By Sanjay K Bissoyi:
Public health care in India is patchy. We have made great strides, but about 1.2 million children under the age of five died in 2015 alone. Besides, as this report reveals, 9.7 million malaria infections are reported on an average per year. 2015 also saw 2.5 million new cases of Tuberculosis cropping up nationwide. Out-of-pocket expenditure (OoP) forced 63 million people to go below the poverty line. According to the World Bank Data and Draft National Health Policy, 2015 report, 28% of deaths were due to preventable but communicable diseases such as lack of maternal and perinatal nutrition and only 65% children between one to two years age were fully immunized. With underfunded and overcrowded hospitals and clinics, and inadequate rural coverage, is it possible to provide universal healthcare to 1.25 billion Indian people?
The government has initiated some good programs to tackle the public healthcare like National Newborn Action Plan, Mission Indradhanush (new vaccines), National Health Mission (Integrating NUHM), Swachh Bharat, RSSY, National eHealth Authority, Draft National Health Policy, etc. However, such programs don’t give expected results due to improper implementation at grassroots levels and fall short mid-way.
Expenditure on health care in India was an estimated to be 5% of gross domestic product (GDP) in 2013, but in the last union budget, the NDA government allocated roughly 2% of the GDP – that is Rs. 297 billion ($4.81 billion). If we go through the heath care fund allocations of the 54 countries with GDP greater than $ 300 billion, Pakistan, South Africa and Nigeria ranked below India. However, countries like USA, Australia, and Brazil spend more than 5% of the GDP on essential facilities such as health care.
Data reveals that hospitalization facilities available in rural Indian are available for only 35 people out of 1000 while urban India manages to cater to 44 only. About 70% of the OoP expenditure on health care are met with savings money while the rest is borrowed. On an average, every Indian spends 48% of their total annual income on health care.
The government spends a mere 0.1% of the GDP on publicly funded drugs while 70% of the total OoP health expenditure was incurred for purchasing drugs and medicines.
Given that over 70% of the total health care expenditure was incurred in private sectors and that most rich and upper middle-class don’t depend on public health care facilities, India will be able to solve much of its medical problems if it primarily caters to the poor and lower middle-class population. Nevertheless, it is not wise to limit such essential services to a certain section of the population.
According to a report by KPMG, by 2030, non-communicable-diseases will cause 67% of mortality in India. The only solution for this drastic scenario is “Robust Primary Care” in the country. The existing primary care system in our nation has various weaknesses. We have a good physical infrastructure, immunization, cold chain, reproductive health care, experienced ANMs and emergencies facilities available in some places but there are also bottlenecks such as lack of public trust in public health care. Most of the beds in hospitals are unutilized, absenteeism and shortage of doctors and other medical personnel is a recurrent problem, and there are very minimal OP services, no proper drug supplies, lack of robust data collection etc. These flaws push patients towards quacks or expensive health facilities, and tertiary hospitals end up overcrowded.
The population of USA is 318.9 million, and their health workforce is 12.2 million that is 3.8% of the total population. The population of the United Kingdom is 6.4 million; health workforce is 1.6 million which is equal to 2.4% of the population. However, in Indian, health sector workforce is almost abysmal. India’s population is 1250 million; health workforce is only 3.6 million and that stands for a meager 0.28% population ratio. Thus, India can create jobs for millions of unemployed youth in public health care sector.
No country ever achieved their universal health goals overnight. There are various ways to improve such systems. The Government should use existing tax revenues to pay for health care system. When the tax base widens, the government can consider levying income tax to support the health care programs. The government should spend more on primary care so that basic and preventive health care can reach the masses.
Our county needs to develop an all-India common public health service for every state. AADHAR-based registration, electronic patient records, ongoing and onward care biometric should make such a process more transparent. Free supply of generic drugs should also increase.
We should actively ask to the state how far and in what way has politics been engaged in public health care. The record is disappointing, there are no political debates for the interest of the poor, and we seldom find healthcare policies being implemented well at ground zero. But if there is will there is a way. One hopes India achieves its health care goals and brings relief to the 1.25 billion people of this country.