India’s health care delivery mechanism is defined by shortcomings; the doctor-patient ratio is skewed, over 75 per cent of India’s population has no health insurance, there is a shortage of two million hospital beds compared with the global requirement of 2.5 beds per 1000 people and the spending on health is abysmally low at a little over one per cent of the GDP.
These statistics however, are not the only illustration of the gaps that exist in the system; the inability to utilise the available infrastructure worsens the problem. This was endorsed by the Union Health and Family Welfare Minister J.P. Nadda’s recent admission that “there are health centres where there is an X-ray machine, but nobody who knows how to operate it.”
Extremely high out-of-the-pocket expenses on diagnostics and medicines, poor quality of services in government-run hospitals and lack of human resource to deliver the services have been identified as the major lacunae that the government needs to address with alacrity.
Also counted as failures of the system are insufficient attention to research (including developing newer medicines and vaccines) and preventable nutritional disorders, maternal and child mortality and reduction in the burden of non communicable diseases.
A white paper ‘Aarogya Bharat 2015’, released by NATHEALTH, Healthcare Federation of India this past week shows India requires $3 trillion in cumulative funding and has the potential to generate 15 to 20 million jobs by 2025.
Yet, less than one per cent of delivery providers are accredited and although rural India accounts for about 70 per cent of the population, it has less than one-third of the nation’s hospitals, doctors and beds resulting in huge disparities in the health outcomes.
Under spending on health care and pharma sectors has been flagged thus in the report; compared to the U.S. (8,895 $) and China (322 $), India (58 $) had the lowest per capita health care expenditure in 2012; the per capita spending on pharma products and medical devices in 2013 stood at $15 as against $ 1440 in the U.S. and $90 in China. The doctor-patient ratio too is among the lowest with a mere 0.5 doctors for every 1000 patients in large parts of the country.
India’s GDP spending on health brackets it with lower income countries, the Sub Saharan Africa, Afghanistan, Haiti, Azerbaijan and Georgia says a World Bank report of 2012. A consequence of out patient treatments and direct payments is individuals being pushed below the poverty line.
Poor availability of generic and quality drugs in the Indian markets has been flagged as another area of concern. India that exports drugs to 210 countries, and has a drug market of Rs. 82,000 crore is yet to streamline the rational use of drugs and improve the quality of generics that are manufactured for local consumption.
Despite 98 per cent of drugs needed for treatment of various disorders manufactured in India, 65 per cent of the population does not have access to essential and life-saving drugs says the WHO 2012 World Medicine Situation Report.
Every State procures medicines for free distribution to patients, but the free medicine model has been slow to pick pace; with Rajasthan, Kerala and Tamil Nadu being the only States that have a better record to show.
As the Centre gets ready to roll out its ambitious Universal Health Assurance Mission (UHAM), there are doubts about how it will ensure quality health care for Indians.
Recently, there was a downsizing of the health budget after the revised estimates for the last quarter showed that States have failed to utilise what was earmarked for spending on healthcare. While the Ministry was quick to defend that none of its flagship programmes would be affected by the cuts, it raised questions on why States have been dragging their feet on executing the spending.
All eyes now rest on the Health Minister’s commitment that the UHAM will not merely be limited to pumping more money into the system, but removing the bottlenecks that choke the health care system.
“There is no dearth of funds, the issue is optimum utilisation of resources and assurance of services,” he said promising to fill the gaps in the health delivery system.
