A Comprehensive Health Report On Maharashtra

Title: Health and Healthcare in Maharashtra - A Status Report Authors: Ravi Duggal, T R Tulip, Prashant Raymus Publisher: Centre for Enquiry into Health and Allied Themes (CEHAT) Pages: 66

In the present era of information explosion where knowledge and information systems are crucial for development, the information available on healthcare issues in Maharashtra is found to be inadequate. “Health and Healthcare in Maharashtra - A Status Report” fills this gap by offering a detailed and analytical information on the critical aspects of healthcare issues in the state.

The book focuses on socio-economic and demographic profile of the state, the organisational structure and systems of public healthcare services in urban and rural areas, the wide rural-urban disparity in access to these services, healthcare facilities available in public sector, analysis of declining public expenditure on healthcare services, indicators of health status such as Infant Mortality Rate (IMR), child mortality, life expectancy and so on.

The chapter, “Contextualising Healthcare” states that Maharashtra, despite being the financial capital, is plagued by two major issues. One is food availability (rather access) which is the cause of unacceptable levels of malnourishments, and the other, the declining sex-ratio, especially in the 0 to 6 year age group.

The chapter, “Organisation of Public Health Services” reveals Mumbai’s enviable ratio of one public bed per 500 persons and if private hospital beds are added, the ratio comes down to a figure of one bed per 250 persons, which is akin to any developed country. The chapter, “Delivery of Healthcare: Physical Infrastructure” gives district-wise account of availability of healthcare infrastructure in the state, availability of Primary Health Centres (PHCs), Rural Hospitals (RHs) and Sub-centres in the state. The chapter also states that urban areas, especially in and around Mumbai and South-Western Maharashtra are well endowed, but the rest of the state lags behind in health infrastructure.

The chapter “Healthcare facilities in Public Sector” throws light on the physical infrastructure and the drawbacks existing with the district hospitals, community health centres (CHCs), first stage referral units (FRUs) and primary health centres (PHCs). While the district hospitals have most of the essential medical equipment, there is a severe shortage of these facilities in FRUs and CHCs. To cite an example, more that 50 per cent of FRUs and CHCs were not having even Boyle’s apparatus, oxygen cylinder, high-pressure steriliser and ECG machine.

The chapter “Public Expenditure on Health” states that despite its achievement in overall economic development, the state has failed to give the required significance to health and healthcare, given the fact that health expenditure as a percentage of Net State Domestic Product (NSDP) at current prices has declined from the levels of 1.0 per cent in the 80s to 0.7 per cent in 2001-02, and as a proportion to total government spending from over 6 per cent in the 80s to 4.6 per cent in 2001-02.

The last chapter “Some Indicators of Health Status” discusses trends in IMR, child mortality indicators by place of residence in the state, district wise variations in infant and under five mortality indicators in 1991. The chapter gives an account of the infant mortality and life expectancy at birth, which has shown substantial improvements over the years. According to a study, the infant mortality rate (IMR) in the state has come down from 129 per thousand population in 1971 to 48 per thousand population presently.

This book is a good reference point for economists, journalists, policy makers and planners, when accessing the latest and basic information on healthcare of the state.

By Shardul Nautiyal