The Indian constitution charges the states with "the raising of the level of nutrition and the standard of living of its people and the improvement of public health" (see The Constitutional Framework, ch. 8). However, many critics of India's National Health Policy, endorsed by Parliament in 1983, point out that the policy lacks specific measures to achieve broad stated goals. Particular problems include the failure to integrate health services with wider economic and social development, the lack of nutritional support and sanitation, and the poor participatory involvement at the local level.

Central government efforts at influencing public health have focused on the five-year plans, on coordinated planning with the states, and on sponsoring major health programs. Government expenditures are jointly shared by the central and state governments. Goals and strategies are set through central-state government consultations of the Central Council of Health and Family Welfare. Central government efforts are administered by the Ministry of Health and Family Welfare, which provides both administrative and technical services and manages medical education. States provide public services and health education.

The 1983 National Health Policy is committed to providing health services to all by 2000 (see table 8, Appendix The Legislature, ch. 8). In 1983 health care expenditures varied greatly among the states and union territories, from Rs13 per capita in Bihar to Rs60 per capita in Himachal Pradesh (for value of the rupee--see Glossary), and Indian per capita expenditure was low when compared with other Asian countries outside of South Asia. Although government health care spending progressively grew throughout the 1980s, such spending as a percentage of the gross national product (GNP--see Glossary) remained fairly constant. In the meantime, health care spending as a share of total government spending decreased. During the same period, private-sector spending on health care was about 1.5 times as much as government spending.

Expenditures

In the mid-1990s, health spending amounts to 6 percent of GDP, one of the highest levels among developing nations. The established per capita spending is around Rs320 per year with the major input from private households (75 percent). State governments contribute 15.2 percent, the central government 5.2 percent, third-party insurance and employers 3.3 percent, and municipal government and foreign donors about 1.3, according to a 1995 World Bank study. Of these proportions, 58.7 percent goes toward primary health care (curative, preventive, and promotive) and 38.8 percent is spent on secondary and tertiary inpatient care. The rest goes for nonservice costs.

The fifth and sixth five-year plans (FY 1974-78 and FY 1980-84, respectively) included programs to assist delivery of preventive medicine and improve the health status of the rural population. Supplemental nutrition programs and increasing the supply of safe drinking water were high priorities. The sixth plan aimed at training more community health workers and increasing e420 efforts to control communicable diseases. There were also efforts to improve regional imbalances in the distribution of health care resources.

The Seventh Five-Year Plan (FY 1985-89) budgeted Rs33.9 billion for health, an amount roughly double the outlay of the sixth plan. Health spending as a portion of total plan outlays, however, had declined over the years since the first plan in 1951, from a high of 3.3 percent of the total plan spending in FY 1951-55 to 1.9 percent of the total for the seventh plan. Mid-way through the Eighth Five-Year Plan (FY 1992-96), however, health and family welfare was budgeted at Rs20 billion, or 4.3 percent of the total plan spending for FY 1994, with an additional Rs3.6 billion in the nonplan budget.

Data as of September 1995