A research paper published in a top San Francisco-based multidisciplinary open access journal by a non-profit, PLOS, has said that the public health spending in India (4% of GDP) is among the lowest, not only in the larger economies of the world, but also compared to poorer countries such as Malawi (8.3%), Namibia (7.7%), Tanzania (7.3%) and Sudan (6.5%).
Insisting that India needs to “prioritise” its public health spending, especially Janani Suraksha Yojana (JSY) entitlements, in order to address the “exceedingly high Out-Of-Pocket Expenditures (OOPE) that many women incur for maternity care”, the paper says, this is particularly important “given the large disparities in the cost of maternity care between public and private health facilities.”
Insisting that “there is also a need to control the sky-rocketing costs of private health care services, and increase the availability and accessibility of quality public health facilities for maternity care in India”, the paper says, India remains “the highest contributor in terms of absolute numbers of female deaths occurring in the world due to pregnancy-related causes.”
“In 2014, India along with Nigeria accounted for one-third of all global maternal deaths, with 17% (50,000) in India and 14% (40,000) in Nigeria.”, the paper, titled “High Spending on Maternity Care in India: What Are the Factors Explaining It?”, the paper adds.
“Further”, the it complains, “Public expenditure on healthcare in India has stagnated since the early 1990s. Government expenditure on health care is considerably low compared to other countries with similar levels of per-capita income, inequality and poverty.”
“On the other hand”, it adds, “the private healthcare industry has witnessed an unprecedented boom, growing at a rate of over 15% compounded annually, more than twice the growth rate for all services over the same period.”
“As a consequence, the pattern of current health spending suggests that households meet 71% of their total health spending, with government contributions accounting for only 20% (Central), 6% (State) and the remaining 2% made up by local bodies, other firms and external flows respectively”, the paper underlines.
Commenting on Government of India efforts to reduce OOPE on maternal health care services, and improve maternal health outcomes in the country, through JSY, the world’s largest Conditional Cash Transfer (CCT) scheme under the National Health Mission (NHM), the paper says, it is “grossly insufficient” in providing “quality health care services” a forte of private health care facilities.
“Government health services in India are marred by unavailability and absenteeism of health professionals, poor health care facility and infrastructure, shortage of drugs and equipment, physical inaccessibility and some anecdotal evidence of callous behaviour of healthcare professionals”, the paper says.
Pointing out that “maternal healthcare related expenditures” are becoming “catastrophic for households”, the paper, which is based on the 2016 National Sample Survey Organisation (NSSO) report, “Key Indicators of the Social Consumption in India: Health”, says, “The average Cost of ANCs and PNCs per pregnancy were US$ 46 and US$ 28 respectively, with delivery expenditure (US$ 160) accounting for the largest share of average Total Maternity Expenditure or TME (US$ 258)”.
Revealing that the lowest earning (5% of all households) spent 75% of what it calls households' catastrophic maternal expenditure or CME, the paper says, “The proportion reduced with the rise in the income level – “to 50% the 10% threshold level and further decreased to 34% at 15% level”, the paper underscores.
“Average spending on total maternity cost was US$235 among women in the age group of 15–24 years, US$ 241 in the age-group 25–29 years, falling to US$ 225 for women aged 30–49 years”, the report states, adding, “Urban women incurred higher maternity expenditure (US$ 326) than their rural counterparts (US$ 196).”