Professor Amartya Sen has advocated important reforms in the realms of primary education and primary health care. What are your suggestions to improve their status and performance ?

(1) Lack of healthcare professionals in rural areas As per Lancet report, no. of doctors - 0.7/1000 people WHO recommends - 2/1000 people

(2) Poor infrastructure such as no beds, diagnostics, first aid equipment in PHCs. (3) Lack of hygiene practice knowledge among poor. (4) Immunisation rate is still 75% (Bangladesh-93%). (5) Presence of dubious quacks, uncertified doctors. (6) High out of pocket expenditure - 69%. (7) Expenditure on Health - 1.5% of GDP (Thailand - 3.5%).

Status of Secondary & Tertiary healthcare

(1) Prevalence of Corruption in MCI (as given by Parliamentary Standing Committee) (2) High Capitation fee by medical colleges (3) Lack of district hospitals in many districts. (4) Poor health insurance coverage esp among rural areas (5) High disease burden by sedentary diseases - Heart stroke, diabetes etc.

Focus on Tertiary Sector

(1) AIIMS and other medical colleges were established after independence but primary care neglected. (2) Amartya Sen observes that this resulted in poor human development & drag down on economy

Poor Health - Poor GDP

(3) Also hygiene practices such as cleaning hands, prohibiting open defecation have not been given enough emphasis.

Way Ahead

• National Health Policy plans to raise health exp to 2.5% of GDP
• Govt must increase funds to PHC infra - beds, equipment etc
• Train doctors to create dedicated rural workforce
• electronic vaccine Network (eVIN), ASHAs must be strengthened so that primary healthcare is made effective and we realise mandate of Art 47 of Constitution.