Healthcare woesThe right to good health is of paramount importance. It’s sad that we, the world’s most populous democracy, can’t guarantee that to our citizens. India has the most inequitable healthcare scenario feasible. On one hand, our country is fast becoming the hub for medical tourism where people from other countries flock to get good quality, affordable medical treatment.  On the other most of these facilities are simply not available to the natives.

So how did the situation get so bad?

Healthcare was never a top priority after independence. The initial onus was on agriculture, infrastructure and military. This led to social sectors like health and education being neglected. In fact, it wasn’t until 1982-83 that the National Health Policy was endorsed by parliament.  Most of the services provided thereon were preventive (vaccinations against various ailments) and very few curative healthcare services were provided. Preventive services were mostly provided by the private sector. Medical education too was neglected, a case in point being that there are no superlative medical institution brands like the IITs or the IIMs.

Here are some of the major issues we need to tackle if we hope to one day become the nation that our freedom fighters and forefathers thought we’d become: 

1. Woeful rural healthcare

Mahatma Gandhi had a dream that India would be a land of self-sustaining villages.  ‘The true India is to be found not in its few cities, but in its seven hundred thousand villages. If the villages perish, India will perish too.’ The health scenario in rural India would’ve caused him great pain.  The basic problem in this case is the lack of resources – human or otherwise. Initiatives like the National Rural Health Mission (NRHM) or a compulsory Bachelor of Rural Health Care (BRHC) course haven’t made much headway. 

 Here are some of the stark facts about the lives of our rural brethren:

  • 50% of all villagers have no access to healthcare providers.
  • 37% are chronically starved
  • 10% of all babies die before their first birthday
  • 50% of all babies are likely to be permanently stunted due to lack of proper nutrition
  • 33% people have no access to toilets, while 50% defecate in the open

Source:  Indiafacts.in and India Development gateway

2. Women’s and Children’s Health

 According to a poll by Thomson Reuters, India is the worst place for women among G20 nationsFemale foeticide, unequal rights, dowry killings, poor maternal health and lack of sexual education are just some of the reasons for the same. Here are  few stark realities about women in India:

  • 12 million girls were aborted in the last three decades in India
  • Child marriage has a domino effect since this also leads to lowered education levels and lower levels of awareness
  • 45% Indian women are married before they turn 18. This results in early pregnancies, higher morbidity and mortality rates.
  • A mother dies every ten minutes in India

The children’s healthcare situation is equally bad. While some diseases have been controlled to a large extent others continue to wreak havoc.

  • Over 1.25 million children die annually in India.
  • 48% of all children have stunted growth due to malnutrition.

Source: Lancet 2011 and Save the Children

  • Only 7% children in India receive the minimum acceptable diet set by the WHO. The other countries we share such a dubious honour with are sub-Saharan African countries and Pakistan.

Country

Pakistan

Nigeria

Congo

Mali

% of children who receive minimum acceptable diet

4%

3%

4%

7%

 Source: Save the Children

3. Low government spending, high out-of-pocket expenses and lack of insurance

 As we mentioned before, the government spending on healthcare is grossly inadequate. It spends about 1% of the nation’s GDP on healthcare. This has led to very high out-of-pocket (OOP) expenditure for the general public. This means that 78% of all spends on healthcare are paid by the people and 72% of this is on drugs alone. Estimates suggest that 39 million people are forced into poverty because of medical expenditure. Here’s a breakdown of total % of GDP spent on healthcare, percentage spent by individuals and per capita spent by the governments of various developed, developing and under-developed countries. 

 

Country

Total % of GDP spent on healthcare

Private Expenditure %

Per capita spent on healthcare (US $)

Per capita government spends on healthcare (US$)

India

4.1

70.8

132

39

USA

17.9   

46.9

8362

4437

UK

9.6

16.1

3480

2919

South Africa

8.9

55.9

935

412

China

5.1

46.4

379

203

Brazil

9

53

1028

483

Pakistan

2.2

61.5

59

23

Nigeria

5.1

62.1

121

46

Russia

5.1

37.9

998

620

Source: WHO

As we can see we’re nowhere near the top bracket US or UK. We don’t even spend anything close to what our BRICS (Brazil, Russian, India, China and South Africa) counterparts spend. In fact, our spends are even lower than a country like Nigeria’s. 

Because of the centre’s negligent attitude, most of the resources lie with the private sector. It currently has 80% of all doctors, 26% of nurses, 49% of beds and 78% of ambulatory services and 60% of in-patient care. It seems audacious not to exploit those resources. To this effect, the Planning Commission had suggested that the public sector tie-up with the private sector to improve the country’s healthcare scenario. However, the proposal was vehemently opposed by health activists who felt that it would corporatize’ healthcare.

Another big issue is lack of medical insurance. Only 243 million of India’s 1.2 billion citizens are covered under Govt health insurance schemes and a total of 300 million (25% of total population) don’t have health insurance at all. 

 Source: Planning Commission Health Division report for the 12th Five Year Plan

4. Medical Education and Healthcare Human Resources

India has some top quality medical institutes which provide quality education and a huge number of medical professionals are added to the task-force every year. While that is indeed a huge number, most of them are based in urban centres resulting in deficit of healthcare services in rural and semi-urban India. 

Health HR

Doctors

Specialists

AYUSH*

Nurses

ANM**

Pharmacists

Total

Numbers graduating annually

30,000

18,000

30,000

54,000

15,000

36,000

163,000

*Practitioners of Ayurveda, Yoga, Unani, Siddha and Homeopathy

**Auxiliary nurse middle-wife (for childbirth)

 Some stats to ponder about:

  •  Urban India has four times more doctors and three times more nurses than rural India.
  • Only 193 of India’s 640 districts have medical colleges. This has a domino effect on the local community with doctors moving away, either to urban centres with medical colleges or abroad. 
  • Almost 80% of the medical colleges are located in South and West India creating a dearth of professionals in Central, Eastern and Northern India.

To bridge these issues, various steps have been suggested - 

However, most of these initiatives met vehement criticism and have experienced opposition from the medical community.

Source: Planning Commission Health Division report for the 12th Five Year Plan

5. High number of avoidable deaths

Avoidable deaths refer to those that could’ve been avoided extremely easily with either the most basic or cheap medication or treatment. Some of the more common avoidable diseases are malaria, tuberculosis, kala azar and Japanese Encephalitis. Deaths from conditions like nutritional deficiencies or perinatal deaths are also considered in this list. A rough estimate suggests that over 2.1 million people died in India from conditions that could’ve been avoided. Here’s how we arrived at the number.  

Diseases

Estimated deaths in South  East Asia (2008)

Est. deaths in India* (2008)

Tuberculosis

405974

357257

Malaria

43200

38016

Diarrhoea

1141586

1004596

Dengue

7064

6216

Japanese Encephalitis

11313

9955

Kala Azar

10130

8914

Nutritional deficiencies

84,123

74028

Perinatal conditions

8,72,676

767955

Maternal conditions

80620

70946

Total

26,56,686

2337884

 *Assuming 88% of these deaths were in India, since it accounts for 88% of the population in this region.

Note: It’s extremely hard to track deaths due to avoidable diseases. WHO estimates over 2.6 million people died in South East Asia in 2008 from these conditions. However, official records show the numbers to be far lesser. For example, India had only around 1000 reported malaria deaths in 2008. However, when the entire SE Asian region is taken the number of estimated malaria deaths is 43,200. Now this region has a total population of 1.3 billion and India had an estimated population of 1.15 billion in 2008. So it’s clearly implausible that despite having 88% of the population it only accounted for 2 percent of malaria deaths. So we’re assuming that 88% of all deaths caused by these diseases are in India. We’re assuming of these 2,656,686 deaths, 2,125,348 occurred in India.

It’s extremely sad that so many Indians are losing their lives to diseases and conditions that could’ve been easily avoided with the most basic of healthcare services.

Read more about causes, symptoms, diagnosis and treatment of diabetes.

Rise of Lifestyle diseases

While rural India battles third world diseases like malaria and dengue, rising urbanisation has led to the middle and upper classes being afflicted with ‘developed world’ lifestyle diseases like diabetes and obesity. A fast food culture, increased smoking and alcohol consumption has led to a rise in obesity related diseases like diabetes and cardiovascular ailments.  To read a more comprehensive report about lifestyle diseases click here.

The road ahead 

Most of our healthcare woes could be vanquished if we as a nation simply worked together for it. When I say nation, I mean everyone – doctors and other medical professionals, rural and urban citizens, bureaucrats and politicians, the state and central governments. 

It’s a travesty that 66 years after Independence we still can’t make even the basic healthcare services accessible to everyone. Most of us reading this probably haven’t experienced the grim grip of poverty, malnutrition or ill-health. We’ve probably never gone to bed hungry or lost a loved one because we couldn’t afford a drug. Sixty-five years ago we freed ourselves from colonial rule; it’s about time we sent ill-health packing. 

Imagine a country where healthcare is accessible to all. Or as Tagore would say, ‘Into that heaven of freedom my father let my country awake.’  Jai Hind. 

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  • abdul qadir khan

    My suggustion is that plz refer forign techology in india like maleria deasise

  • Ria

    It is a really good article . It is really true many people in India do not have access to medical treatment . So many villagers die cue to poor health infrastructure in villages . But why do doctors do not want to work in villages ? Only because of bad pay? But the country that has done for you so much can’t we do even that much? But I am literally not going to do like this . If suppose to become a doctor the I would serve my nation in every possible way. On the account of this Gandhi jayanti ,let us all take an oath of improving India in every aspect . I would definetely like to fulfill Mahatma Gandhi ‘s wish,he said that “I wish of such an India were poor will have the SAMs say as the rich has”. Jai Hind!!!

  • aseem

    I am an Indian doctor, a cardiovascular surgeon, currently working in the Middle East. The miserable situation the Indian healthcare sector (esp. Govt hosp) is in, is a very well known fact now. The scarcity of doctors especially specialists and medical teachers is extremely worrisome.
    Inspite of a strong desire to work at a district level hospital and provide cardiac services and teach medical students, many doctors from non English countries with specialist qualifications (PhD) cannot do so. That is because the Government (MOHFW & MCI) have never even bothered to take a fresh look at recognizing specialist qualifications from these countries. No rules have been formulated, no conditions laid down….the matter is just left to rot over the last 10-15 years. The brain drain is logical- why would any specialist wait so long?
    There is already an acute shortage of medical teaching staff, from where will we get the teachers if we just keep building new colleges and increasing medical seats? The need of the hour is to utilize the ready manpower from abroad urgently!

  • Rahul

    Well sorted out article. Due to all these issues, private healthcare is making hay…cost of healthcare in private sector has gone up tremendously. People dont have any choice, than to go to private care. Adn even there, its a trap. Once you enter private care, fear psychosis stops you from coming out. But a good trend is that, people are now realizing the benefit of seeking good quality care. People are no longer fooled by influencers to go to high cost, branded private care only. They are seeking out good yet cost effective healthcare. Case in example is if we put medanta and narayan Hrudalaya side by side, I am sure, many people will opt to the latter. Coz both offer good quality care, but the later is much more cost effective. So, patients need to be made aware of such better options to help contain the cost of healthcare. Interestingly, now there are services available to do exactly that. entreprenurs like healthps.com and medeel.com offers such services to the patients. the point is – a whole ecosystem is being built around private healthcare which allows patients to opt for better options at lesser cost. Such a choice is crucial for middle class families to access quality healthcare in inda.

  • Dr S K Mathur

    There are two issues:
    A: Providing the quality health care in Rural area: 1.we need experienced doctors rather than freshers. Hence instead of expex=cting a fresh graduate to serve in rural area, govt. should involve retired physicians to run rural health centres. Because of their experience they would be able to provide both preventive aswell as therapeutic health care. Encourage them to form groups and cover rural areas by rotation.
    2. Govt should encourage seting up iof ndustries in rural area and make it coumpalsory for them to set up quality health and education centres accessible to the neighbouring villages.
    B: provision for Quality Medical education in our Medical Colleges

  • Fulan

    There’s no refund per se for hetalh insurance premiums (unless McCain gets elected and has his way). The way it works now is, if you are self employed, you can offset your income with the amount of hetalh insurance premiums paid. So if you made $ 50,000 at your business and paid $ 5,000 in premiums, you would reduce your taxable income by the $ 5,000, which in turn reduces your income tax. (It doesn’t reduce self employment tax however.)If you’re not self-employed, you can deduct your hetalh insurance premiums on Schedule A, Itemized deductions. This is a lousy deal for most people because (1) unless you have a home mortgage or tons of medical expense, you’re probably better off with the standard deduction rather than itemizing and (2) you can only deduct medical expense to the extent that they exceed 7.5% of your adjusted gross income. So if you made $ 50,000 in wages, you could deduct medical expenses in excess of $ 3,750 (that’s $ 50,000 x 7.5%). In this scenario, if you had $ 5,000 in hetalh insurance premiums as your only medical expense, you could only deduct $ 1,250. And unless you had more itemized deductions like mortgage interest or lots of charitable contributions, you’d still be better off taking the $ 5,450 (for 2008) standard deduction. In this scenario, your hetalh insurance premiums would do you no good at all on your taxes.

  • Indrani Choudhuri

    Really an alarming situation depicted in a very lucid manner. Awareness among common man is the need of the hour.

  • iqbal masih

    india isa very big country. Mostlt people living in village.there is no complet oregment for patient.people must go to the city.

  • maninder

    truly remarkable piece of writing and information,, showing the true picture to healthcare providers and healthcare industry would only put us on the road discussed above….happy independence day to u!!