The recent outbreak of Acute Encephalitis Syndrome (AES) in Bihar leading to a rising death toll of children points to the dilapidated public healthcare system in the country. According to the latest data available with the Ministry of Health and Family Welfare, about 79.5% of the 1,719 villages of the Muzaffarpur district in Bihar do not have access to healthcare facilities. Moreover, Bihar health officials reportedly said that Encephalitis cases have been witnessed in poorly developed areas with rudimentary health infrastructure. The dismal state of affairs is not limited to Bihar. Deaths of new born babies and children in the Gorakhpur district of Uttar Pradesh are equally worrying.
The healthcare system is one of the most important pillars in the developmental journey of any country. The fire part of healthcare is treatment part. The second part is associated with the overall physical and health position of the citizens of a country, including their overall environment and nutrition level. The latter is quite important as it is directly associated with the overall health condition of the county’s population.
Importance of healthcare in an economy
Professor Amartya Sen and many other social scientists have been categorically emphasising on the importance of healthcare and education in an economy. Prof. Sen delivered a lecture at the launch of the International Centre for Human Development on January 4, 2012, at New Delhi. He said, “Education, healthcare and expanding productivity of human beings not only help human life, which is the primary impact, but, it also makes economic growth possible and easier. China went in that direction and went for universal education straightaway even before its economic reforms. China has continued to grow faster than India.”
A recent report shows that India accounts for 25.5 million children who are wasted, followed by Nigeria (3.4 million) and Indonesia (3.3 million). Wasting, or low weight for height, is a strong predictor of mortality among children under five.
It is usually the result of an acute and significant food shortage and/or disease.
Again, under-five mortality is 63% (the rate is the probability expressed per 1000 life birth) in India. In China, it is 18%. According to Prof. Sen, the difference is partly due to the nature of economic policy making. India spends 1.2% of its GDP on public healthcare. China spends around 2.7%.
Private healthcare ahead of public healthcare
In India, about 75% of healthcare services are provided by the private sector. Studies show that the unavailability of proper infrastructure is the main reason of common apathy towards the public healthcare sector. But, at the same time, there are quite a large number of government health centres, which are preferred by the people.
Experts say that for every 10,189 people there is one doctor and for one bed there are 2,046 people in India. Another report states that the physician ratio in India stands at 0.7 per 1000 population while this ratio for China is 1.9 and for the members of the Organisation for Economic Co-operation and Development (OECD) it is 3.2. Additionally, majority of healthcare professionals are concentrated in urban areas in India and rural areas remain largely under served.
About 24% of the population has some kind of medical insurance in India. The government’s contribution to the insurance stands at around 32% while in the UK it is around 83.5%. India primarily relies on commercial health insurance which has serious deficiencies. This type of insurance is highly restricted to hospital treatments. Outpatient treatment and prescription medicines are not covered.
Some of the specific goals and objectives of the Health Policy 2017 of the Indian government are as follows:
l Increase life expectancy at birth from 67.5 to 70 by 2025.
l Reduce infant mortality rate to 28 by 2019.
l Increase utilisation of public health facilities by 50% from current levels by 2025.
l Meet the need of family planning above 90% at national and sub national level by 2025.
l Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
l Increase health expenditure by the government as a per-centage of GDP from the existing 1.15% to 2.5% by 2025.
l Increase state sector health spending more than 8% of their budget by 2020.
l Establish primary and secondary care facility as per norms in high priority districts (population as well as time to reach norms) by 2025.
l Ensure district-level electronic database of information on health system components by 2020.
l Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.
l Establish federated integrated health information archi-tecture, Health Information Exchanges and National Health Information Network by 2025.
Vikash Bajpai, in an article published in the Economic and Political Weekly, on July 24, 2018, analysed the Indian health policy. He stated that the National Health Policy, 2017 reflects the perfunctory attitude towards public health that is entrenched among the mandarins of the health department. The policy paves the way for the contraction of public healthcare systems, thereby reducing the government’s involvement in the deliveryof health services and facilitates. However, in the absence of a robust public healthcare system, the goal of achieving “healthcare for all” becomes even more onerous.
Medical equipment and its importance
Medical technology plays a very important role in fostering the change of healthcare delivery. It increases the scope of better health outcomes. According to the European Confederation of Medical Devices Associations (EUCOMED), “Medical technology extends and improves life. It alleviates pain, injury and handicap. Its role in healthcare is essential. Incessant medical technology innovation enhances the quality and effectiveness of care. Billions of patients worldwide depend on medical technology. Wheelchairs, pacemakers, orthopaedic shoes, spectacles and contact lenses, insulin pens, hip prosthe-ses, condoms, oxygen masks, dental floss, MRI scanners, pregnancy tests, surgical instruments, bandages, syringes, life-support machines all fall under this category.” But in India, the average use of medical equipment (in dollar terms) is quite low. The world average is $43 and it is only $3 in case of India.
Financing medical expenditure
The ever increasing medical expenses are a major problem in India as there is a significant portion of Out of Policy (OOP) expenditure. It is suggested that one solution can be Medical Savings Accounts (MSAs). These are like regular savings accounts. The savings here are exempted from taxes as long as they are used for healthcare expenditures. But the success of this account in the healthcare system has been mixed and it cannot be used to serve the medical requirements of the economically marginalised.
How to deal with manpower shortage
In India, there is a huge shortage of trained medical manpower and doctors. This is more intensive in rural areas. Rural areas are not financially lucrative for doctors. Additionally, the infrastructure of healthcare system is also weak in rural areas. The government should take care of enhancing the supply of doctors and medical staff - especially in rural areas.
The government needs to increase manpower through the expansion of training of physicians and health workers under the current system. Secondly, the government needs to expand the system to provide certification and training to new categories of paramedical staff focused on public health, primary and preventive care. This can be done by providing specific trainings to undergraduates.
India has a long history of a weak health sector. The present central government has been planning for universal health coverage by providing health insurance to the poor. But the need for an effective healthcare system in the country is the need of the hour. India cannot be an economically vibrant country without having a healthy population.