Developments in Health Sector of Rajasthan economy

Rajasthan is the largest state of India, positioned
in the north-western region of the country. It embodies 11% of the total
geographical surface of the country equaling to 342,239 square km. The
population of Rajasthan as per the census of 2011 is 6.86 crore. Topographically Aravali Range separates Rajasthan into 2
geographical zones – desert on one side and forests on the other. Population
density differs with the desert region having 60-80 people per square km and
other areas up to 200 people per square km. 10 High Priority Districts & 6
Tribal Districts (3 under HPD) have been identified in Rajasthan based on lower
composite health index.

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Infant Mortality Rate: 41 in

Under 5 Mortality Rate: 51 in

Maternal Mortality Rate:  244 in SRS 2011-13

Sex Ratio – Sex Ratio at birth:
887 in NFHS 4

Literacy Rate: 67.06 % in
Census 2011

Age at Marriage:  20—24 years women married before 18 years: (35.4%

Full immunization: 74.2% in AHS

Total Fertility Rate: 2.4 in

Institutional Births: 84% in

10.  Children under age 6 months exclusively breastfed: 58.2% in NFHS 4

11.  Rajasthan has reported percentage of Underweight (Weight for age) of
under five children is 36.7% in 2015-16(30.7% in urban areas and 38.41% in
rural areas)

12.  Percentage of stunted (height for age) under five children are 39.1%
in 2015-16(33% in urban areas and 40.8% in rural areas)

13.  Percentage of wasted (weight for age) under five children is 23% in
in urban areas and 23.4% in rural areas)

14.  Percentage of anemia in 60.3% children aged 6-59 months (<11.0 g/dl) in 2015-16, (55.7% in urban areas and 61.6% in rural areas) 15.  Percentage of anemia in non-pregnant women aged 15-49 years (<12.0 g/dl) is 46.8% in 2015-16, it is 40.7% in urban areas and 49.0% in rural areas. 16.  Percentage of anemia in Pregnant women aged 15-49 years (<11.0 g/dl) is 46.6% in 2015-16( 41.4% in urban areas and 48.0% in rural areas )   Rajasthan Government has implemented various inventiveness and schemes with the support of latest technology which have contributed to a dignified rise in the health index of the people in the state. The Government has opened gates for the private players to invest in the state. The Government is working with Public-Private- Partnership (PPP) to provide proper healthcare delivery to women and childen, and improving the nutrition status. Governments plans to run a Primary Health Centre (PHC), CT scan and MRI, Hemodialysis in district hospitals, cancer care units in 17 district hospitals, IVF center in district hospitals under Public-Private- Partnership (PPP). However, the state has to take long strides so as to meet SDG goals by 2030.   The topography of the State with a dispersed population presents a challenge for access to healthcare especially in Thar and Bhil zones. Some other challenging areas are Rural/ Urban Disparities in Health scenario, Shortage of staff, Reluctance of staff to work in rural areas, Influence of quacks, myths, misconceptions resulting from lower literacy, increasing burden of lifestyle diseases, challenge of skewed sex ratio due to sex-selective abortions ,continued neglect and poor health care-seeking for the girl child. Reasons being desire of male child, dowry system, social customs, lack of educational status of women and empowerment. Rajasthan falls under the category of high priority state, due to its poor socio-development indicators, particularly in the areas of family planning, MCH and Nutrition. Rajasthan is highly affected by malnutrition with an under 5 mortality rates of 51. State has high fertility rate, looking at the fertility dynamics of the state the Centre has identified 14 districts namely Dholpur, Karauli, SawaiMadhopur, Bharatpur, Udaipur, Dungarpur, Rajsamand, Banswara, Jalore, Barmer, Jaisalmer, Pali, Baran and Sirohi. for intensive and improved family planning services. Looking at the achievements of NHP 2002 and Millennium Development Goals with respect to population stabilization, disease control program, and inequities in health outcomes and quality of care, India’s performance has been a few notches below the target levels with respect to Infant mortality rate (IMR), Maternal mortality ratio (MMR), and Under-5 mortality rate (U5MR). NHP 2002, actually missed on the requirement to address the whole range of current health problems, and the social, economic and ecological determinants of health. In the NHP 2017, all elements of Health Policy Triangle as framed by Walt and Gilson in 1994 have been considered. Like a good cake needs right kind of ingredients, same way Draft National Health Policy was reviewed by various actors that included health ministers of various States, NGOs, civil society participation, representation of private sector. However, the Government has no consideration to make health as a fundamental right. National Health Policy, 2017 advocates progressively incremental Assurance based Approach with focus on preventive and promotive healthcare. Need of hour is what Rajasthan has to look at in new policy that leads us to understand that is futuristic as described by Hon’ble Prime Minister, Shri Narendra Modi in his tweet but before that need to look at comparatives of the Goals as per NHP-2002[2], NHP-2017[3] and SDG[4] S. No. Health Indicator NHP 2002 NHP 2017 SDG India 1 Increase Life Expectancy 64.6 achieved till 2000 67.5 to 70 by 2025   2 TFR 2.1 by 2012 2.1 by 2025 at all levels Reduction of TFR to 2.1 3 IMR 30 by 2012 28 by 2019 Reduction IMR to 19 4 U-5 mortality NA 23 by 2025 25 5 MMR 100/Lakh by 2010 100 by 2025 Reduction of MMR to 75 by 2017 6 NMR   16 by 2025   7 Elimination of Leprosy & Kala-Azar, Lymphatic Filariasis By 2005, 2010, 2015 By 2018 & 2017   8 Reduce Prevalence of Blindness 0.50/1000 by 2010 0.25/1000 by 2025   Comparatives of the Goals as per NHP-2002, NHP-2017 and SDG The National Health Policy 2017 recognizes the need of better access, education and empowerment for effective population stabilization. The policy stresses to move from camp based approach of offering the family planning health services or immunization services to make it available on all days or at least on a fixed day. NHP 2017, promises to cover the length and breadth of India reaching the unreachable in providing quality healthcare to every citizen of India thus addressing the key principal approach of policy formation that is Equality, Equity and affordability. Among key targets, laid out by NHP 2017 and SDG are in Fig-1. Even though Government of Rajasthan has made intensive efforts to improve on Maternal and child mortality yet to reach the SDG goals and met the indicators laid down in NHP -2017, the need is to accelerate the pace of decline. (Fig2 to Fig 5 ) show decline in mortality and fertility trends of Rajasthan and India. Also, this should be kept in mind that there is large disparity between the rural and urban mortality indicators                   Besides this the policy looks at following indicators: Ø  Decline in the premature mortality from NCDs -25% by 2025. Global target of 90:90:90 for HIV/AIDS by 2020     Ø  Reduce incidence of new cases of TB by 2025 and aim at Cure rate of (>85%)
in new sputum positive patients

Ø  Increase of 50% in utilization of public health facilities by 2025

Ø  Ensuring skilled birth attendance and ANC care above 90% by 2025

Ø  Ensuring more than 90% of newborns are fully immunized by one year
of age (2025)

Ø  Addressing family planning need above 90% at national and sub
national level by 2025.

Ø  80% of known hypertensive and diabetic individuals at household
level maintain

Ø  Decrease in prevalence of tobacco use (15% by 2020 and 30% by 2025)

Ø  40% reduction in prevalence of stunting of under-five children by

Ø  Under Swachh Bharat Mission, access to safe water and sanitation to
all by 2020

Ø  Decline in the health expenditure of households by 25% by 2025

Ø  Ensure availability of paramedics and doctors as per Indian Public
Health Standard (IPHS) norm in high priority districts by 2020 and establishing
primary and secondary care facilities in High priority districts.

Ø  Ensure district-level electronic database of information on health
system components by 2020

Ø  Strengthening the health surveillance system and ensuring district-level
electronic database of information

Finance and Impact on Gross Domestic Product

The policy recommends
enhancement of public health expenditure from 1.15% to 2.5 % of the GDP in a
time-bound manner. Earlier we have had experience of experiencing decline in
public health investment as a percentage of GDP declined from 1.3% in 1990 to
.9 percent in 1999. India’s public health spending is 1.16% of gross domestic
product (GDP) while the World Health Organization (WHO) recommends spending 5%
of GDP. India has yet to go a long way to meet the 2010 target of spending of 2%
of GDP on health, it has always been on the lower side while as Global mean
health spending is around 5-6 %. But this is a very bold and pragmatic
initiative and will definitely reap dividends. The policy has also laid down
increase in state health spending upto >8% of their budget by 2020.

Hence state should give tail wind to the following
pointers to achieve the indicators laid down by Health policy 2017 and SDGs are

The need allocates strengthen primary
health care, ensure availability of two beds per 1,000 population, provide
comprehensive primary healthcare services – including maternal and child
health, nutrition services, CDs, NCDs, collaboration with National Health

Address the high Total
Fertility Rate (TFR) in HPDS by having availability family planning commodities
and ensuring counselling.

Ensuring maternal nutrition
before, during and after pregnancy. Ensuring balanced energy, protein, calcium,
and multiple micronutrient supplementation

To address malnutrition and
guaranteeing good healthy practices in children the practices followed should
be growth monitoring, exclusive breastfeeding and appropriate complementary
feeding, full immunization, prophylactic iron supplementation

In addition to counselling of
families; distribution of iron and folic acid (IFA) supplements to children as
well as mothers. This can be achieved through appropriate training to ASHAs,
ANMs and Angan wadi workers.

Urgent need of having adequate
staff both clinical and administrative staff, functional equipment’s, medicines
and diagnostic tests.

Well monitored centers (e.g.,
doctor attendance/ Paramedical attendance).

Capacity building, supportive
supervision, onsite correction of gaps and hand holding of staff nurses,
Medical officers and Pediatricians.

Uniform centers with delivery
protocols, cleanliness / hygiene protocols, designated and approved IEC
materials, appropriate signage, uniform coloring

Grievance redressal mechanism,
feedback systems gauge and enhance patient satisfaction and engage, empower the
community to drive accountability

Need to have a robust MIS
system with a common platform linking all the current information system which
work in silos Patient focused systems: 
PCTS (NIC), Arogya (NIC), Raj eOffice (DoIT), ASHASoft (NIC), eAushadhi
(CDAC), eUpkaran (CDAC).

MIS that encourage the use of
evidence-based medicine, guidelines, electronic prescribing in inpatient and
outpatient settings though the implementation of the EHR; this will, in time,
encourage healthcare data collection, transparency, quality management, patient
safety, efficiency, efficacy and appropriateness of care.

Transport availability for
which people fail to access institutional health service.

Develop standard operating
measures for examination by which doctors, nurses and pharmacists are able to
practice and get employment.

 Ensuring that Hospitals
in the state get national accreditation in order to get paid by insurance
companies. However, a performance incentive plan for those who address the
quality and specific treatment parameters.

 Looking at the provision of connecting with
private insurance agencies so as to provide medical insurance coverage to the
larger populace.

 Develop partnerships
between the line departments and private sectors players for better convergence

Conclusion: Rajasthan, given its large population base and
a diversified economy in mining, agriculture and tourism has shown significant
progress in improving governance and tackling high mortality indicators.
However, to meet SDG indicators the state should invest in the interventions
that will help in accelerated decline population growth as well as reduce child,
infant and maternal mortality. Measures should also be taken to reduce disparity
of rural urban divide by chalking out strategies to address tribal and scattered
population, interdepartmental convergence and involvement of PRIs in the
planning, implementation and monitoring process. The state should benefit from considerable
growth in Public-Private Partnership (PPP) and Foreign Direct Investment (FDI)
for the development of healthcare sector and adopt certain measures to meet the
rural and urban healthcare needs. Thus, there is a need of appropriate planning
to reduce inter and intra district variations in educational and health
development, adopt a state-of-the-art platform for people, hospitals and
healthcare professionals















[i]Atlas of Sustainable Development Goals 2017



[i]National family Health Survey-2014


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