Table Of ContentOxford India Studies in Contemporary Society
series editor
sujata patel
OXFORD INDIA STUDIES IN CONTEMPORARY SOCIETY is a new series of
interdisciplinary compilations on issues and problems shaping our lives
in twenty-fi rst century India. The Series appears at an opportune time,
when the boundaries of social science disciplines are being redefi ned,
and theories and perspectives are being critically interrogated. Using
the frameworks developed by social science interdisciplinarity, this
Series captures, assesses, and situates social trends in contemporary
India. It affi rms the necessity of analyzing issues and themes that have
a direct bearing on our daily lives, and in doing so, brings fresh per-
spectives into play, integrating knowledge from a variety of unexplored
sources in conventional social science practice in India. The Series aims
to introduce to a wider audience the central importance of interdisci-
plinarity in contemporary social sciences. It presents novel themes of
investigation and builds a fresh approach towards the longstanding
debates on methodologies and methods. With its emphasis on the
debates on and about ‘society’ rather than ‘social sciences’, this Series
should fi nd an audience not only among the students and scholars of
conventional social sciences, but also among the students, researchers,
and practitioners of fi elds such as law, media, environment, medicine,
policy studies, and business studies.
The series editor would like to acknowledge the help of University of
Hyderabad’s UPE II (C1.2) grants for the support of this work.
Sujata Patel is Professor, Department of Sociology, University of
Hyderabad, India.
OTHER BOOKS IN THE SERIES
Rowena Robinson (ed.)
Minority Studies
Sanjaya Srivastava (ed.)
Sexuality Studies
Ravi Sundaram (ed.)
No Limits: Media Studies from India
Meena Radhakrishna (ed.)
First Citizens: Studies on Adivasis, Tribals, and
Indigenous Peoples in India
Kalpana Kannabiran (ed.)
Violence Studies
Oxford India Studies in Contemporary Society
EQUITY
AND ACCESS
HEALTH CARE STUDIES IN INDIA
edited by
Purendra Prasad
and
Amar Jesani
1
1
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It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trademark of
Oxford University Press in the UK and in certain other countries.
Published in India by
Oxford University Press
2/11 Ground Floor, Ansari Road, Daryaganj, New Delhi 110 002, India
© Purendra Prasad and Amar Jesani 2018
All contributors hold copyright to their chapters.
Th e moral rights of the authors have been asserted.
First Edition published in 2018
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence, or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
ISBN-13 (print edition): 978-0-19-948216-0
ISBN-10 (print edition): 0-19-948216-0
ISBN-13 (eBook): 978-0-19-909373-1
ISBN-10 (eBook): 0-19-909373-3
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Tables and Figures
TABLES
1.1 Th e Long-Term Programme Personnel 29
4.1 Proportion of Enrolled Students by Social Category
(as per information submitted by institutions) 97
5.1 Causes of Death in India, 2002 118
5.2 Procedural Skills Required for Primary
and Secondary Care 119
5.3 Analysis of Strengths and Weaknesses 120
6.1 Impact of 1970 Patents Act on Introduction
of New Drugs in India 130
6.2 Comparative Drug Prices in 1991–2: Impact
of Generic Production of Patented Drugs
(All Prices Calculated in Indian Rs) 130
6.3 Pre-grant Oppositions by HIV+ve Patients Groups 138
6.4 Some Important Patent Litigations Post-2005 139
6.5 Cost of Patented Protected Drugs 141
7.1 Range of Prices to Retailer (PTR) Used for Calculating Simple
Average Price 162
7.2 Conversion or Manufacturing Costs as Per Cent
of Cost Price; and Cost Price Compared
to DPCO-2013 Ceiling Price 163
x Tables and Figures
7.3 Comparison of DPCO-2013 and RMSC Rates 164
7.4 Market for NLEM-2011 Drugs and Combinations 168
8.1 Start-up Times, Screening Failure, and Median Drop-out Rates
for Phase III Oncology Studies 185
8.2 Clinical Trials Registered in the CTR-I by Sponsor,
as of 30 June 2010 186
8.3 Clinical Trials Registered with the CTR-I by Country of Origin
of Sponsors of 30 June 2010 186
8.4 Distribution of Trials by Type at Five Leading
Institutions, 2011 187
8.5 Trials Registered with the Clinical Trials Register of India,
by Study Type, 2011 and 2012 192
8.6 Approvals of Trials by DCGI by Year and Type,
January 2013–December 2017 195
15.1 Top 20 Mortality and Morbidity Burdens (2013) 328
15.2 Top 20 Conditions, Procedures, and/or Events in Malappuram
and Palakkad (2013) 330
15.3 Public and Private Health Facilities in Malappuram
and Palakkad, Kerala (2013–14) 331
15.4 Per Th ousand Distributions of Spells of Ailment Treated
on Medical Advice over Levels of Care for Each Gender 333
16.1 Health Expenditure Trends in India 343
17.1 Patent Oppositions in Indian Courts 380
FIGURES
1.1 Plan Proposed by HLEG for UHC by 2020 40
5.1 Roles Th at a Medical College May Play 114
5.2 Proposed Model 115
5.3 Designing a Contextual Curriculum 117
6.1 Generic Competition As a Catalyst for Price Reductions 131
14.1 Vision for Health Assurance 319
Acknowledgements
Despite signifi cant advances in medical knowledge and profession in
India, the health care scenario continues to present exacerbated inequality,
discrimination, and inaccessibility to a large majority of people. In the
past few decades, health and health care as a subject has assumed lot
of signifi cance and has been much under discussion and debate. While
there are numerous research studies on aspects of health care, there is no
single volume that captures health equity or inequity across the sectors.
Th erefore, commissioning fresh set of papers and bringing together
scholars from diff erent domains—social sciences, medical profession,
policymakers, health activists, legal experts, gender specialists, and
others—has been a challenging task. Subsequently, thinking through
and creating pathways towards an interdisciplinary fi eld of health
care studies in India was both exciting and arduous. Th is has been
possible only because of the commitment, deep refl ection, and creative
ideas that contributing authors brought to this book that has taken
more than three years to complete, from conceptualization to the fi nal
document, and we thank all the contributors for their cooperation and
patience.
We thank Sujata Patel, the series editor, for her encouragement,
discussions, ideas, and critique at diff erent stages of this book. Th e David
and Lucile Packard Foundation, USA, and Indian Council of Social
Science Research (ICSSR), New Delhi, India, generously supported the
workshop during 6–7 March 2015, upon which this volume is based,
and preparation of the manuscript. Th is workshop provided a unique
opportunity for contributors and discussants in debating and generating
xii Acknowledgements
new ideas for this book. We are grateful to the David Lucile Packard
Foundation, California, USA and ICSSR, New Delhi, India.
We express our sincere thanks to the discussants, reviewers, and
subject experts at the workshop: Ghanshyam Shah, V.R. Muraleedharan,
George Th omas, V. Sujatha, Veena Shatrugna, Padma Prakash, Arima
Mishra, Aditi Iyer, Amita Dande, Gopal Dabade, Veena Johari, N.
Sarojini, Ravi Duggal, K. Sujata Rao, R. Srivatsan, Sheela Prasad,
Kalpana Kannabiran, Narendranath, Chakrapani, Aparna Rayaprol,
and V. Janardhan for their insightful comments and meticulous reviews
which helped improve the quality of the book immensely.
Starting from the workshop organization to the post-workshop
manuscript preparation work, several research scholars from the
Department of Sociology helped: Shilpa Krishna, Ch. Satish Kumar,
Chandrashekar Reddy, Lalhmangaihi Chhakchhuak, Priyam Sharma,
Debapriya Ganguly, Bhupati Reddy, Lalatendu Keshari Das, Abhijit
Dasgupta, and Anu Gupta. We particularly thank Shilpa who took on
much of the grunge work involved in producing an edited volume and
handled the nitty-gritties in transitioning from a bunch of papers to a
single volume.
We want to place on record the special contribution by Padma
Prakash whose ideas and critique helped in substantially reshaping and
enhancing the quality of the manuscript. We remain indebted to her for
all the time, energy, and enthusiasm that she brought to this book. We
also thank IKF Knowledge Foundation, Mumbai, India, for copyediting
the manuscript.
We also would like to place on record our sincere appreciation for
the work by the administrative staff of the Department of Sociology,
University of Hyderabad, India—Geetha Patil, Sreedharan, Chandra
Kumar, and Srinivas.
We are grateful to the team at Oxford University Press, India, for
their support and cooperation.
Purendra Prasad
Amar Jesani
Abbreviations
AABY Aam Admi Bima Yojana
ADRs American Depository Receipts
AIDAN All-India Drug Action Network
AIIMS All India Institute of Medical Sciences
ANM Auxiliary Nurse-Midwife
APL above poverty line
ASHA Accredited Social Health Activists
BA/BE bio-availability and bio-equivalent
BPL below poverty line
CEDAW Convention on the Elimination of All Forms of
Discrimination Against Women
CEHAT Centre for Enquiry into Health and Allied Th emes
CGHS Central Government Health Scheme
CRC Convention on the Rights of the Child
CRO contract research organization
CrPC Code of Criminal Procedure
CSDH Commission on Social Determinants of Health
ESI Employee State Insurance
ESIC Employees State Insurance Corporation
FDI Foreign Direct Investment
FMP Family Medical Practitioner
FSW female sex workers
GDP Gross Domestic Product
GDRs Global Depository Receipts
GNP Gross National Product
xiv Abbreviations
HLEG High-Level Expert Group
ICDS Integrated Child Development Services
ICESCR International Covenant on Economic, Social and
Cultural Rights
IJME Indian Journal of Medical Ethics
IRDA Insurance Regulatory Development Authority
IRDAI Insurance Regulatory and Development Authority of India
ITPA Immoral Traffi cking Prevention Act
LOCOST Low Cost Standard Th erapeutics
MFC Medico Friend Circle
NACO National AIDS Control Organisation
NAPCP National AIDS Prevention and Control Policy
NCEUS National Commission for Enterprises in the Unorganized
Sector
NDPS Act Narcotics Drugs and Psychotropic Substances Act
NEN North East Network
NHS National Health Service
NLEM National List of Essential Medicines
NRUHM National Rural Health and Urban Health Missions
NSDP Net State Domestic Product
NSSO National Sample Survey Organisation
OOP out-of-pocket
PFHI publicly funded health insurance
PFHI Public Health Foundation of India
PPP public–private partnership
PWDVA protection of women from domestic violence law
RSBY Rashtriya Swasthya Bima Yojana
SDGs Sustainable Development Goals
SDP State Domestic Product
STI sexually transmitted infection
TRIPS Trade-Related Aspects of Intellectual Property Rights
UAHC universal access to health care
UDHR Universal Declaration of Human Rights
UHC Universal Health Care
UNCRPD UN Convention on Rights of persons with dis-abilities
UPA United Progressive Alliance
VAW violence against women
WTO World Trade Organization
