Skip to main content

With mere 1.3% investment of GDP, India ranks "close to bottom of the pile" on most international health indices

By Moin Qazi*
India’s economy is soaring but its healthcare system remains an Achilles’ heel. For millions of people, the high cost of treating illness continues to undermine economic progress. This is largely on account of the abysmal and chaotic healthcare system owing to the declining budgetary healthcare support by the government. India now ranks close to the bottom of the pile in international rankings on most health indices.
With an investment of 1.3% of GDP in health services— which has remained at the same level for a decade—India ranked 187th out of 194 countries according to the World Health Organization (WHO), while accounting for a full 20% of the global healthcare burden. Comparable rates are 1.5% in Sri Lanka, 2.7% in China, and 3% in Thailand. In order to remedy this, the National Health Policy 2017 has proposed an increase in public spending on health care from the current dismal rate of 1% to a meagre 2.5% of GDP by 2020. This would still leave India well below the world average of 5.99% of GDP.
Compared to its spending on health, India spends around 2.4% of its GDP on defence. Global evidence shows that, unless a country spends at least 5-6% of its GDP on health with most of that coming from public funds, basic healthcare needs are unlikely to be met.
Illnesses are a severe risk and can shave off most of the hard-earned savings in low income communities. They are the No. One route to bankruptcy. The Ministry of Health found that a quarter of all people hospitalised were driven to penury by their hospital costs ~ not including the cost of missed work.
Universal healthcare in India remains a distant reality because healthcare still continues to rank very low on the government’s priority card. Nobody wants to talk about the elephant in the room. While facilities in Indian metros are competing with the world’s best medical centres, the scenario beyond the urban conglomerates is quite distressing. The demand and supply in healthcare services still show a significant disparity in urban and rural areas as also regional imbalances. Here’s a snapshot:

  • 30% of Indians do not have access to primary healthcare facilities.
  • About 39 million Indians fall below the poverty line each year because of healthcare expenses.
  • Around 30% of people in rural India do not visit hospitals due to fear of the expenses.
  • 47% of healthcare needs in rural India and 31% of the need in urban areas are financed by loans or the one-off sale of assets

· About 70% of Indians spend all their income on healthcare and drugs.
Out-of-pocket spending on healthcare in India—which makes up 69% of the total expenditure on health—is among the highest in the world, and is much more than the rates in Thailand (25%), China (44%), and Sri Lanka (55%).
Nearly 30,000 doctors, 20,000 dentists and 45,000 nurses graduate from medical colleges across India every year. However, the doctor-to-patient ratio in India is only six for every 10,000 people. This is far below the rate in Australia (1 for every 249), the UK (5 for every 1,665) and the US (9 for every 548). The global ratio stands at 15 doctors for every 10,000 people.
The distribution of doctors is also uneven across the country, with a low ratio in states like Chhattisgarh and Jharkhand—just two doctors for every 1, 00,000 people. And there are only six hospital beds and two surgeons per lakh of population. There is one government doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. In comparison to these dismal numbers, the US has 24.5 doctors for every 10,000 people and one hospital bed for every 345 citizens.
India has a laggardly record in updating its healthcare coverage. In per capita terms, adjusted for purchasing power, India’s public expenditure on health is $43 a year, compared to $85 in Sri Lanka, $240 in China, and $265 in Thailand.
European nations spend 10 times and the US 20 times. According to the Insurance Regulatory and Development Authority (IRDA), the Indian government’s contribution to health insurance stands at roughly 32%, as opposed to 83.5% in the UK. India’s high rate of out-of-pocket expenses for health in stems from the fact that 76% of Indians do not have any health insurance.
The recently released National Health Accounts (NHA) for 2014-15 show that the average amount spent by the government for each citizen per year was just Rs 1,108. This is against nearly Rs 6,300 spent on each central government employee.
According to the NHA, India’s total health expenditure in 2014-15 worked out to Rs 3,826 per person. Of this, people had to spend Rs 2,394 (63%) out of their own pockets. In 2014-15, the Union government’s expenditure on the National Health Mission was Rs 20,199 crore. Spread this cash injection over a population of roughly 1.25 billion and it comes out to a paltry Rs 162 per head.
The apathy of the government is reflected in a rather poor prognosis for the health system. Primary health centres (PHC) in villages are supposed to screen and feed medical cases to specialised hospitals in districts and further on to state-level specialised hospitals. PHCs do not exist in many villages (about 1 for every 20 villages), and where present are so acutely undermanned that the “access” system is broken at the first mile.
As many as 18 per cent of PHCs were entirely without doctors, This impacts not only the filtering of patients but also deeply impairs prevention and early detection which is a must if costs in the whole system are to be contained. The only redeeming feature is the committed cadre of Auxiliary Nurse Midwife (ANM) at PHCs and their sub-centres and accredited social health activists (ASHAs).
Our healthcare facilities have grown significantly in terms of numbers and expertise of our professionals, but this has largely been in the private sector. The government’s failure to deliver quality care has led to a rapid expansion of private hospitals, which today account for 93 per cent of all hospitals (up from 8 per cent in 1947), 64 per cent of all beds, and 80 to 85 per cent of all doctors. But mass access continues to remain a challenge. For the private sector, affordability in Tier 3 cities and rural areas is a critical limiting factor for further expansion.
The health infrastructure is heavily skewed in favour of urban areas. Nearly 75 per cent of dispensaries, 60 per cent of hospitals and 80 per cent of doctors are located in urban centres. Doctors cater to a third of the urban population, or no more than 442 million people.
There are around 734 district hospitals across the country which provide secondary healthcare facilities to people. In addition, there are around 300 other hospitals, such as women’s hospitals at the district level. They are powerful nodes in India’s healthcare network and can be revitalized to boost the health infrastructure.
India needs to reform the public health care sector’s governance and management systems. The approach to service delivery has to be a functional referral linkage and establishing a ‘continuum of care’ across the spectrum from village to sub-health centre to primary health care, sub-district hospital and the district hospitals. The challenge remains to reform the health system and its workforce in particular, so that practitioners, administrators and others have the skills, knowledge and professional attributes to meet the emerging health-care needs of our community.
Several laudatory policies are already in place. The direction of travel, so to speak, is right but we have to accelerate the pace of the journey. For reforms to be successful we need hard-coded timelines and accountability of those tasked with the administration. It is now for the policy doctors to collaborate with the professional doctors to use their ingenuity to come up with radical solutions that can cope with the mounting challenges of healthcare.
---
*Author of “Village Diary of a Heretic Banker”, has spent more than three decades in the development sector

Comments

TRENDING

Insider plot to kill Deendayal Upadhyay? What RSS pracharak Balraj Madhok said

By Shamsul Islam*  Balraj Madhok's died on May 2, 2016 ending an era of old guards of Hindutva politics. A senior RSS pracharak till his death was paid handsome tributes by the RSS leaders including PM Modi, himself a senior pracharak, for being a "stalwart leader of Jan Sangh. Balraj Madhok ji's ideological commitment was strong and clarity of thought immense. He was selflessly devoted to the nation and society. I had the good fortune of interacting with Balraj Madhok ji on many occasions". The RSS also issued a formal condolence message signed by the Supremo Mohan Bhagwat on behalf of all swayamsevaks, referring to his contribution of commitment to nation and society. He was a leading RSS pracharak on whom his organization relied for initiating prominent Hindutva projects. But today nobody in the RSS-BJP top hierarchy remembers/talks about Madhok as he was an insider chronicler of the immense degeneration which was spreading as an epidemic in the high echelons of th

Central pollution watchdog sees red in Union ministry labelling waste to energy green

By Chythenyen Devika Kulasekaran*  “Destructors”, “incinerators” and “waste-to-energy (WTE) incineration” all mean the same thing – indiscriminate burning of garbage! Having a history of about one and a half centuries, WTE incinerators have seen several reboots over the 19th, 20th and 21st centuries. 

First-of-its-kind? 'Eco-friendly, low cost' sewage treatment system installed in Gujarat

Counterview Desk Following the installation of the Unconventional Decentralized Multi-Stage Reactor (UDMSR) for sewage treatment, a note on what is claimed to be the  first-of-its-kind technology said, the treated sewage from this system “can be directly utilized for agricultural purposes”, even as proving to be a “saviour in the times of water crisis.”

A Hindu alternative to Valentine's Day? 'Shiv-Parvati was first love marriage in Universe'

By Rajiv Shah*   The other day, I was searching on Google a quote on Maha Shivratri which I wanted to send to someone, a confirmed Shiv Bhakt, quite close to me -- with an underlying message to act positively instead of being negative. On top of the search, I chanced upon an article in, imagine!, a Nashik Corporation site which offered me something very unusual. 

Indo-Bangla border: Farmers facing 'illegal obstacles' in harvesting, transporting yields

  Counterview Desk  In a representation to the chairperson, National Human Rights Commission, human rights defender Kirity Roy, who is secretary, Banglar Manabadhikar Suraksha Mancha (MASUM), has said that Border Security Force (BSF) personnel are creating "illegal obstacles" for farmers seeking to harvest their ripened yields and transport them to the market in village Jhaukuthi of Cooch Behar district.

'Flawed' argument: Gandhi had minimal role, naval mutinies alone led to Independence

Counterview Desk Reacting to a Counterview  story , "Rewiring history? Bose, not Gandhi, was real Father of Nation: British PM Attlee 'cited'" (January 26, 2016), an avid reader has forwarded  reaction  in the form of a  link , which carries the article "Did Atlee say Gandhi had minimal role in Independence? #FactCheck", published in the site satyagrahis.in. The satyagraha.in article seeks to debunk the view, reported in the Counterview story, taken by retired army officer GD Bakshi in his book, “Bose: An Indian Samurai”, which claims that Gandhiji had a minimal role to play in India's freedom struggle, and that it was Netaji who played the crucial role. We reproduce the satyagraha.in article here. Text: Nowadays it is said by many MK Gandhi critics that Clement Atlee made a statement in which he said Gandhi has ‘minimal’ role in India's independence and gave credit to naval mutinies and with this statement, they concluded the whole freedom struggle.

Wasteland, a colonial legacy, being used to 'give away' vast tracts to Ratnagiri refinery

By Fouziya Tehzeeb* William D’Souza, a 55-year old farmer from Kuthethur, Mangalore, was busy mixing cattle feed when we arrived at his doorsteps. Around 25 km from the bustling city of Mangalore, Kuthethur is a lush green village with thick vegetation. On the way to William’s house the idyllic view gets blocked by the flares and smoke arising from the Mangalore Refinery and Petrochemicals Limited (MRPL).

CAA disregards India's inclusive plural ethos, 'betrays' ideals of freedom struggle: PUCL

Counterview Desk    "Outraged" at the move of the Central government to implement the Citizenship Amendment Act, 2019 (CAA 2019) weeks before the election, the top rights group, People's Union for Civil Liberties (PUCL), has demanded that the law be repealed. 

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

Invincible, Modi 'taller' than BJP, RSS: An opportunity for Congress beyond 2024?

By NS Venkataraman*  With the announcement of poll schedule for the 2024 parliamentary election, there is palpable excitement and expectation amongst the countrymen  about the shape of things to happen in India after the  results of the election would be announced. There is also speculation abroad about the future course of developments in India.