India is a land of contrasts, and nowhere is this truer than in its state of healthcare. With vast variances in the access to and affordability of healthcare across different States, and vivid differences between private and public healthcare and rural and urban health systems, it is necessary to take a view that will not allow the averages to overwhelm the true picture.
India faces daunting healthcare challenges. Despite gradual progress in improving access to health systems, including a meticulously planned National Rural Health Mission (NRHM), the twin conundrums of access and affordability remain.
The bulk of the historically unreached populations are in rural areas and in remote locations, where the lack of access to healthcare is clearly demonstrated in poor human development indicators, which lag behind the State average.
Poor maternal mortality rates, higher infant mortality rate, poor morbidity and higher mortality rates, high rates of infectious diseases, with high expenditure on healthcare are the discernible factors in these areas, served only by the Primary Health Centres (PHC).
As the last mile in healthcare delivery, PHCs have seldom received the kind of attention or fund allocation due to them, even in States with better outcomes. It was to set right this historical wrong that the Union government launched, in 2005, the NRHM to expand access to primary healthcare among rural populations. Towards this goal it ploughed in the necessary funds and diverted a fair bit of the attention to rural healthcare, especially in 18 high focus districts.
A January 2014 paper, by Health Policy Project researchers, noted that in 2011 the NRHM accounted for 54 per cent of the central government's total health budget. From 2005 to 2011, the Centre released Rs. 52,832 crore for the NRHM, of which Rs. 38,420 crore was spent. Between 2011 and 2015, a total of over Rs. 55,000 crore have been used as the Centre's allocation for the project (as per the Health Ministry) and additionally, there has been the States' contribution.
But the key to achieving the desired health outcomes, the Health Policy Project paper says, is to ensure the funds are targeted, allocated, and used effectively by the different States.
Additionally, rational appointment of medical and nursing staff in the PHCs is vital. It is hoped that the Centre's Universal Health Care project, launched in 2010, will be able to serve the goal of providing easily accessible and affordable healthcare to all Indians irrespective of caste, location or income.
In rural U.P., negotiations for baksheesh range from casual demands for chaff-pani to dramatic threats of injuring the bleeding mother or the newborn. Sometimes, in the labour room, cash is flung back on the OT floor when found to be insufficient.
This is the second part of the series, Malady Nation, on India's multi-dimensional healthcare crisis. This part shines a light on gaps in the healthcare system across rural India.
