Written By: Nirmalya Dutta | Updated : June 4, 2014 12:10 PM IST
The 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:
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 nations. Female 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:
The children's healthcare situation is equally bad. While some diseases have been controlled to a large extent others continue to wreak havoc.
Source: Lancet 2011 and Save the Children
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-upwith 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:
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 likenutritional 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.
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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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