The change in India's productive population

Health in our hands

India would have seen a medical boom only if the government can reach out to every single citizen of this country with quality healthcare

Reports of baby deaths in West Bengal hospitals, almost on a daily basis, were making headlines last month.  Most of us have probably moved on after pondering at the state of dismal public health for a few moments. But the time to pause — and think — is now. While West Bengal is a case in point, let us also not ignore several encephalitis deaths in Uttar Pradesh.  Encephalitis is something the Uttar Pradesh government has not been able to tackle since 1978. Its a crying shame that the mosquito-borne disease has claimed 8000 lives till now in that state.

Some diseases that should have been eradicated long ago are still prevalent in India. India was one the last few countries to be declared polio-free only recently. Why is it that despite so many health initiatives taken up by respective and successive governments, people have not been able to benefit from them?

The public health investment in the country over the years has been comparatively low, and as a percentage of GDP had declined from 1.3 percent in 1990 to 0.9 percent in 1999. The aggregate expenditure in the health sector is 5.2 percent of the GDP. The central budgetary allocation for health over this period, as a percentage of the total Central Budget, has been stagnant at 1.3 percent, while that in the states has declined from 7 percent to 5.5 percent. The current annual per capita public health expenditure in the country is less than Rs 200. It is no surprise that the reach and quality of public health services has been way below the desired standard.

Now contrast this state of dismal affairs in public health in the country with the booming private health sector in India,driven largely the private players who are promoting India as a medical tourism destination.

The country today is the leading destination for global medical tourists. In 2004, India received 150,000 medical tourists and this number had grown by a whopping 33 percent by 2008 to 200,000 inbound medical tourists. It is estimated that by the year 2015, India will receive over half a million annual medical tourists annually. India’s private medical sector offers the most advanced medical treatments and technology available in the world today.

Health sector may be booming in India but it isn’t all encompassing.  On the one hand, we have the booming medical tourism in urban pockets and on the other are tragic reports of our failing public health sector. While the cities struggle with lifestyle diseases, our rural areas still face hurdles in getting proper healthcare for their basic well-being. The world class facilities reach out only to the urban population of this country where one-third of India resides. The rest of our people reside in Tier-2 and Tier-3 towns, and in rural India. Even in the urban areas, there is a sizable percentage which is living on the fringes and can’t afford the high medical costs. The rural areas are much worse off.

Despite the large sums of money being provided to states for rural healthcare, most primary health centres remain sadly short of staff and medicine. Lack of proper implementation of government schemes, combined with people’s lack of awareness of their rights, has led to failures of such schemes at various levels. Is our country really equipped to handle an emergency outbreak, if god forbid there was one such as the bird flu? Even if India had a policy to handle epidemics, there would still be implementation hurdles.

The health of the country’s economy is also heavily dependent on the health of its people. The economy bears the brunt of such policy failures. If the country cannot provide its citizens’ the basics, we will continue to languish among the list of underdeveloped countries.

There is a need to focus on some factors that could lead to a vigorous change in the public health sector.  A start must be made by giving more importance to sanitation and hygiene standards in the country. It is an area which has for long been ignored or rather the country has been found lacking in. The encephalitis deaths in Uttar Pradesh are a direct outcome of the neglect of this core issue.

In West Bengal, the baby deaths were caused due to critical gaps in healthcare infrastructure, especially in terms of health centres and trained staff. The other critical aspect that could be looked into is providing the country with good doctors and ancillary staff by making medical education more quality-driven rather than money-driven. We have seen a mushrooming of private medical colleges but the quality of doctors being produced remains questionable.

In rural areas we need monitoring systems that can act as a deterrent to corruption. The states should reform the administrative divisions found ill-prepared to handle critical situations. Government must encourage the private sector to invest a share of its health funds in medical research. Medical research is one sector which needs to be incentivised because it can lead to finding solutions for India-specific health issues.

The focus on health changes in every state in India because health is a state subject. Depending on their area of focus, the state governments allocate budget for health. Unfortunately, so far none of the states have taken decisive actions to make basic health for all its citizens a priority. This problem can be partially overcome if health is treated as a concurrent subject rather than a state subject.

We are headed in the right direction when we promote medical tourism in the country but it is also very important to try and maintain the same standards in the public health sector. The country would have truly seen a medical boom only if the government can reach out to every single citizen of this country with quality healthcare. This would be good news not just for the people of this country but also for the economy. India will only gain if it decides to make itself the healthcare destination of the world. Our time is now; let’s not squander it.