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Updated: November 30, 2012 10:01 IST

‘Government must increase health expenditure’

Tanu Kulkarni
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Rudiger Krech, Director, Department of Ethics and Social Determinants of Health, at the World Health Organisation
Rudiger Krech, Director, Department of Ethics and Social Determinants of Health, at the World Health Organisation

Reducing out-of-pocket health expenditure and improving access to health care will go a long way in solving the problem of poverty, believes Rudiger Krech, Director, Department of Ethics and Social Determinants of Health, at the World Health Organisation (WHO).

In an interview with The Hindu, he spoke on the need to work towards universal health coverage (UHC) and step up public spending on the healthcare sector.


Why is there a need for countries to move towards UHC?

Globally, as many as 100 million people fall into poverty every year because of healthcare expenditure. Most of them pay over 75 per cent of their income on medical expenses. This is why, in the coming years, the WHO will emphasise on the need for countries to adopt UHC.

The Indian government allocates less than two per cent [of its GDP] for healthcare. Is this enough?

This allocation is very little. The proposed six percent by the High Level Expert Group on UHC is a good margin. Health is a key driver for development and it is also an outcome variable, therefore there is a need to increase government expenditure on health.

Is increasing expenditure alone adequate?

There is a need to see that the individual states build their absorptive capacity. This can be done by ensuring there is trained manpower in this sector. India can learn from countries that have improved their health indicators; but given the diversity, there is a need to look at your own experiences too.

Do private healthcare providers have a role to play in UHC?

There is a need to understand that a majority of the population depends on private healthcare, not out of choice but out of compulsion. But we need to understand that there are different players in the health sector. There is also a need to establish mechanisms to monitor private healthcare.

Apart from maternal and infant mortality, another challenge that India is facing is that a large section of its children are malnourished …

It is important to note that while on the one hand malnutrition is a problem, on the other, the levels of obesity in the country are also increasing. India’s economy is rapidly develo ping. This trend reflects the rising inequity in the society. No miracles can solve this. There is a need to adopt technical instruments to solve the problem. It needs political priority and commitment. Addressing the issue of malnourishment is complex but it can be done by addressing the inequity in society.

Most of the focus in India is on treating a medical ailment rather than prevention. How important is it to focus on prevention?

Several countries give importance to treating disease and there is a need to shift the priority to prevention. In the next 30 years, cardiovascular disease, cancer and diabetes will crack all the developing economies of the world if enough [attention] is not given on prevention. The cost of treatment of non-communicable diseases is lifelong and more such patients will have to be treatment if the social determinants of health are not looked into.

As a developing country, India has to invest in several sectors: it is a matter of priority setting. There is nothing without good health. At the same time, you need to realise that other sectors will also contribute to health and there is a need to look at the health potential within the sectors. But that would call for a new form of governance.

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