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What ails India’s health sector?

Most discourse on the health sector in India ends with a lament about underfunding and not without reason. India is one of 15 countries in the world that has a public spending record of about 1% of its GDP on health. Such low spending cannot be expected to deliver much. After all, health is expensive. The more sophisticated the technology, the better the chances of survival but also the higher the cost. A PET (positron emission tomography) scan can help with accurate diagnoses and can improve chances of survival but also costs a hundred times more than the familiar X-ray machine. Many Indians can ill afford to bear the cost of drugs, doctors, technicians, or hospitals with beds and operating theatres, and look to the government for help. So discussions around increased public funding in a poor country like India are critical.

But then, money does not buy everything. What is equally important is attention to systems of governance based on trust and empathy. Systems that recognise that when people are sick, they are equally vulnerable, regardless of means, age, or gender. Such a system would foster patient-centered health delivery and a culture of values such as honesty, integrity, and the pursuit of knowledge. As a society, we do not seem to give these issues much importance. But then it hurts when one recalls and reads about the poor tribal Manjhi carrying the dead body of his wife Amang back home on his frail shoulders as he could not afford an ambulance. And again when in the Guntur Medical College ICU, a ten-day-old infant died of rat bites. What is disturbing is that such instances of indifference are rapidly becoming the norm. Such disregard for human life is a strong indictment on us as a people as much as it is on the government.

Clearly, what is needed is a deepening of dialogue and the creation of a discursive environment for policymaking in a conscious and deliberate manner. This implies a deepening of democracy, over and above the symbolic elections. Policies that impact the daily life of the people, such as health, need to be formulated based on the people’s participation. For this to occur, systems have to be built and organisational structures put in place. There is some evidence of such approaches having been adopted in the battle against HIV-AIDS and polio. These community-anchored and people-centered approaches helped design policies that created results faster. Fund utilisation was also more efficient and misuse more difficult. India needs to build on these experiences and construct a democratic architecture where common people and patients have a voice in formulating policy and actively help in its implementation. For ultimately, democracy is as much about parliaments as it is about hearing people’s voices and redressing their problems as a matter of routine—every day, not just once in five years.

Understanding what ails us provides us with the opportunity to go forward.

But then, adequate funding, value-based societal relations, and people-centered governance models can only be possible when there is clarity on the type of future we aspire to. Such clarity is sadly missing. For example, we have a vast private sector that caters to more than half of the people’s health needs but is largely unaccountable to either price or quality. On the other hand, we have a public sector that is overburdened, understaffed, and underfunded. There is no clarity on the implications of such a system to notions of equitable access, improved health or cost. Likewise, we have a situation where the upper tiers of tertiary care are built on the foundations of a rickety primary care system. Primary healthcare, if effectively delivered, can address 90% of people’s health needs. India’s primary healthcare system barely addresses 15%. So more than half of the meagre resources are being spent on tertiary care benefitting 2% of the sick, largely financed through third-party insurance in the private corporate hospitals. What is worrisome is that both the burgeoning private sector and health insurance markets are poorly regulated with little accountability to the patient. Such unplanned and haphazard growth in the sector resembles the US model where healthcare is similarly fragmented, costly, and inefficient. The question is whether India can afford a US model of healthcare and what its implications are for a country that has such a large reservoir of the sick and the poor.

Finally, there is a need for dialogue around what we mean by development. Is it about GDP? Is poverty to be measured only in terms of income thresholds or should it be viewed more multi-dimensionally? The latter view involves thinking of health in its broader sense and placing a charge on the state to provide clean air, water, and sanitation; environmental hygiene; nutrition; and basic healthcare for all its citizens without prejudice.

Policy choices are not made in a vacuum. They are the result of the lobbying power of interests and stakeholders. I believe that to act for the future, we need to understand the past and comprehend the present. In other words, we need to have a comprehensive understanding of our context—our strengths, our weaknesses, our beliefs, and our aspirations. Such holistic perspectives are necessary as all policies and actions flow as a continuum, which is why copy-cat solutions or imitating another country’s experiences most often fail and fall short. We need to understand what ails the health sector and what we need to do. For every problem has its solution embedded within it.

Understanding what ails us provides us with the opportunity to go forward.

Featured image credit: Thermometer, by stevepb. CC0 Public Domain via Pixabay.

Recent Comments

  1. Amol Ghodke

    Governments apathy and ignorance by the civil society is major issue. It is very saddening and outrageous to witness such events. Your blog is eye opener to everyone mam. Need more activism and leadership from person like you. Thank you

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