In India, the great divide between the rich and poor on the health front is ever widening. Going by the results of an international survey, India stands at 135 position among 176 countries, indicating that the gap between the health-rich and the health-poor, contributing to the deaths of thousands of children every day.

The report released by World Vision The Killer Gap: A Global Index of Health Inequality for Children, assessed 176 countries around the world according to the size of the gap between those who have access to good health and those who do not. The study used four indicators – life expectancy, out-of-pocket expenses for using health services, adolescent fertility rate and coverage of health services (health personnel for population).

According to the report, Indians are forced to spend 61.7 per cent of their savings to access health services; 86 out of every 1000 women in India give birth between the ages of 15 and 19; and for every 10,000 people there are less than seven doctors. More than 4700 children still die before the age of five every day. Comparatively, three of India’s neighbours: Sri Lanka, Nepal and Bangladesh have fared very well.

“It is a disturbing reality, but in India the gaps are much more than just economics… the gap in political will to prioritise the needs of the poor, the gap in budget allocation for children…” says Jayakumar Christian, CEO of World Vision India. The gap is ‘devastating’ because of what it leads to – the deaths of thousands of children every day, the report claimed.

“There have been a number of studies of late which showed the increase in out-of-pocket expenditure, even in States that generally have better health facilities and parameters,” says Rakhal Gaitonde, of Jan Swasthya Abhiyan, a people’s health movement.

“One of the major reasons for the increase in out-of-pocket expenditure is that utilisation of services in the private sector, especially for diagnostics and drugs. They have what is called catastrophic health expense – 40 per cent or more of the family budget is spent on health care expenses,” explains P.Balasubramanian of Rural Women’s Social Education Centre, Kancheepuram, who was involved in one of the studies on health expenditure. When people are poor, they also have a poor health-seeking behaviour, he adds.

“Over the past years we have made a lot of progress – the Food Security Bill and the move to revamp the ICDS system. But there is an urgency to do more and do everything,” Dr. Christian stresses.

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