<–2/”>a >The major Health and demographic indicators of the State like infant mortality rate (IMR), maternal mortality ratio (MMR), total fertility rate (TFR), etc. are much higher than the all-India level and reflect a poor health status in the State. The Human Development index (HDI), a composite of Literacy, life expectancy and per capita income, has increased for Bihar like the rest of India. But the State still lags at 0.367 compared to the Indian Average of 0.472. Amongst the major States, the HDI of Bihar has been the lowest for the last three decades. In view of the large Population size, high POVERTY ratio, and high decadal Growth indices in the State, Bihar is one of the States covered by the National Rural Health Mission.
Health sector in Bihar” width=”259″ height=”194″ />
Based on the indicators primarily related to primary health care Infrastructure-2/”>INFRASTRUCTURE and reproductive and child health care, the State ranks 35th in the country. On a similar basis, the districts in Bihar have also been ranked . Amongst the districts which are lagging behind in the State are-Seohar, Samastipur, Kishangaj, Jahanabad, Nalanda, Khagaria, Araria, Sitamarhi, and Pashchim Champaran.
The MMR in Bihar is 371 per 100,000 live births, which is fourth highest in the country. The high level of MMR can be attributed to low level of institutional / supervised deliveries, high level of anaemia among Women, and low level of full ante-natal coverage etc.
Though the infant and child mortality rates in Bihar are nearer the national figures, yet the State is amongst the States with high mortality rates. The Infant Mortality Rate (IMR) in the State is 61 per 1000 live births, which is close to the national average of 58.0. The Total Fertility Rate in the State is second highest in the country. However, the mean age of marriage in Bihar is relatively high at 18.9 years. Figures for Birth Rate and Death Rate in the State are still higher than the national average with Birth Rate being 30.4 and Death Rate as 8.1 per thousand population.
The coverage under routine immunization and pulse polio is also very low as compared to the national figure. As per 2001 census, full immunization in the State was only 11% against the national average of 54%. As a result, a large number of cases of vaccine preventable diseases are still reported in the State. Under-Nutrition among children and women is also much higher than the national level with 54.4% children being underweight and 81% anaemic. The Percentage of women with chronic energy deficiency (39.3%) is also higher than the national figure of 35.8%.
However, the recent National Family Health Survey (NFHS-3, 2005-06) indicates some improvement since NFHS-2(1998-99). It has shown increase in: immunization coverage from 12% to 33%; contraceptive use from 24% to 34%; institutional deliveries from 15% to 22%; and the proportion of women who have heard of AIDS from 11% to 35%. But the figures are still far off from the national Averages. Malnutrition continues to be very high. In fact, malnutrition among children has increased from 54% to 58%. Number of children showing wasting (weight for age) has gone up by 8%. Anaemia has gone up from 81% to 88% amongst children of 6-35 months and from 46% to 60% amongst pregnant women.
The State has the largest number of Kala-azar cases. The prevalence of other Vector Borne Diseases like malaria, filariasis and communicable diseases like tuberculosis is quite high. The occurrence of water borne diseases is also high. In 2006-07, the second highest number of polio cases in the country is from Bihar.
Available data on rural primary health care infrastructure indicate that, in Bihar, there are substantial gaps in sub-centres, primary health centres and, community health centres, and also in essential requirements in terms of manpower, equipment, drugs and consumables in primary health care institutions. The State has a shortage of 1210 sub-centres, 13 primary health centres, and 389 community health centres. As per the 11th Plan approach paper of Government of Bihar, there is only one sub-centre for 10,000 population. However, according to the national norms there should be at least one sub- centre for 5000 population. Moreover, Bihar has one Primary Health Centre for one lakh population where ideally there should be one PHC for every 30,000 population.
Shortage of human Resources in the health sector is another major problem with 5648 female health workers and 9786 male health workers being deficient. There is also a lack of specialists at the Community Health Centres.
NSSO-60th Round reflected a drastic decline in the share of public health facilities in treatment of non-hospitalized ailments in both rural and urban areas. In rural areas, the share declined from 13% to 5% . In urban areas, it declined from 33% to 11% during the corresponding period. The survey also showed that the number of hospitalized cases treated (per 1000) in public hospitals in rural areas is only 144 as compared to all-India average of 417. In urban areas, the figure is 215 as compared to all-India average of 382.
At the end of one year of implementation of the NRHM, based on a survey conducted in 17 districts of the State, the Centre for Health and Social Justice reported that half the Anganwadis Workers (AWW) had not heard about the NRHM. Most of the Auxiliary Nurse Midwives (ANMs) and AWWs felt that ASHA was meant to assist them in immunization and listing of pregnant women. A few districts did not even receive the Money to disburse as untied fund and District Action Plans had not been prepared. Neither the women got any money under the Janani Evam Bal Suraksha Yojana, nor did the ones who were sterilized know about the family planning insurance schemes. However, now the official figures at the end of second year of NRHM reflect a better picture.
The State has 11 Ayurvedic, 5 Unani and, 11 Homoeopathic hospitals. It also has 311 Ayurvedic, 143 Unani and, 179 homoeopathic dispensaries (Department. of AYUSH, Ministry of Health & Family Welfare). By placing AYUSH practitioners in the PHCs along side the MBBS doctors, it will be possible to mainstream this system into the general health care system and also enable the patients to avail the care in the system or their choice. Training and reorientation of AYUSH practitioners in Family Welfare and National disease Control Programmes will help in improving the coverage under these programmes.
The important Issues concerning Health in Bihar are:
(i) Substantial gaps in sub-centres, primary health centres, and a very large gap in community health centres.
(ii) Substantial gaps in essential requirements in terms of manpower, equipment, drugs and consumables in the primary health care institutions.
(iii) Skewed sex ratio (919).
(iv) Very low Couple protection rate (34%).
(v) Very high fertility rate (4.2).
(vi) Very high percentage of girls marrying below 18 years of age (51.5%).
(vii) Very low coverage of Full Immunization (33%).
(viii) Very low Awareness of HIV/AIDS (25.6%).
(ix) Low level of institutional delivery (23.2%) and high level of maternal deaths (3.71 per 1000).
(x) High level of malnutrition among children of age 0-6 years (55.9% children are moderately and 24.5% are severely malnourished).
(xi) Very high levels of anaemia among children (81%), adolescent girls (40.9%) and pregnant women (63.4%).
(xii) Very low coverage for Vitamin A (10%) and salt Iodisation 25.2% (15 ppm & above).,
The health sector in Bihar is a complex and multifaceted system that includes a variety of stakeholders, including the government, private sector, and civil Society. The sector is responsible for providing a range of Services to the population, including primary care, secondary care, and tertiary care. It also plays a role in public health, such as disease prevention and control.
The health sector in Bihar faces a number of challenges, including a shortage of qualified personnel, inadequate infrastructure, and limited resources. Despite these challenges, the sector has made some progress in recent years, such as increasing the number of hospitals and clinics and improving access to essential medicines.
The following are some of the subtopics related to the health sector in Bihar:
- Health infrastructure
- Health personnel
- Health financing
- Health services
- Public health
- Disease prevention and control
- Health research
- Health Education
- Health policy
- Health governance
- Health Equity
- Health outcomes
Health infrastructure
The health infrastructure in Bihar is inadequate, with a shortage of hospitals and clinics, especially in rural areas. This shortage of infrastructure makes it difficult for people to access healthcare services. In addition, the quality of care in many hospitals and clinics is poor.
Health personnel
There is a shortage of qualified health personnel in Bihar, especially doctors and nurses. This shortage of personnel makes it difficult to provide quality healthcare services to the population. In addition, the salaries of health personnel are low, which makes it difficult to attract and retain qualified personnel.
Health financing
The health financing system in Bihar is fragmented, with a mix of public and private funding. The public sector provides free healthcare services to the poor, but the quality of care in these services is often poor. The private sector provides better quality care, but it is expensive and not accessible to everyone.
Health services
The health services in Bihar are not evenly distributed, with better services available in urban areas than in rural areas. In addition, the quality of care in many health facilities is poor.
Public health
The public health system in Bihar is weak, with a shortage of qualified personnel and inadequate infrastructure. This makes it difficult to prevent and control diseases. In addition, the awareness of public health issues is low among the population.
Disease prevention and control
The disease prevention and control system in Bihar is weak. This is due to a shortage of qualified personnel, inadequate infrastructure, and low awareness of public health issues. As a result, diseases such as malaria, tuberculosis, and diarrhea are common in Bihar.
Health research
The health research system in Bihar is weak. This is due to a shortage of qualified personnel, inadequate infrastructure, and low funding. As a result, there is limited knowledge about the health problems of the population and the effectiveness of interventions to address these problems.
Health education
The health education system in Bihar is weak. This is due to a shortage of qualified personnel, inadequate infrastructure, and low funding. As a result, the population is not well aware of health issues and how to prevent and control them.
Health policy
The Health policy in Bihar is fragmented and not well-coordinated. This makes it difficult to implement effective health policies. In addition, the health budget is low, which limits the government’s ability to provide quality healthcare services to the population.
Health governance
The health governance system in Bihar is weak. This is due to Corruption, lack of transparency, and poor accountability. As a result, the health sector is not well-managed and resources are not used efficiently.
Health equity
There is a lack of health equity in Bihar. This means that not everyone has equal access to quality healthcare services. The poor and marginalized groups are more likely to be deprived of healthcare services.
Health outcomes
The health outcomes in Bihar are poor. This is due to a number of factors, including the poor health infrastructure, shortage of qualified personnel, inadequate financing, and weak public health system. In addition, the population is not well aware of health issues and how to prevent and control them.
The health sector in Bihar is facing a number of challenges. However, there are some positive developments, such as the increase in the number of hospitals and clinics and the improvement in access to essential medicines. The government needs to address the challenges in the health sector and improve the health outcomes of the population.
What is the health sector?
The health sector is a broad term that encompasses all aspects of health care, from prevention and treatment to research and education. It includes both public and private health care providers, as well as government agencies and non-governmental organizations.
What are the challenges facing the health sector?
The health sector faces a number of challenges, including:
- Access to care: Millions of people around the world lack access to basic health care services.
- Quality of care: Even when people have access to care, the quality of that care can be poor.
- Cost of care: The cost of health care is rising rapidly, putting a strain on both individuals and governments.
- Workforce shortages: There is a shortage of health care workers in many parts of the world.
- Innovation: The health sector is constantly evolving, and it can be difficult to keep up with the latest advances.
What are some of the successes of the health sector?
Despite the challenges, the health sector has made significant progress in recent years. Some of the successes include:
- The development of new Vaccines and treatments: New vaccines and treatments have helped to prevent and treat a number of diseases, including polio, measles, and malaria.
- The reduction in child mortality: The number of children dying before the age of five has declined significantly in recent decades.
- The increase in life expectancy: Life expectancy has increased in many parts of the world, thanks to improvements in health care.
- The control of infectious diseases: Infectious diseases, such as HIV/AIDS and tuberculosis, are now being controlled more effectively than ever before.
What are the future trends in the health sector?
The health sector is constantly evolving, and it is difficult to predict the future with certainty. However, some of the trends that are likely to shape the health sector in the coming years include:
- The aging population: The world’s population is aging, and this will put a strain on health care systems.
- The rise of chronic diseases: Chronic diseases, such as heart disease, stroke, and diabetes, are becoming more common.
- The increasing cost of health care: The cost of health care is rising rapidly, and this will put a strain on both individuals and governments.
- The need for innovation: The health sector is constantly evolving, and it will be important to continue to innovate in order to meet the needs of the population.
What can be done to improve the health sector?
There are a number of things that can be done to improve the health sector, including:
- Investing in health care: Governments need to invest in health care in order to ensure that everyone has access to quality care.
- Promoting healthy lifestyles: Individuals can help to improve their health by making healthy choices, such as eating a healthy diet and exercising regularly.
- Supporting research: Research is essential to finding new ways to prevent, treat, and cure diseases.
- Advocating for change: Individuals and organizations can advocate for changes to the health system that will improve the quality of care.
- The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
- The main components of the health sector are:
- Health promotion: This involves activities that aim to improve the health of the population by encouraging healthy lifestyles and reducing risk factors for disease.
- Disease prevention: This involves activities that aim to prevent the occurrence of disease, such as vaccination and screening programs.
- Health care: This involves the provision of medical care to people who are sick or injured.
- The health sector is important because it plays a vital role in the well-being of the population. A healthy population is more productive and can contribute more to the economy. A healthy population is also less likely to suffer from poverty and social exclusion.
- The health sector is a complex system that involves many different actors, including governments, non-governmental organizations, and the private sector. The challenges facing the health sector are many, including:
- The increasing burden of chronic diseases, such as heart disease, stroke, and diabetes.
- The rising cost of health care.
- The shortage of health workers.
- The lack of access to health care in many parts of the world.
- The future of the health sector is uncertain, but there are some trends that are likely to continue, such as:
- The increasing importance of chronic diseases.
- The rising cost of health care.
- The shortage of health workers.
- The need for more innovative approaches to health care delivery.
Here are some MCQs on the health sector:
- Which of the following is not a component of the health sector?
(A) Health promotion
(B) Disease prevention
(C) Health care
(D) Education - The main goal of the health sector is to:
(A) Improve the health of the population
(B) Prevent the occurrence of disease
(C) Provide medical care to people who are sick or injured
(D) All of the above - The health sector is important because it:
(A) Plays a vital role in the well-being of the population
(B) Improves productivity and economic growth
(C) Reduces poverty and social exclusion
(D) All of the above - The challenges facing the health sector include:
(A) The increasing burden of chronic diseases
(B) The rising cost of health care
(C) The shortage of health workers
(D) All of the above - The future of the health sector is uncertain, but some trends that are likely to continue include:
(A) The increasing importance of chronic diseases
(B) The rising cost of health care
(C) The shortage of health workers
(D) All of the above