Health care systems in transition III. India, Part I. The Indian experience

Indian society is distinguished by marked cultural pluralism and a relatively young population that in 1999 has grown to one billion. Its regional and economic diversity and complex social structure and extremes of poverty and wealth make planning a challenging task. Developing economic self-reliance tackling poverty and building a strong welfare state were major commitments of the newly independent India. After 1949 a conscious effort was made to invest in education and health services. Constitutionally health services were the responsibility of the provincial states. The role of central government was to define policies provide a national strategic framework financial resources and specified services such as services for people crossing international borders and medical education. In the 26 States and two Union Territories districts were the operative units wherein the population of about 1.3-1.5 million was served by a network of Primary Health Centres (PHCs) and sub-centres organized as a pyramid with the district hospital at the apex. Health sector planning had two major thrusts: the first to build an infrastructure to provide basic medical care maternal and child health (MCH) services health information education and referral services; and the second to develop specific national health programmes to control communicable diseases provide family planning services (FPSs) and control severe forms of nutritional deficiencies. To carry out these tasks a support system had been developed which included education and training research health information and monitoring drug and equipment production etc. (excerpt)