Data from the National Family Health Survey-III (2005-06) clearly highlight the caste differentials in relation to health status. The survey documents low levels of contraceptive use among the Scheduled Castes and the Scheduled Tribes compared to forward castes. Reduced access to maternal and child health care is evident with reduced levels of antenatal care, institutional deliveries and complete vaccination coverage among the lower castes. Stunting, wasting, underweight and anaemia in children and anaemia in adults are higher among the lower castes. Similarly, neonatal, postnatal, infant, child and under-five statistics clearly show a higher mortality among the SCs and the STs. Problems in accessing health care were higher among the lower castes. The National Family Health Survey-II (1998-99) documented a similar picture of lower accessibility and poorer health statistics among the lower castes.
Out of the 175 countries ranked by the World Health Organisation (WHO), India is fifth from the bottom (or 171) in terms of public health spending as a proportion of GDP. It is, therefore, significantly below almost all sub-Saharan countries and other least developed countries that have much lower per capita incomes. Public health spending accounts for only 0.9 per cent of the GDP or even less.
Private spending (out-of-pocket expenditure by households), therefore, has necessarily to make up the rest and is as much as 85 per cent of the total health spending in the country. In fact, sudden health expenditures are estimated to be among the main factors that push households into poverty.
The United Progressive Alliance (UPA) government promised in 2004 to increase public health spending up to 3 per cent of the GDP. This is a relatively modest target: after all, China spends nearly 6 per cent of its GDP on public health and is planning to increase this further in the next two years.
The share of the Central government even in total public spending on health is very low and has stagnated since 2007. In the budgetary allocation for the current year, the share of expenditure on “Medical and Public Health” is slated to remain unchanged from the previous year, at only 0.12 per cent of the GDP. In “Family Welfare”, the share of expenditure is to increase from 0.11 per cent of the GDP in 2008-09 to 0.12 per cent in 2009-10, which is no more than the proportion that was already attained in 2007-08.
The latest National Family Health Survey (conducted in 2005-06) provides grim evidence of very slow (even decelerating) improvement in infant mortality rates, persistently poor rates of child immunisation, low rates of institutional deliveries and other indicators. Shocking nutrition indicators, poor conditions of sanitation.