Inequitable coverage of non-communicable diseases and injury interventions in India

We examined the inequities in coverage of interventions for non-communicable diseases (NCDs) and injuries in India.

Data collected by the WHO World Health Survey in 6 Indian states in 2003 were used to estimate the coverage of interventions for NCDs and injuries. Coverage was defined as the proportion of individuals who reported receiving the intervention among those in need of it. Multiple logistic regression analysis was used to assess inequities in coverage of interventions. Composite coverage was calculated for each state and assessed against expenditure on health.

The composite coverage of interventions for NCDs and injuries for all states combined was 43.9% (95% CI 43.0%-44.8%), and was higher in urban than in rural areas. Lower wealth quintiles had higher odds of being in need of interventions but lower odds of being covered. Overall, the highest quintile had composite coverage of 54.5%, compared with 34.1% for the lowest quintile. The states with lower coverage of interventions had a higher proportion of households reporting selling items or borrowing money to cover health expenditure; this proportion was highest (58.8%) in Rajasthan state that had the lowest composite coverage (36.6%).

The higher need for and lower coverage of interventions for NCDs and injuries in the poor, and the associated high risk of further adverse economic impact due to health spending, suggest that the public health system of India should improve access to these interventions at no cost for the economically disadvantaged.