Select Health Parameters: A Comparative Analysis across the National Sample Survey Organization (NSSO) 42nd, 52nd and 60th Rounds
of Health and Family Welfare Government of India in Collaboration with WHO
Country Office for India.
Authored by: Dr. K.V. Rao, statistician and former DG, NSSO.
Ministry of Health and Family Welfare Government of India
01 Jan, 2007
The National Sample Survey Organsation, Ministry of Statistics and Programme Implementation, and the State Statistical Bureau of various states have been collecting socio-economic data across several parameters in its various rounds since 1953-54.
In 1973-74, the NSSO conducted a full scale survey on morbidity and since then data on morbidity and a second survey on social consumption was carried out in its 42nd Round in 1986-87 and in the 52nd Round between July 1995 and June 1996. The 60th Round between January and June 2004 is a survey of morbidity and healthcare.
Socio-economic data collected over these rounds provide valuable insights into the patterns of health expenditure and how health facilities are accessed. This report looks at the status of basic infrastructure and amenities, morbidity and healthcare, immunisation, maternal healthcare and health of the aged.The enquiry on morbidity was conducted with a reference period of 15 days. All spells of ailment suffered by each member of the sample household during the 15 days preceding the date of enquiry, whether or not the patient was hospitalised for treatment, were covered in the surveys. For hospitalised treatment, information was collected for every event of hospitalisation of a member, during the 365 days preceding the date of enquiry.
About 75 per cent or more households in rural Chhattisgarh, Assam, Orissa, Jharkhand and West Bengal lived either in kutcha or in semi-pucca structures.
The most common source of water in rural areas was ‘tube-well/ hand pump’, followed by ‘tap’ and ‘pucca well’. The percentage of households reporting the use of drinking water from these three sources were 56 per cent, 25 per cent and 13 per cent, respectively.
Only 1 per cent of the bottom 20 per cent of the population has LPG for cooking in rural India. Among the bottom 20 per cent of the urban population, 17 per cent have LPG.
The NSSO measures Proportion of Ailing Persons (PAP) as the number of persons reporting an ailment during a 15-day period per 1,000 persons. In 2004, the bottom 30 per cent of the population reported PAP of 63, while the top 20 per cent reported PAP of 132 in rural India. This, the report states, indicates that the reporting of morbidity improves with an improvement in the level of living.
The “ailment not serious” category has come down from 75 per cent in 86-87 to 51 per cent in 95-96 and to 32 per cent in 2004 in rural India. But the “financial reason” has gradually increased from 15 per cent, 24 per cent and 28per cent during the same period, showing the increased burden of health stress.
Hospitalised treatment shows a declining trend in both rural and urban India during the three survey periods. The share of public providers declined from 597 in 1986-87 to 438 in 1995-96, and further reduced to 417 in 2004. The corresponding figures for urban areas are 603, 431 and 382, respectively.
The bottom 20 per cent of the rural population depended for hospitalised treatment on the public sector. Some of the state figures are: Assam (82 per cent), Chhattisgarh (50 per cent), Jharkhand (55 per cent), Madhya Pradesh (68 per cent), Orissa (81 per cent) and Rajasthan (51 per cent). The least utilisation of public sector hospitals in rural India was in Bihar (13 per cent) followed by Uttar Pradesh (36 per cent).
The average fee given to the doctors/ staff during the stay at a hospital was Rs. 1238 in rural and Rs. 1567 in urban in private hospitals in2004. The diagnostic tests per case in private hospitals in 2004 cost Rs. 449 in rural areas and Rs. 449 in urban India. Medicine per case cost Rs. 2000, both in rural and urban areas, in the private sector.
The loss of household income in rural areas due to hospitalisation was the highest in Himachal Pradesh (Rs. 1,893), followed by Jammu and Kashmir (Rs. 1,377) and Jharkhand (Rs. 1,357). This was much higher than the all-India estimate of Rs. 636.
The cost of deliveries in private hospitals Rs. 4137 in rural India as compared to Rs. 5480 in urban areas. Only in rural Bihar, the expenditure in government hospitals (Rs. 2327) was more than in a private hospital (Rs. 2187) during January-June 2004.