A new book, published by the New York-based Monthly Press Review (MPR), has blamed Microsoft founder Bill Gates for “crowning” the crisis allegedly engulfing India’s health sector, stating, the top American billionaire’s foundation of late has acquired “extraordinary influence" over India’s public health governance, giving a fillip to a policy that deprives access of public healthcare facilities for majority of the country’s population.
The book states, “So great is Gates’ authority that, in May 2020, Modi urged him to ‘take the lead in analysing the necessary changes in lifestyles, economic organisation, social behaviour, modes of disseminating education, and healthcare, that would emerge in the post-Covid world’,” but believes, Gates’ influence has been “profoundly harmful”.
Thus, at a time when India needs to address “the question of public health in a comprehensive way, encompassing nutrition, sanitation, drinking water, and curative care, his “public health model promotes the exact opposite”, believes the book, which is titled “Crisis and Predation: India, Covid-19 and Global Finance”.
Prepared by MPR’s Research Unit for Political Economy, the book states that under the scheme of things worked out by the Gates Foundation, India has begun to put “private corporations in the driver’s seat” assigning “technological interventions the key role – a magic bullet for each disease. This will not ensure public health, but it will deliver private profits.”
This, thinks the book, comes at a time when there has been “long-standing refusal of the government to spend on public health”, which has led to “chaos and distress” during the Covid-19 period. Things have particularly turned bad, according to the book because, “even before the advent of Covid-19, India’s economy was in a depression. The condition of vast masses of people, particularly those in the informal sector, was grave.”
One of the consequences of this situation has been “tight-fistedness than the field of public health – precisely the sector directly confronting Covid-19”, says the book, adding, “This policy of fiscal starvation may have informed the government’s choice of a lockdown as a ‘low-cost’ strategy to tackle Covid-19”, without realising that “such a draconian measure” does not by itself “reduce the ultimate number of deaths on account of the virus.”
Giving the background of how the Government of India is refusing what has gone wrong in the health sector, the book cites a November 2019 report by the Niti Aayog (“Health System for a New India: Building Blocks – Potential Pathways to Reform”), which “acknowledges that the principal reason India’s health system ‘lags behind comparable countries on multiple dimensions’ is its low public expenditure”, and yet “rules out this possibility.”
It quotes Niti Aayog report as saying, “India’s fiscal funding of healthcare, around 1.0 percent of GDP, is among the lowest in LMICs [low-middle income countries].” However, the report adds, “Fiscal funding is likely to remain at 1.0–1.3 percent of GDP”, even as ruling out the possibility of achieving the target set by the National Health Policy, 2017 of achieving 2.5 percent of GDP.
In fact, the Niti Aayog report believes, “A substantial additional fiscal space as the only alternative would mean that India would need to wait for decades until macroeconomic conditions allow for it.” The report explains, the main reason for the constraint is, while the private health facilities accounted for only 8 percent of the total the sector in 1947, today things have just reversed.
Niti Aayog acknowledges that India’s health system lag is due to low public expenditure, and yet rules out this possibility
Thus, “In 2010–11, there were an estimated 1.04 million private health enterprises across India, including roughly 80,000 private hospitals and 575,000 private medical clinics. The private sector thus employs 88 percent of doctors. By comparison, there were fewer than 200,000 government-run health care facilities across all provider levels in 2016.” Worse, “69 percent of primary health centres function with only one or no doctor, and 65 percent of community health centers report a shortfall of specialists.”
“As a direct result of the government’s refusal to spend, people are forced to divert their meagre incomes to health care. ‘Out of pocket expenditures’ account for a staggering 64 percent of India’s total health expenditures, a higher percentage than in comparable economies”, the book says, quoting authoritative sources.
It adds, “The sum India spends on health – about Rs 5 trillion in 2015 – is not the problem; the problem is the breakup of these expenditures. Thus, of India’s total health expenses of nearly Rs 5 trillion in 2015, public expenditure accounted for only trillion and contributory schemes for Rs 0.7 trillion. The burden of the remaining Rs 3.2 trillion was borne by out-of-pocket expenditures.”
Continues the book, “The consequences for ordinary people are both financial and physical. The National Sample Survey found in 2017–18 that private sector hospitalization costs were six times higher than the public sector ones in rural areas, and 8 times higher than the public sector costs in urban areas. In the case of other medical treatments (that is, those not involving hospitalization), the costs in the private sector were two to three times those in the public sector.”
It quotes the “Oxfam Inequality Report” of 2019 as saying, “Even using the official poverty lines (which are unconscionably low), about 8–9 percent of households, around 120 million people, were pushed below the poverty line in 2014 due to health care payments – an appalling fact. Perhaps to avoid such a fate, a fifth of the ill in both rural and urban areas deny themselves treatment.”
Things have reached a point where, the book says, even according to the Niti Aayog, “Large corporate chains and standalone hospitals dominate the top-end of the private market. Generally, these companies provide highly specialized services employing state-of-the-art technologies in tertiary and quaternary facilities located in major urban centres.”
The policy-making body admits, “Corporate chains have started to expand beyond major cities to establish large (100+ bed) hospitals in Tier II and III cities, indicating a desire to broaden their target demographic. This expansion has been encouraged by government, including through favourable tax policies.”
Not without reason, says the book, the Oxfam report comments, while India ranks “5th on the Medical Tourism Index”, ironically, it is 145th among 195 countries “in terms of quality and accessibility of healthcare”, adding, the slogan “Universal Access to Health Care” has been replaced with “Health for All”.
According to the book, this stands in sharp contrast to the emerging “global” view that an “increase in public spending on health and public provision of health care leads to better and more efficiently achieved health outcomes”, whereas an increase in private health care expenditure is “actually be associated with higher mortality rates.”
Continues the book, “The consequences for ordinary people are both financial and physical. The National Sample Survey found in 2017–18 that private sector hospitalization costs were six times higher than the public sector ones in rural areas, and 8 times higher than the public sector costs in urban areas. In the case of other medical treatments (that is, those not involving hospitalization), the costs in the private sector were two to three times those in the public sector.”
It quotes the “Oxfam Inequality Report” of 2019 as saying, “Even using the official poverty lines (which are unconscionably low), about 8–9 percent of households, around 120 million people, were pushed below the poverty line in 2014 due to health care payments – an appalling fact. Perhaps to avoid such a fate, a fifth of the ill in both rural and urban areas deny themselves treatment.”
Things have reached a point where, the book says, even according to the Niti Aayog, “Large corporate chains and standalone hospitals dominate the top-end of the private market. Generally, these companies provide highly specialized services employing state-of-the-art technologies in tertiary and quaternary facilities located in major urban centres.”
The policy-making body admits, “Corporate chains have started to expand beyond major cities to establish large (100+ bed) hospitals in Tier II and III cities, indicating a desire to broaden their target demographic. This expansion has been encouraged by government, including through favourable tax policies.”
Not without reason, says the book, the Oxfam report comments, while India ranks “5th on the Medical Tourism Index”, ironically, it is 145th among 195 countries “in terms of quality and accessibility of healthcare”, adding, the slogan “Universal Access to Health Care” has been replaced with “Health for All”.
According to the book, this stands in sharp contrast to the emerging “global” view that an “increase in public spending on health and public provision of health care leads to better and more efficiently achieved health outcomes”, whereas an increase in private health care expenditure is “actually be associated with higher mortality rates.”
Not without reason, it adds, India has “the dubious distinction of being the world leader in tuberculosis infections and deaths, with annual figures of nearly 3 million new cases and half a million deaths.”
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