Map 3: Map of Nalbari district
5.1 MORBIDITY IN INDIA AND ASSAM: AN OVERVIEW
State level estimates on healthcare and morbidity are available from the National Sample Survey Organization and the National Council of Applied Economic Research. Since one of the main objectives of this thesis is to study the status of health in Assam in the post liberalization period, the morbidity prevalence rates are compared based on the NSSO and NCAER estimates emerging from the 1990s and 2000s. Apart from the NSSO and NCAER, morbidity data is also collected in national level surveys like National Family Health Survey. However NFHS collects disease specific data on common infectious and communicable diseases like tuberculosis (TB), diabetes and goitre.
The NSSO is the first national level organization which conducted morbidity study on a large scale for the first time. The NSSO has been publishing reports on morbidity and healthcare since its seventh round in 1953-5420. The successive rounds in 1961-62 (17th round21), 1973-1974 (28th round22), 1986-87(42nd round23), and 1995-96 (52nd round) also
20 It was the first survey on morbidity by NSSO. The sample was very small (only 8253 rural households and
1720 urban households). The survey collected information on sex, age, marital status, occupational status, cause of illness and duration of illness.
21 The 17th round report was entitled as ‘Report on Pilot Survey on morbidity’. This was a pilot survey attempting to examine the alternative approaches to morbidity reporting.
22 The 28th round survey entitled ‘Note on Morbidity, NSS’ was a full scale survey conducted on the basis of the earlier surveys on morbidity. There was a shift in the idea of morbidity to utilization pattern since the 28th
provided detailed morbidity and health related estimates. The main objective of the 52nd round survey was to study the pattern of utilization of public and private health care services together with creating a morbidity profile of the population. Another round of survey on morbidity was conducted from January to June, 2004 (60th round). The 60th round entitled Morbidity and Condition of the Aged collected information on general health care system, utilization of health care services provided by the public and private sector and expenditure incurred on medical treatment by the households. Information on conditions of health of the aged was also collected in this round. The 71st round report on health and education is one of the parts of the decennial series which started during the period of 1980s.24 The 42nd, 52nd and the 60th round of the NSSO have also been a part of the decennial series on health.
The 71st round (January-June 2014) released a report entitled Key Indicators of the Social Consumption in India: Health which focused on the trends and patterns in morbidity rates, the role of public sector in providing health services and the cost of health care in both public and private health care sector.
The major differences between NSSO 71st round and the 52nd and 60th round on morbidity are: Firstly, in the previous rounds persons with disabilities were considered as ailing persons. In the present round, pre-existing disabilities are considered as disabilities on the condition that they were under treatment for a month or more than a month during the reference period. If this condition is not met, it is not considered as an ailment. Secondly, in the earlier rounds only those individuals were considered to have sought treatment who received some kind of medical attention in hospitals, but in the 71st round, those who were self-medicated were also considered treated if the treatment was undertaken on medical advice. Thirdly, in the present round, additional information on ailments, as on the date of survey, was not collected for any age groups. In the earlier rounds, ailments reported on the date of survey and the nature of treatment of such kind of ailment during the reference period of last 15 days was also collected (Sundararaman and Muraleedharan, 2015).
In 1995-96, Assam’s rate of morbidity was higher than the Indian average. Other states that had morbidity rates higher than the Indian average are Andhra Pradesh, Bihar, Gujarat, Haryana, Maharashtra, Orissa, Punjab, Tamil Nadu, Uttar Pradesh, West Bengal and Kerala.
round survey. NSSO has not taken any separate survey on morbidity since this round. Morbidity estimates are now collected as a part of the decennial survey on social consumption.
23The 42nd round report was entitled as ‘Morbidity and Utilization of Medical Services’. It was the second survey on social consumption and for the first time the survey collected data on utilization of health services in India incorporating data on both inpatient and outpatient care.
24 The 52nd and the 71st round were quinquennial round survey while 60th round was thin round.
In 2004 as well morbidity rate in Assam was higher than the Indian average. During this period the states with morbidity rates above Indian average were Andhra Pradesh, Haryana, Maharashtra, Punjab Tamil Nadu, Uttar Pradesh, West Bengal and Kerala. In 2014, the morbidity prevalence for the state of Assam (31 per one thousand populations) seems to decline with respect to the all India average of 87 per one thousand populations (Table 5.1).
However, Kerala may be considered to be an outlier in all the years, showing a morbidity prevalence rate much higher than the Indian average. For example, the morbidity estimate in 1995-96 is seen to be almost two times higher than the Indian average. Since Kerala is in the last stage of demographic transition it is expected to be experiencing lower levels of morbidity prevalence. One of the explanations of Kerala’s high morbidity estimate is that reporting is very high. Secondly the nature of disease prevalence, unlike in the case of other states, is mostly related to lifestyle. In other states the incidence of communicable diseases are relatively high. The variations in the morbidity estimates across different rounds may be attributed to changes in some of the concepts and definitions with respect to the earlier rounds. Thus the estimates of the 71st round are not strictly comparable with the earlier rounds. Although incomparable, the estimates are still useful in terms of depicting the levels of morbidity in the Indian states.
Table 5.1 Prevalence rate of morbidity (per thousand population) for the major states of India during the 52nd, 60th and 71st round of National Sample Survey Organization
Major states 52nd round (1995-96) 60th round (2004) 71st round (2014)
Andhra Pradesh 64 90 155
Assam 80 82 31
Bihar 36 53 57
Gujarat 46 69 92
Haryana 61 95 56
Karnataka 45 64 93
Madhya Pradesh 41 61 53
Maharashtra 52 93 80
Orissa 62 77 103
Punjab 76 136 161
Rajasthan 28 57 54
Tamil Nadu 52 95 146
Uttar Pradesh 61 108 68
West Bengal 65 114 161
India 55 85 94
Kerala (Outlier) 178 358 310
Source: NSSO, 52nd and 60th round and 71st round, 1998, 2004, 2015 Note: The reference period for all the rounds is 15 days
National Council of Applied Economic Research (NCAER) has also been collecting data on morbidity. The NCAER first published morbidity estimates in 1992 in a report entitled Household Survey of Medical Care. This report provided data on nature of illnesses suffered, source of medical treatment and costs borne by the patient during the period of treatment.
Another survey report titled Household Survey of Health Care Utilization and Expenditure was published in 1995.. NCAER (1992) referred only to ‘treated illnesses’ while NCAER (1995) gathered information on ‘both treated and untreated ailments’. Elaborate results were also published on prevalence rate of morbidity by gender, hospitalized and non-hospitalized cases, utilization of health care services by type of provider, use of various systems of medicine, and expenditure on hospitalized and non-hospitalized treatment. NCAER (1995) estimates show that the morbidity prevalence rate (based on treated and untreated) was higher than the Indian average in the states of Andhra Pradesh, Karnataka, Madhya Pradesh, Orissa, Punjab, Rajasthan, Uttar Pradesh and Kerala. In this report, Assam is seen to have relatively lower rate of morbidity. The NCAER morbidity surveys have not been updates since then.