Health Infrastructure and Inputs

As you know, health infrastructure consists of several parameters which have direct and indirect influence on health status of the people. These factors include aspects like health personnel viz., doctor-population ratio, nurse-population ratio, peripheral worker-population ratio, bed-population ratio, distance to hospital, transport facilities, availability of specialities, hospital facility and so on. Out of these factors, you may see certain high priority factors discussed below. 

Health delivery personnel :

a)  Doctors: In most of the Asian countries more or less similar hierarchy of staff, types of hospitals and human resource development programmes are observed. However, facilities for human resource development in the field of health care are more available in China and India but very inadequate in the rest of the Asian countries. Therefore, these small Asian countries depute their candidates to India, England and other developed countries for training in the field of medicine. Of course, they have facility for training peripheral workers in the field of health. Despite these deficiencies noticed in human resource development in most of the small Asian countries they do not lag behind the big countries like India and China in the health delivery system.

As you can see from the above table, China and South Korea have the best advantage of having one doctor per 1000 and 1160 population each as against 9460 population in Indonesia, 6730 in Bangladesh, 6290 in Thailand, 5520 in Sri Lanka and 2520 in India. In other words, number of doctors in India is not even half of the number in China and South Korea. It is the most critical infrastructural facility for better health delivery system in any country. Therefore, inadequate number of doctors to serve the rural population is the key factor for the general poor health delivery system in most of the Asian countries. Although India is fortunate in this context being next to China and South Korea, there is distortion in the distribution of doctors in our country because more than two-third of the doctors concentrate in urban areas to serve only one-fifth of the total population. 

Doctor and Nurse Population Ratio

b)  Nurses : As regards the availability of nurse-population in Asian countries, South Korea tops all other six Asian countries having one nurse for every 580 population as against the maximum of 8980 in Bangladesh. Surprisingly, India and China have a moderate nurse-population  ratio (1:1700). Interestingly small Asian countries like Indonesia (1:1260) and Sri Lanka (1:1290) have a favourable nurse-population ratio but not a doctor- population ratio. The service rendered in the field of health delivery systems is far from satisfactory. Should we not identify the factors for this problem and provide a remedy  on a war footing? 

c)  Peripheral workers : Outreach of the programme at the peripheral  level depends very much on the number and nature of peripheral functionaries employed in a country. Such services are well organised in China and brought through the bare-foot doctors and so also in South Korea but not in other Asian countries. Although India has a large number of indigenous Dais and so also Dukuns in Indonesia, they have not been trained, and effectively used in these countries. In addition, there is no syc,ematic involvement of these people in health prograinmes. In addition, Indi- produces the largest number of qualified nurses in Asia and so also doctors but a very largest number of them leave India to serve in other countries. Such a peculiar situation is not there in most of the Asian countries. Therefore, should we not have a rethinking on human resources development in the field of health,man-power planning and successful utilisation of trained man-power in a need-based equitable manner in rural and urban areas as has been done successfully in China?

Utilisation of the existing health facilities by the pepole concerned is another problem noticed in Asian countries. It varies from country to country. However,in most of the Asian countries, except China, 50 per cent or more of the health facilities are not  being used by the pepole. It amounts to collossal waste of investment and various inputs in field of health. For instance, when three-fourth of the health facilities in China have been used by the people, hardly one- third of the facility is being used  in India. No doubt, it tremendously varies in India. It is being used  by over 80 per cent of the population in Kerala, whereas in Uttar Pradesh the same facility is not being made use of by even one-fifth of the population. In addition, excess health facilities exist in urban areas and very inadequate facilities exist in rural areas. Should we not do something in this regard ?

Distortion in health inputs exists in certain Aisan countries particularly in India. While China gives highest priority to the rural peripheral health delivery system, in India maximum input is proyided to urban hospitals and creation of super speciality hospitals. In fact most of the patients may not need super speciality facilities. Therefore, how far is it justifiable in investing more money for a minority of population living in urban areas neglecting the majority of the population living in rural areas? In the two biggest countries of Asia, namely China and India, health delivery is well taken care of in some parts of the countries but notin others.

Inputs of the health programmes also include: immunization, oral rehydration therapy (ORT), access to health services and communication technology. All these inputs substanially vary across these Asian countries. The following table will give you an overview of the inputs provided through the health delivery system in Asian countries.

Different service inputs  immunization ,ORT use rate and access to health services

 A comparison of various inputs of health promotion programmes in the seven Asian countries gives a general picture of the preventive and curative service and service facilities in these respective countries. Regarding preventive care (e.g. to immunization programmes) the programme related to prevention of TB by administering BCG has become almost universal in most of these countries. Similarly, DPT,  polio and measles vaccinations have spread extensively in most of the countries, except in Bangladesh. In all these preventive measures India has progressed more or less on par with most of the progressive Asian countries, except China, where the success rate is almost cent per cent on most of these programmes. 

Moreover provision of tetanus toxoid  to pregnant women to prevent risk to the life of mother and child and promotion of ORT to avoid dehydration deaths of children resulting out of diarrohoea are yet to become universal in many countries; in fact their coverage range is between 25-75 per cent only in several countries. Further overall accessibility to health care service in general also falls short of the real requirements in Bangladesh, South Korea and India. On the contrary China, Sri Lanka, Indonesia and Thailand succeeded extensively in promoting these programmes. Thus, most of these countries of Asia have achieved greater success in health care and they are China, Sri Lanka, Indonesia a& Thailand. However, India, Bangladesh, South Korea and such other countries in Asia have to go a long way to achieve complete coverage in health promotion programmes particularly prevention of communicable diseases.