Equal access to essential health and sanitation services continues to be a priority for India, which houses one-sixth of the world’s population. India has already made tremendous strides in the eradication of polio and the elimination of neonatal tetanus. This, along with better-than-average progress on key health indicators such as infant and maternal mortality rates, as well as the reduction in the incidence of HIV, TB and malaria, helped India meet the Millennium Development Goals on Health (MDGs 4, 5 and 6).
Still, despite the headway made in the last 15 years, major challenges persist: Significant inequalities, a disproportionate burden of communicable and non-communicable disease, and poor access to good quality and affordable health services. Low budgetary allocations for health are a key reason. The government’s health expenditure has remained at around 1% of GDP over the past decade, which puts the country significantly behind than the global average. These funds are also not efficiently utilised due to fragmented planning and vertical disease programmes.
The private sector, which provides care to about 70% of the population, is unregulated and poorly integrated into health service delivery systems, despite the lack of infrastructure and human resources in the public sector. Access to life-saving drugs remains a challenge despite India’s role as a global pharmacy.
India also faces significant challenges in the provision of quality water, sanitation, solid waste management and drainage. Inequality in access is acute, with more than 90% of urban residents accessing sanitation facilities compared to only 39% in rural India. Additionally, 44% of the population continues to defecate in the open.
Despite a lower-than-global-average financial investment in health services, the Indian government has demonstrated its commitment to the overall well being of its citizens. Back in 2005, the central government established the National Health Mission and introduced many structural reforms to strengthen health care and sanitation. The proposed National Health Policy 2015 clearly articulates the government’s commitment to reforming the health sector and achieving universal health coverage. The country has also launched a national campaign to end open defecation by 2019 through its flagship initiative, the Swachh Bharat Abhiyan (Clean India Mission).
These national health and sanitation priorities, including reproductive and adolescent health, non-communicable diseases, mental health, safe and affordable drinking water and sanitation management are consonant with Sustainable Development Goals 2, 3 and 6.
In 2015, the World Health Organization (WHO) and UNICEF – convenors for the priority areas group focusing on good health, well being and sanitation along with other agencies, including UNFPA – held extensive advocacy, sensitisation and consultative events to broaden the public discourse on SDG-3 (good health and well being) and the overarching target of universal health coverage. Later, the Delhi Commitment on Sustainable Development Goal for Health was released after a two-day National Consultation on Transitioning from MDGs to SDGs organised by the WHO India office in collaboration with the Ministry of Health and Family Welfare.
Since then, there have been regular meetings with policymakers and health officials regarding the design and implementation of strategies to ensure universal access to health and sanitation services.