Crumbling Healthcare Infra
Recently, NITI Aayog released a report on rank of states and UTs in terms of healthcare system. The report painted a gloomy picture of north Indian states, particularly Uttar Pradesh and Bihar, for their performance in improving healthcare system. Populous and politically important Uttar Pradesh comes on the rear on the overall health index with a low score of 28.61, while the national leader, Kerala, has scored 74.01. Here it is worth mentioning that some time back, Yogi Adityanath, in his visit to Kerala, said that Kerala should learn from UP how the medical system should be in a state. The saying goes one should study the findings of people who have failed rather than trying to learn from the people who succeeded, so that one could get some value addition. It seems Yogi meant exactly this. Anyway, Kerala, the national hero, securing the highest score in the health index produced by NITI Aayog, is really an exceptional example in the health sector. Recently, the whole India witnessed the efficient efforts of people of Kerala to fight against Nipah virus. The whole Kerala united together, irrespective of politics and the government with the support of the people, and succeeded to stop spreading of Nipha virus. But having said this, it is apt to mention here that in the country 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 healthcare, which leads to such a severe stage that it forces 63 million into poverty every year due to healthcare costs alone. Furthermore, 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 out of pocket health expenditure was for purchasing drugs. However, generic drugs can reduce costs up to 75 per cent. But what is more, since over 70 per cent of the total healthcare 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 healthcare 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.
It is noteworthy that the Central government launched some good initiative to combat 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, Ayushman Bharat etc. However, such programmes don’t give expected results largely due to improper implementation at grassroots levels, and fall short on the mid-way. It is a fact that both the Centre and state governments invest a huge amount of money in the health sector, however, the implementation and execution are not done effectively. The responsibility of governments is not finished by releasing funds but they have to watch close the execution of various methods. People should be educated to make use of various measures taken by governments. Hence, in this perspective, it may be a better advice to construct smart cities than undertaking development activities in existing unplanned healthcare infrastructure. The most important question that comes to mind and needs consideration is the fiscal viability and funding gap. Each of the smart cities in the world that embarked on this change had similar challenges and we may hide behind the obvious, stating that they are rich economies. But it is widely known in the globalised world how these very countries have been recession prone and are cash strapped. Yet, they had the vision to take this up for one and only reason–we have the right to quality life and our future generations should inherit a healthy world and proudly state that we gave them a better world.
By Deepak Kumar Rath