How to get India's public healthcare off life support

With shrinking public expenditure in health services and the continuous threat of infectious diseases, strengthening the public health system in India has become critically important. A recent global study has indicated that India ranks 143 among 188 countries in health index. Many Indians may be happy with this because we rank better than Pakistan and Bangladesh, but we are, in fact, placed below the countries like Syria, Iraq and Ghana.

India’s high Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) are a matter of serious concern. Even though the Millennium Development Goal targets were set to be achieved in 2015, we are yet to close the target on these parameters. Whereas the IMR is going down worldwide, India has had the highest number of child deaths at 1.3 million in 2015.

India is followed by Nigeria and Pakistan. Bangladesh has improved faster than expected, while India has shown a slower pace in the reduction of such deaths. Countries like Sri Lanka, Syria, Iraq and Libya have been declared malaria-free by the World Health Organisation (WHO) but India’s record is abysmally poor. It is third among 15 countries registering the highest cases of and deaths due to malaria and, therefore, remains in the red zone.

Public health is a critical component of the larger concept of the health systems and works on the premise “what we as a society do collectively to assure the conditions in which people can be healthy”. India’s public expenditure on health at 1.4 per cent of the GDP is one of the lowest among the SEARO countries, with Myanmar being the only exception. It is also the lowest among the BRICS countries.

The health sector in India in India is at crossroads today. Universal health coverage still eludes Indians. The BJP, in its manifesto, had promised health assurance to all Indians and vowed to reduce out-of-pocket expenditure on healthcare. Besides, it had also promised an AIIMS-like institute in every state.

However, despite the completion of half of its tenure, basic healthcare facilities are out of reach for the common man. India’s public health financing deficit is the primary reason why millions of citizen go bankrupt. Lack of affordable and accessible public health services opens the doors to unscrupulous health mafia fleecing poor patients. For example, in Punjab, ill-equipped and poorly staffed government hospitals have led to the proliferation of private hospitals where medical bills can kill a patient before the disease.

The state of healthcare has deteriorated to the extent that one serious illness in a middle class family can push it below the poverty line. Poverty caused by medical expenditure is increasing significantly in both urban and rural India. Recently, there was a news report that in Mumbai, an individual may have to spend two years of his family’s annual income for treating a disease like TB.

Contrary to the WHO recommendation of one doctor for one thousand people, we have one doctor for 1450 people. With this ratio, nearly a quarter of the posts are lying vacant and the situation is all the more severe in rural areas which have a deficit of six lakh doctors. The doctor population ratio in rural India is about 1:3200. The situation is worse than Vietnam and African countries like Algeria. People of no other emerging economy are as vulnerable as Indians when it comes to emergency healthcare.

As we are moving from the Millennium Development Goals (MDGs) to achieve the Sustainable Development Goals (SDGs) which seeks to ensure health and wellbeing for all, at every stage of life, the dismal record of our public health infrastructure is a serious challenge. Growth has no meaning if people are not well fed, or not in a good state of health. There can be no demographic dividend if the human resource is not healthy and fit for economic activities.

India urgently needs to spend more on healthcare and save its poor population from poverty and hunger or face the risk of slower economic growth. India needs to increase public expenditure on health and ensure better healthcare facilities.

Nearly 60 per cent of the total health expenditure is incurred by patients directly for which there is no provision for reimbursement or insurance. It shows that it is imperative for India to have a well-designed health insurance scheme which will act as a safety net for these people. The formulation of relevant healthcare policies with effective tools for implementation and monitoring are the need of the hour. We are losing six per cent of our GDP to preventable illness and premature deaths. The cost will escalate in the future because of our demographic structure.

If, by increasing public expenditure on health by two to three per cent, combined with effective policy interventions, we can save the six per cent of the GDP or at least four to five per cent, we should do it and invest in a healthier and wealthier future for the country.

The succesful experiences of Sri Lanka, Thailand and Iran show that better healthcare facilities are not limited to the developed countries. Even developing countries can have sound healthcare systems provided that it is recognised as a priority area for the government with due focus on planning, budgeting and implementation.

If a country like Sri Lanka, which was consistently reeling under the threatening impact of mosquito-borne diseases, can make itself malaria-free, why can't we?