When Will India Achieve Universal Health Care?
Public health care in India is patchy. We made great strides but there were 1.2 million children under five died in 2015, 9.7 million malaria infections per year, 2.5 million new cases of Tuberculosis in 2015, out-of-pocket expenditure (OoP) that forces 63 million people to go below poverty line, 28 per cent of deaths due to preventable diseases (communicable diseases and maternal, perinatal and nutritional), 65 per cent of children between 1-2 years age are fully immunised, according to World Bank Data and Draft National Health Policy, 2015 reports. With underfunded and overcrowded hospitals and clinics, and inadequate rural coverage, is it possible to provide universal healthcare to 1.25 billion Indian people?
Government has initiated some good programmes to tackle the public healthcare like National Newborn Action Plan, Mission Indradhanush (new vaccines), National Health Mission (Integrating NUHM), Swachh Bharat, RSSY, National eHealth Authority, Draft National Health Policy, 2015 etc. However, such programmes don’t give expected results largely due to improper implementation at grass roots levels, and fall short on the mid-way.
Expenditure on health care in India was an estimated 5 per cent of gross domestic product (GDP) in 2013, but in the last union budget NDA government has allocated roughly 2 per cent of GDP that is 297 billion rupees ($4.81 billion). If we go through heath care fund allocations in budgets of 54 countries with GDP greater than $ 300 billion, Pakistan, South Africa and Nigeria ranked below India. USA, Australia, Brazil like counties spend more than 5 per cent of GDP on health care services.
There are hospitalisation facilities available only for 35 people out of 1000 in rural India while it is for 44 in urban area. Seventy per cent of out-of-pocket expenditure on health care is met from savings and the rest from borrowing. On an average, every Indian spends 48 per cent of total annual income on health care; it leads to such severe stage that it forces 63 million into poverty every year due to health care costs alone. Indians lost almost 37 million years of healthy life in 2013. There are many patients, especially those living in rural and semi-urban areas, receiving services from untrained practitioners. Government spends a mere 0.1 per cent of GDP on publicly funded drugs. Seventy per cent of OoP health expenditure was for purchasing drugs. Generic drugs can reduce costs up to 75 per cent.
Since over 70 per cent of the total health care expenditure is incurred in the private sector and that most rich and upper middle-class don’t depend on public health care facilities, the purpose will be served if the health care model reaches the poor and lower middle-class population. Nevertheless, it is not wise to limit it to a certain section of population, the process should be self-selecting. The voice and demand of middle class ensures accountability and quality in healthcare services.
According to a report by KPMG, a professional service company, by 2030, non-communicable-diseases will cause 67 per cent of mortality in India. There will be a total burden of $ 3 trillion in next 18 years. The only solution for this drastic scenario is “Robust Primary Care” in the country. Existing Primary Care System in our country has various weaknesses. We have good physical infrastructure, immunization, cold chain, reproductive health care, experienced ANMs and emergencies facilities are available in some places. But there are also bottlenecks such as Indian has lack of public trust on public health care, most of the beds are unutilized, absenteeism and shortage of doctors and other medical personnel, very minimal OP services, no proper drug supplies, lack of robust data collection and mechanisms and so on. These flaws push patients towards quacks or expensive health facilities and tertiary hospitals become overcrowded.
Population of USA is 318.9 million and their health workforce is 12.2 million that is 3.8 per cent of total population. Population of the United Kingdom is 6.4 million; health workforce is 1.6 million which is equal to 2.4 per cent of the population. However, the state of Indian health sector workforce very abysmal. India’s population is 1250 million; health workforce is only 3.6 million and that stands for 0.28 per cent population ratio. India can create jobs for millions of unemployed youth in public health care sector. So, in India a robust health care system can generate 10 million jobs over a decade.
No country ever achieved universal health overnight. There are various ways to improve our healthcare system. At the moment, Government of India spends around 2 per cent of its GDP on health care. India needs to increase it; as we can’t set a low priority to health. Speaking to Uday India, Jayaprakash Narayan, Founder, Foundation for Democratic Reforms, said: “ The Government should use existing tax revenues to pay for health care system. When the tax base widens, the government can consider on levying a precise income tax to support the health care programmes, which will provide people above a certain income would be equivalent to charging them twice. The government should spend more on primary care, so that basic and preventive health care can reach the masses. County needs to develop an all-India common public health service for every state. AADHAR-based registration, electronic patient records, ongoing and onward care biometric should be more transparent. There must be records which linked to National eHealth Authority. The government aids or cash transfers to be made to physicians as per patient’s choice (Rs. 500-700 per head). The government can introduce a system of mobile out-patient. There must be a mandatory referral for secondary care. Free supply of generic drugs should be increased. Basic diagnostic facilities such as blood and urine tests should be there in every primary health care centres. There doctors must have resided in between 5 and 10 km of area of practice.”
There is a saying ‘health is at bottom an issue in justice’. We should ask to the state as to how far and in what way has politics been engaged in public health care. The record is disappointing, there are no political debates for the interest of the poor, and we seldom find healthcare policies being implemented very well at the ground zero. But if there is will there is way. The Modi government has rolled out several schemes on public health care. One hopes it achieves health care goals and brings smile on the face of 1.25 billion people.
By Sanjay k Bissoyi