STs account for 8.2 per cent of the country’s total population. In the absence of specific Census data, it is not possible to quote the exact figure for the OBCs, but NFHS and NSS estimates roughly about 32-37%. The minorities, who constitute 19.5%, represent Muslims about 13.4 per cent, Christians 2.3 per cent, Sikhs 1.8 per cent, Buddhists 0.8 per cent and Jains 0.4 and others 0.7 per cent to total population in India.
The Constitution of India guarantees social, economic and political provisions for protection and promotion of interest of the SCs/STs, the OBCs and the Minorities. In order to bring them at par with the rest of society by adopting the approach of social justice to ensure equal rights, access to public services and resources to enable them to develop their potential and capacities as agents of social change, through the process of planned development.
The discussion here is focuses on equity perspective of the present health status and patterns of health care access and utilization by different social groups viz. SCs/STs and OBCs others and the religious minorities both in absolute term and relative terms. The National Family Health Survey NFHS-II (1998-99) provides recent information on aspects of health status, access to health care, and utilization of health service by different sections of population in India.
Equity in Health
Generally the assessment health conditions of population, it is often restrict to a few measurable aspects, such as mortality, morbidity, and nutritional status. The health status of individuals affects their capabilities both in gaining access to socio-economic opportunities and therein community at large. Other things being equal, a better health status enhances the capabilities and productive skills of individuals. Differentials in the health status of individuals in a population, in tandem with differentials in other basic endowments, will have a bearing on their pattern of access and utilization to health care services. Following sections describe the attainment of these indicators and difference between caste and religious groups in India.
Mortality: Mortality is an important indicator and reflects a country’s level of socio-economic development and quality of life of population. It indicates that rate of death occurred in given period of time for 1000 population. The NFHS gives major three mortality rate related to children namely, Infant Mortality Rate (IMR), Child Mortality Rate (CMR) and Under-five Mortality Rate (U5MR) reflects the probability of dying in early childhood.
Infant Mortality Rate is the proportion of newborn dying before completion of the first year of age. According to the NFHS-II, the infant mortality rate for Hindus 77 per thousand much higher than Christians (49 per 1000) and Muslims (59 per 1000), but close to the average for India (73 per thousand) as a whole. Similarly, in case of child mortality and under-five mortality rates are again higher for the Hindus followed by Muslims and Christians. About 32 per thousand children born in Hindu have probability of dying between 1 and 5 years of age, this is 25 per thousand for Muslims and 19 per thousand for Christians. In case of under-five mortality rate, again the level is much higher for the Hindus as about 107 per thousand live birth dies before completing five years of age. The level was much lower for the Christians 68 and as 83 for Muslims well below for the national average, 101 per thousand live births.
Mortality Indicators for Castes and Religious Groups - India, 1998-99
Morbidity
Mrbidity is another important indicator of health status of population. Given the limitation of the data, we discuss prevalence of Acute Respiratory Infection (ARI), and diarrhoea. ARI primarily pneumonia, is a major cause of illness among infants and children and diarrhoea is a major killer disease for children under age five worldwide. ARI/pneumonia and dehydration is fairly common and, if no early diagnosis treatment is provided, could lead to death (IIPS 2000). Acute respiratory infection and diarrhoea are generally prevail among all the religious groups at 20% rate except the diarrhoea is relatively low among the Christians 16% as compared with Hindus and Muslims about 20%.
Morbidity Indicators for Castes and Religious Groups - India, 1998-99
Nutritional Status among Children
Undernutrition is a major factor responsible for the high morbidity and high mortality among the Indian children. The anthropometric measurements in the two NFHS surveys show that nearly half of the children have weights too low for their age compared to international standards and are classified as undernourished. Further the survey reveals that undernourished prevails generally among all religious groups expect among Christians. It is high among children belongings to SCs and STs as about 55% of suffer as undernourished. The lowest level of undernutrition is seen among Christian (30%) from religious groups and among other caste (40%) among caste groups. Similarly among women the nutritional status seem to persist in same patterns (see the figure below).
Prevalence of under nutrition among Castes and religious groups all-India, 1998-99
Access to Health Care
Access to health care generally assessed in terms of indicators such as vaccination of children; vitamin A supplementation; antenatal check-up; TT injection and IF supplements; institutional delivery; and medical assistance at birth. Following section looks at the these indicators and its variation among caste and religious groups.
Vaccination & Vitamin ‘A‘Supplementation
Children are future assets and get special care in a society. As part of this special care Universal Immunization Programme (UIP) was introduced in the mid 80s in all districts of the country with the objective of covering at least 85 per cent of all infants against preventable diseases till 1990. For a child, the recommended set of immunizations includes three doses each of DPT antigen (diphtheria, pertussis, tetanus) and polio vaccine, one dose of BCG (against tuberculosis), and one dose of measles vaccine, before the completion of one year of age. The NFHS has obtained data on these for the children of age 12-23 months at survey from the women interviewed in the survey shows indicator of percent of children that received all the recommended doses (BCG, measles, three doses each of DPT and polio) as well as the percent of children that received none of these.
The coverage is far from being universal, only abut 42 percent of children received all the recommended doses in India. There is difference between three major religious groups, Christians and Hindus have, over 60% and 42%, whereas and Muslims with (32%) that less than national average of 42% full immunisation. Among caste groups the rate of immunisation (full vaccination) was higher for others about 47% and lower for STs about 27% of children and 30% for SCs.
Per cent of children Vaccination & received Vitamin ‘A‘Supplementation
among Castes and religious groups all-India, 1998-99
In case of vitamin A supplementation, NFHS-II gives information on children of age 12-35 months who received at least one dose is quite dismal about only 30 per cent children received. Children belongings to Christians received vitamin A are 33% and among Hindus are 30% and for Muslims about only 24% are well below the national average. Among social groups again the SCs/STs gets low than the other caste.
Ante Natal Care - Antenatal check-up & TT injection
Antenatal care refers to pregnancy related health care and importance to receive adequate doses to tetanus toxoid (TT) vaccine and other health check-up. The NFHS-2 estimates that during the late 1998-99 ante-natal check-up was conducted by qualified professionals in case of 65 per cent of births. Christians generally does and received both the check-up and TT vaccine (85%) as compare to other religious groups (65-70%). Among the caste groups taking TT and antenatal care was fairly widespread results only marginal variation.
Per cent of women not received any ANC and TT
among Castes and religious groups all-India, 1998-99
Delivery Care: Institutional delivery& medical assistance at birth
In India, a majority of deliveries, especially in rural areas, continue to take place at home irrespective of caste and religion. But this is relatively low among Christians. The NFHS-2 estimates of percentage of deliveries at home are about 45% for Christians and about 66-67 for Hindus and Muslims. Among caste groups, the percentage is very high for SCs/STs about 70-80 and low for others. In case of professional assistance at delivery, about 34 percent of deliveries were assisted by a professional, that is, a doctor or trained midwife/health workers. The SCs/STs are less in receiving medical assistance during delivery as compare to others.
Delivery care among Castes and religious groups all-India, 1998-99
While summing up, the foregoing analysis shows that, there are inequality among social groups in health status and access to health care and this difference is relatively smaller among religious groups as compare between caste groups.
Reference:
International Institute for Population Sciences (2000): India: National Family Health Survey (NFHS-2), 1998-99.
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