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There have been improvements in India’s health sector over the last 30 years.  Average life expectancy has gone up markedly.  The number of babies dieing before their first birthday has almost halved. 
However, health standards in India are still very low by international standards.  Millions still do not have access to the most basic healthcare.  Average life expectancy is still just 62 years old, and almost unique to South Asia, is higher for men then women. 
Healthy living conditions and access to good quality healthcare are not only basic human rights, but are essential for social and economic development.

Infectious and parasitic diseases dominate
Tuberculosis kills 500,000 Indians per year and this number has hardly changed in 5 decades.  It disproportionately affects the poorest sections of society.  It is estimated that the economic cost of TB to India is more then US $2 Billion per year. 
Malaria affects 2.6 million people each year, and killed at least 20,000 people in 1999.
Almost 100,000 people died from respiratory infections in 1998.
The HIV / Aids epidemic has fast become one of the most serious challenges to face India since independence.  An estimated 5.1 million people in India have HIV / Aids.  In 2003 alone, 600,000 new people are thought to have contracted HIV / Aids.  It is hindering decades of health, economic and social progress.  The voluntary sector has a vital role to play in education about prevention and control, providing treatment to those that have the disease, and lobbying the government to respond in an effective way. 

Women’s Health
More then 100,000 mothers die in India every year, which amounts to one maternal death every 5 minutes.  Over 75% of these deaths would be preventable if proper medical attention is provided.  For every maternal death, there are 10-15 maternal disabilities, due to lack of medical attention.
More than one-third of married Indian women have chronic energy deficiency; more than half of them are anemic.
A number of community-studies are shedding light on the number of women who suffer illness without treatment.  The main reasons reported for this are that they can’t afford treatment, health facilities are inaccessible or because they don’t believe the condition is treatable. 
Child Health
More than one-third of all deaths in India take place in children under the age of five.
The Infant Mortality Rate (the number of babies who die before their first birthday) is still very high at 70 per 1000.  Babies continue to die every day of treatable respiratory infections, diarrhea and other illnesses.  Most are preventable through clean water, nutritious food and cheap vaccines, or treatable with basic drugs.
The Child Mortality Rate is 95 per 1000, compared to just 5-6 per 1000 in developed countries.  Forty-five per cent of children under three are severely and chronically malnourished.  Only 42 per cent of children between the age of 12 and 24 months have completed their immunisation schedule.  A massive 14.4 per cent have not received a single vaccine.

Urban Health
India’s urban population of 300 million represents 30% of its population.  An urban slum growth rate of 5% is causing serious health concerns.  Urban slums are home to a wide array of infectious diseases.  They easily spread in densely populated areas where water and sanitation services are non-existent. 
Poor housing conditions, exposure to excessive heat or cold, air and water pollution, and occupational hazards, add to the environmental health risks for the urban poor. 
In addition, urban residents are extremely vulnerable to macroeconomic shocks that undermine their earning capacity.  They do not have back-up savings, large food stocks or social support systems that they can draw on during economically difficult times.
Though the healthcare facilities are overwhelmingly concentrated in urban areas, there are considerable barriers to access for the urban poor.

Environmental Health
Contaminated water and poor water supply is responsible for a large proportion of diseases in India.  Poor hygiene and sanitation account for 9% of all deaths.  At present only 20% of rural households have a toilet.  At current rates, it will take around 80 years to achieve 100% coverage.
Poor people suffer disproportionately ill-health in India.  The poorest 20% are almost 5 times more likely to die from TB and 3 times more likely to suffer from Malaria.  A child in the ‘Low standard of living’ economic group is almost 4 times more likely to die in childhood than a child in the ‘High standard of living’ group.
Access to healthcare services is much more limited for poorer people.  A person from the poorest quintile of the population, despite having more health problems, is six times less likely to access hospitalization than a person from the richest quintile. This means that the poor are unable to afford and access hospitalization in a very large proportion of illness episodes, even when it is required.

Primary Healthcare
The most peripheral and most vital unit of India’s public health infrastructure is the primary health centre (PHC).  These facilities are part of a tiered health care system that funnels more difficult cases into urban hospitals, while attempting to provide routine medical care to the vast majority in the countryside. 
The 1983 National Health Policy highlighted the need for a primary health care approach.  This involved a new emphasis on preventing illness and promoting health, as opposed to simply trying to cure symptoms after they develop.  It envisioned an inexpensive but decentralized system of health care, depending on volunteers, paramedics and community participation.
The next decade saw the rural health infrastructure develop with a massive expansion of primary health care facilities.  However, this effort was sabotaged by a combination of poor quality facilities, inadequate staffing and supplies and ineffective management. 
In a recent survey it was noticed that only 38% of all PHCs have all the essential manpower and only 31% have all the essential supplies.  Clinical and curative concerns continue to dominate over the intended emphasis on preventative work. 
Access Problems
People's access to health care is limited by their ability to pay and the availability of services. 
Geographic Barriers 
Those who live in remote areas with poor transportation facilities are often unable to access good quality health facilities. Incentives for doctors and nurses to move to rural locations are generally insufficient. Equipping and supplying remote healthcare facilities is difficult. 
Inadequacies due to poor supply deter people from using existing facilities.
Income Barriers
Though the spending on healthcare is 6% of gross domestic product (GDP), the state expenditure is only 0.9% of the total spending.  Thus only 17% of all health expenditure in the country is borne by the state, and 82% comes as ‘out of pocket payments’ by the people.
The increasing cost of healthcare that is paid by ‘out of pocket’ payments is making healthcare unaffordable for a growing number of people. The number of people who could not seek medical care because of lack of money has increased significantly between 1986 and 1995. The proportion of people unable to afford basic healthcare has doubled in the last decade.
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