HEALTH is wealth goes the adage. In post-globalisation India, it would have to be changed to wealth is health. The health care scenario in India is urban-centric, dominated by private players and ignored by the governments.
Consider some of the statistical data. Of the total health spending in the country, all levels of government make less than one-fifth contribution. The rest comes from the pockets of ordinary citizens. Two out of five hospitalisations are paid through selling of assets or raising loans. India has a hospital bed density of around 2.5 per 1000 population; the World Health Organization norm is 5 beds per thousand population. According to the Bulletin of Rural Health Statistics in India, while there has been a 60 per cent rise in reported ailments between 1995-96 and 2004-05, the bed density has actually gone down from 0.93 to 0.86. There is more bad news on rural health. Something like 60 per cent of hospitals are located in urban areas, whereas 80 per cent population lives in rural areas. Some 80 per cent doctors and 75 per cent dispensaries are in city areas.
Healthcare is one of the largest sectors. According to a NGO report it is to the tune of `150,000 crore. But 60 per cent of outpatient care and 70 per cent of all hospitals are provided by the private sector. The capital city Delhi has 734 hospitals and clinics, with 36,352 beds, which is 2.14 beds per 1000 population, well below the healthy international average but far above the national average of 0.86; nearly 2.5 times more.
On the other side, India is increasingly becoming the destination for international medical tourism. India has the highest number of medical as well as nursing colleges as compared to other countries. In fact, according to a study by the FICCI, India has the highest number of nurses per thousand population, though in reality there is a shortage of nurses.
All these statistics only go to show that there is a serious mismatch of policy and governance in this important social sector. While the situation has been steadily deteriorating since the liberalisation, with the government increasingly withdrawing from its commitments, under the UPA government it has gone only worse. The previous health minister had a single purpose, to oust the Director and renowned surgeon of the All India Institute of Medical Sciences. The court came to the aid of the director.
Now, the health ministry has three ministers – one of cabinet rank and two ministers of state. The cabinet minister Ghulam Nabi Azad has been given the berth to keep him out of Kashmir. Of the other two one is from Trinamool Congress and the third one is from the DMK. None of them have had anything to do with health service in their public life.
While the doctors in the government hospitals are overworked, attending to multiple patients at a time, the private hospitals are beyond the reach of the common man. Recently the junior doctors in a government hospital in Delhi went on a flash strike because one of them was assaulted by the relatives of a patient who died during treatment. While one can understand the agony of the family members, what upset the doctors was that there was no security arrangement to intervene on their behalf, in a country where leaders are obsessed with security.
The government hospital facilities are under tremendous pressure, so much so that simple tests and X-rays have a waiting list of weeks, if not months. The doctors advise patients to get it done outside. Several private pathological labs operate out of shanties, right outside the ‘world class’ hospitals like AIIMS.
There was a controversy recently over the medical insurance claims and the payment settlements. A huge racket goes on in the name of insurance. The hospitals charge exorbitantly and suggest unnecessary tests to the clients (patients) only because they had health cover or reimbursement facility.
The pharmaceutical sector is absolutely out of any regulation for pricing and supply. Spurious drugs are routinely sold in medical shops and harmful medicines are sold across counters without medical prescriptions. New seasonal diseases with funny sounding names crop up periodically. They bring huge profits to the pharmaceutical companies.
While the issue of healthcare and health insurance can decide the fate of elections in the US, in India, it is not even discussed in public forums. According to the World Health Organization, while the cost of reform of the healthcare in India may be high, the cost of non-reform is higher. According to its estimate, India’s GDP could be pulled back by five per cent by 2015 because of the death caused by all diseases.
Setting up of Primary Health Centres (PHCs) used to be a thrust area of the Ministry of Health. But a run through the latest annual report of the ministry shows no policy initiatives towards the common man. The highlights revolve around administrative decisions that benefit the employees in the government set up.
There are several NGOs working in the area of healthcare. They have from time to time tried to draw the attention of the governments and the policymakers to the malaise in the system. But to no avail. A few years ago, there was a serious campaign against the so-called vitamin tablets and syrups, which are routinely prescribed by doctors. Not only do these medicines not help, but their overuse affects vital functions in the system. The war against spurious drugs is as good as lost. There is a network, a lobby of medicine manufacturers, medical shops and doctors, presided over by ill-informed politicians. The common man is the permanent patient on a gurney.