An impoverished man carried his wife’s body for 12km after the hospital where she died allegedly failed to provide an ambulance to carry the body back to their village. Dana Majhi’s wife Amang, 42, died of tuberculosis in a district hospital in a remote town of Odisha. Majhi said his village was 60km away and he couldn’t afford to hire a vehicle to carry the corpse. Most of us remember this 2016 incident.
Here are 7 reasons why India’s global rank of 150th for healthcare is nothing but a shame
Dogs fed on a body kept in a mortuary. Rats gnawed at a newborn in a hospital. And, it goes on. In India, two children younger than five die every minute. There is one government doctor for every 10,189 people, one hospital bed for every 2,046 people, and one government-run hospital for every 90,343 people. These are figures from the 2019 National Health Profile. Certainly, things look bleaker at present with a pandemic raging on like never before with its second wave.
We have zeroed on six major reasons that cause India to fare so poorly, even worse than Bhutan or Nepal, in terms of healthcare facilities globally.
A huge percentage of total health expenditure occurs as people are forced to spend even as they are selling off their assets, and hence sinking deeper into poverty. This has been happening in our country for ages. A major reason for increased peasant indebtedness, which underlies the upsurge in peasant suicides and farmers’ agitation, is the sharp hike in healthcare costs for commoners. This has been going on due to the greater privatization of healthcare in the neo-liberal age.
The public health expenditure as a percentage of GDP in India is only over 1%, the lowest in the world. This figure is even less than that of India’s neighbors like Bhutan, Sri Lanka and Nepal. It is shocking that the percentage of public health expenditure in GDP has remained stuck around 1% for even more than a decade.
2. Zero or minuscule funding for public healthcare
Despite policy formulations in the past 20 years, public health expenditure is stagnating at 1 per cent of the GDP. The Centre and states are equally responsible for this stark failure to scale up the public health expenditure. This is also depicted in low allocations for health in state budgets.
The Indian government may have made some momentous announcements about the health sector. Ayushman Bharat is one such, which claims to cover about 50 crore Indians with secondary and tertiary healthcare to the underprivileged. But, according to a former Health Secretary with the Government of India, Prasada Rao, the establishment of a string of Wellness Centres under the scheme to provide primary healthcare services hasn’t acquired the same visibility.
3. Lack of accountability
Development economist Jean Drèze, who coauthored books with Amartya Sen on grave inequalities in Indian society and political economy, believes that the privileged mainly depend on private healthcare facilities. This class is unbothered about what happens at a public hospital as the consequences don’t impact them. Besides, a huge social distance separates the doctors who work in public hospitals and their patients. This is the case especially in Odisha, Chhattisgarh and Uttar Pradesh. Patients, who rely on public healthcare, are vastly removed from the spots of power, facilities, care and influence. Therefore, the state or the system easily gets away with an appalling lack of accountability.
4. Widespread corruption
Widespread corruption afflicts India’s healthcare system. According to David Berger, director of the British Medical Journal group and a practicing physician in Australia, “The country’s doctors and medical institutions live in an ‘unvirtuous circle’ of referral and kickback that poisons their integrity and destroys any chance of a trusting relationship with their patients. Given these practices, it is no surprise that investigations and procedures are abused as a means of milking patients.”
Corruption is the very antithesis of patient-centered care. Driven by greed, those in power divert crucial resources away from patients in need, which results in poor quality of care and worsening health outcomes.
5. Lack of education among population
Only one in five doctors in rural India are qualified to practice medicine, a World Health Organization report on India’s healthcare workforce found, highlighting the widespread problem of quackery. Still, a huge percentage of the population hails quacks as “gods”. Some 10 lakh quacks “practice” allopathic medicine in the country, according to the Indian Medical Association. The “spin doctors” or quacks charge very less compared to public health clinics and are easily available to a huge chunk of the rural population. It goes without saying that this aggravates the healthcare system’s misery.
6. Lack of sufficient doctors, staff
While India has a booming private medical sector, the public healthcare system operates at a dismal ratio of 0.08 doctors for 1000 people. The states with the highest shortfall of doctors – Uttar Pradesh, Chhattisgarh, Odisha, and Madhya Pradesh – house a huge share of India’s rural population of more than 0.8 billion. While Delhi has the highest number of doctors working in the public healthcare sector in India, Goa has the highest number of registered doctors, with a doctor to population ratio of almost 2: 1000.
As per the 2018 government data, 10 Indian states face a shortage of doctors at the PHC level. Bafflingly, in most Indian states, the government has sanctioned over the required number of doctors and in many states, the PHCs have more doctors than needed!
7. Healthcare doesn’t feature in political agenda
Healthcare is not something that our present or future leaders care about. Unlike developed countries like the US, where health policies hold the political stage, healthcare in India is not an electoral issue. According to the World Bank data, the Indian government spends about 4.7% of its GDP on public health, including private spending. It is high time elections are fought on issues like health and education reforms.
Any appreciable hike in the budget allocations for the health sector is very unlikely during an election year unless health and education feature prominently in the poll manifestos of top political parties. It takes political will and commitment to overcome resistance from powerful lobbies to carry out various reforms in the health sector.