Articles by A K Shiva Kumar

Despite India's impressive economic performance after the introduction of economic reforms in the 1990s, progress in advancing the health status of Indians has been slow and uneven. Large inequities in health and access to health services continue to persist and have even widened across states, between rural and urban areas, and within communities. Three forms of inequities have dominated India's health sector. Historical inequities that have their roots in the policies and practices of British colonial India, many of which continued to be pursued well after independence; socio-economic inequities manifest in caste, class and gender differentials; and inequities in the availability, utilisation and affordability of health services. Of these, critical to ensuring health for all in the immediate future will be the effectiveness with which India addresses inequities in provisioning of health services and assurance of quality care.

The announcement of the National Rural Health Mission and the commitment in the recent budget to increase allocations for health are necessary steps in the right direction to correct India's shockingly poor health record. As national and state level strategies unfold over the coming months, a vigorous and informed public discussion is needed to create a national consensus for dramatically increasing investments in health with concurrent improvements in accountability and management of the healthcare system. Equally important is induction of a cadre of village-based health activists, all women, who will link communities to an upgraded public health system. These women should emerge as the missionaries dedicated to advancing health in India. Money, medicines and medical facilities will be meaningless without these missionaries. Finally, flexibility, innovation, focus, inclusion and openness must become essential features of the functioning of the National Rural Health Mission in its endeavour to provide good quality healthcare for all

Implications for Research, Policy and Action A K Shiva Kumar Vanita Nayak Mukherjee Policy-makers need to recognise the primacy of good health as an essential component of human development in India. It is also important to view health more holistically, and understand how social, cultural, political, economic and other factors interact to constrain people's access and contribute to human deprivation. The inter-connections are often complex and policy interventions need to be more people-focused, broad-based and multi-pronged.