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Poor healthcare will paralyse GDP targets

Gursharan Dhanjal, Editor, INCLUSION

India faces perhaps the world's biggest healthcare challenge due to demographic burden, poverty and poor infrastructure.

India wants to take lead in BRICS, become the favoured destination for FDI, aims to reduce poverty below 20 per cent, skill develop its demographic dividend, financially and digitally include all households and targets to become a higher middle-income country by 2025. But when it comes to healthcare, the situation is not as promising. For all this to be achieved in a mission mode and also deliver, the nation has to maintain good medical health. The gaps are alarming: we have less than 0.7 beds per thousand people compared to Brazil (2.3), Sri Lanka (3.6) and China (3.8). The global average of physicians is 1.3 compared to only 0.7 in India. We are short of 400,000 doctors, 700,000 beds and about 4 million nurses.

The Primary Health Centres (PHCs, supposed to cover a population of 30,000) and Sub-Centers (for 5,000 population) either don’t exist or, if at all they do, they are understaffed. Only 38 per cent of PHCs have the necessary manpower and only 31 per cent have critical supplies. This overcrowding leads to compromises in quality care. There is huge inequality in healthcare distribution: although 73 per cent of Indians lives in rural areas, more than 75 per cent of Indian doctors are based in cities!!! What’s worse, more than 90 per cent of rural population has to travel minimum 8 kilometers to access basic medical treatment.

Demographic burden, poverty and poor infrastructure means that we face perhaps the world's heaviest disease burden. India’s challenge is rising number of deaths because of the increase in infectious and non-communicable diseases, cancer, diabetes and tuberculosis. For example, the number of diabetes cases in India, earlier projected at 36 million by 2020, has already surpassed 75 million. Soon, one out of every 5 diabetic patient in the world will be an Indian. Another challenge is Tuberculosis (TB). India is also the highest TB burden country in the world, accounting for nearly one-fourth of the global incidence and in 2012, out of the estimated global annual incidence of 8.7 million TB cases; 2-2.4 million were estimated to have occurred in India. India has 26 per cent of the total TB patients.

India has as high as 70 per cent of the healthcare expenditure coming from the private sector as compared to the global average of 38 percent and is higher when compared even with the developed countries. Also, out of the private expenditure, as high as 86 per cent is out of pocket, showing low penetration of insurance in the country. The country still lags behind many developed and developing nations in terms of both overall healthcare expenditure and supply of infrastructure.

While the government is focused on reforms relating to Goods and Services Tax (GST), privatisation, subsidies, labour, defense, insurance, banking, coal, power and gas pricing, little attention is being paid to much awaited and more than urgent health reforms to secure a healthy nation. Moreover, in next few years, due to increase in life expectancy, a large number of Indians will cross 65 years of age. A very little attention is being given to facilities for aging population and its emerging social security requirements including healthcare.

As per the Planning Commission, an incremental supply of 44,000 doctors will be able to meet only 78 per cent of the 2020 demand, leaving a gap of 0.3 doctors per thousand people. Consider this against a booming demand for medical tourism in India. The Indian medical tourism industry, growing at 20 per cent CAGR, is expected to reach $6 billion by 2018, boosting medical tourist arrival to 400,000 up from 230,000 currently. This market is lucrative for business, but at what and whose’ cost? And growing at the current rate, the healthcare industry will not only serve the poor of India less but even lesser medical tourists that has the potential to bring in foreign capital. 

There has so far been too much focus on financing for clinical and facility-based healthcare, in the process; the prevention and public health functions have been given a go by. Equally important is education on hygiene and sanitation. Both for infectious and chronic disease, prevention through government action is critical. This serves the community better compared to creating expensive large-scale facilities.

Investments need to be accompanied by systemic reforms that will overhaul the present system of service delivery, including issues of control and oversight. May be the time has come that the country needs a National Health Regulator under the aegis of Ministry of Health to monitor and speed up universal health coverage.

(Gursharan Dhanjal can be reached at gsd@skoch.in)

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