Looking ahead to 2015: Health Minister JP Nadda needs to go in for major overhaul
Not so long ago, the death of more than ten women because of alleged botched sterilization surgeries at a government hospital near Bilaspur in Chhattisgarh had hit the headlines. It had also brought to the fore stories of spurious drugs, unhygienic and sub-standard state of government hospitals, medical ethics and indifference to the poor. But above all it had once again exposed the sad and sorry state of public healthcare across the country.
Those who have traversed the villages and districts of India know of the stories of absentee doctors and lack of adequate infrastructure in government hospitals forcing the poor to shell out whatever they have to consult a private doctor or hospital or worse die because of no care. Sometimes they are also forced to go to quacks or practitioners with little medical knowledge or formal training. And in big cities, government-funded hospitals like AIIMS are overcrowded and struggling to meet the growing demand. Contrast this with the ‘five-star hospitals’ that have been mushrooming all over the country with state-of-the-art technology (though still limited to big cities), visited by those who can afford them, and one cannot help but wonder at the ‘two Indias’ that exist.
One cannot also help but wonder whether any country can become a world power if its children are malnourished and if its adults do not have access to basic health care. Thus, with a little over four years of the new government left to keep the promises that it had made to the people, Health Minister JP Nadda has to address the core issues that is confronting the country today - what is ailing the healthcare system in the country and what he can do to transform it.
As per statistics released by the Union Health Ministry last year, life expectancy in India has gone up by five years, from 62.3 years for males and 63.9 years for females in 2001-2005 to 67.3 years and 69.6 years respectively in 2011-2015. This apparently happened due to better immunisation and nutrition, coupled with prevention and treatment of infectious diseases. Some of the health indicators have also shown significant improvement across the country in the past 10 years. For example, infant mortality ratio has come down and diseases like smallpox have been eradicated and the WHO has declared India polio-free. But despite all of the above there is little to celebrate as far as India’s healthcare system is concerned.
According to Global Burden of Diseases, Injuries, and Risk Factors Study, among its peers and neighbours, India’s performance is one of the worst when it comes to the health of its citizens. Whether it is under-five mortality (7% of children reportedly die before their fifth birthday in India) or mortality among men and women between 15 and 49 years, on most counts, India’s rank was way below that of China, Brazil and Sri Lanka.
Add to that the fact that cardiovascular disease has become a major cause of mortality in the country with more than a million deaths a year attributed to smoking, nearly 65 million Indians said to be suffering from diabetes, ailments like malaria and tuberculosis still unchecked and illnesses such as diarrhoea killing more than a million children every year.
In a UNICEF review of child rights data from eight countries in South Asia, published last year, India had fared worse than all its neighbours except Pakistan and Afghanistan on social and health indicators. It had also topped the list of countries where people defecate in the open. This exposes them to various water-borne and soil infections. Further, a report by the World Economic Forum and Harvard School of Public Health says that India stands to lose $4.58 trillion to cardiovascular disease, cancer, diabetes, chronic respiratory disease and mental disorders between 2012 and 2030.
And as for the government, it spends only about a little over one percent of gross domestic product on healthcare (1.2%), compared to 1.5% in Sri Lanka, 2.7% in China, 3% in Thailand, 3% in China and about 8.3 percent in the US, according to a World Bank database.
There is more. As per the World Bank and National Commission’s report on macroeconomics, only 5% of Indians are covered by health insurance policies, which is appalling, given the fact that as per a Health Ministry draft around 6.9% of the household monthly per capita expenditure in rural areas and 5.5% in urban areas is spent on healthcare.
Reports have said that out of pocket personal expenditure on health care in India is over 75 percent of the total expenses. In contrast in developed countries like the US and UK it is less than 15 percent. (What is ironical is the fact that the wealth created by India’s expanding economy has doubled twice in the last two decades.)
In this context Prime Minister Narendra Modi’s government’s plan to provide all citizens with free drugs and diagnostic treatment, as well as insurance cover to treat serious ailments under the National Health Assurance Mission (NAHM), which should roll out in phases from April 2015, is a welcome step. (The aim is to cover the entire population by March 2019 and is estimated to cost $11.4 billion annually. The poor will get free treatment while rest will have to pay a minimum premium, depending on age and income categories).
Needless to say that if the plan is approved the government will need to raise its healthcare spending in a major way. As per a FICCI study, universal health cover can be achieved in a decade or so and would require the government to increase the spending on health to about 3.7-4.5 percent of the GDP.
This is where the challenge for Nadda begins. His government needs to speed up NAHM and show political will in getting it implemented. Also, his ministry has to put in place ways to tackle corruption in the healthcare sector, with issues like doctors receiving additional payments for referring patients to a particular clinic or getting gifts from companies for prescribing their drugs being common knowledge.
Matters like better infrastructure in government hospitals, more hospitals and clinics in rural areas, better monitoring at district and village levels and maybe giving incentives to doctors for serving in rural areas must be addressed immediately. Stories of doctors not wanting to serve in villages, wanting to remain in big towns or going abroad for greener pastures is also common knowledge. Public-private initiatives too need to be worked out; research facilities need to be pushed and training of support staff like nursing has to be of better standard.
Moreover, prevention of non-communicable diseases through early screening and controlling the spread of infections, better maternity care with focus on nutrition, tackling the malaise of malnourished children and vaccination to all including those who belong to the lower strata, among other things, need to be addressed. If India wants to reap the advantages of its ‘demography’, then it has to give its citizens accessible and affordable healthcare and improve its health indicators. Only then it can be compete at the world level and be the world power that it hopes to be.
(This article is fifth and last in the 'Looking ahead to 2015' series.)