New Delhi: Observing that health sector in the country has "collapsed", Union Minister Jairam Ramesh on Friday batted for increased participation of states to improve the scenario as he noted that even poorer countries like Bangladesh have superior health indicators.
When countries all over are debating on the issue of increasing public spending on health, Ramesh felt India is a "unique" country where 70 per cent of the health expenditure is private expenditure.
"Today the single most important reason for rural area indebtedness is expenditure on health. We all know that the health system in India has collapsed. India is unique country in the world where 70 per cent of the health expenditure is private expenditure," he said at the Hindustan Times leadership summit here.
In many part of India, he added, public health system simply does not exist.
To improve the social indices, the Rural Development Minister asserted on a fundamental commitment from states for creating elected institutions and institutions of participation, noting that such measures has helped states which have abided by this commitment.
In this regard, he noted that in large part of India where elected representatives are strong or participating institutions are strong, they have better social outputs.
He said the secret of success of Bangladesh and Kenya who have superior infant infant mortality rate and sanitation facilities are due to empowerment of women. "They have been able to deliver than richer country like India".
The time has come, Ramesh said, when the country has to recognise the fact that capability building for poor is a very foundational element of giving them the power to deal with poverty which has a direct bearing on health issues.
In this context, he favoured a fundamental change in the delivery system, noting that investment must be public for universal access, but delivery could be in a non-public domain.
"Public investment does not necessarily mean government delivery. Investment must be public because it can ensure mass access, but delivery could be in a non-public domain. Public delivery of services is highly inefficient and calls for major reform," he said.
Noting that health would remain his top priority, Ramesh said improvement in hygiene and sanitation has led to drop in infant mortality rate.
He emphasised that state cannot abdicate its role in poverty alleviation.
He said state also has a fundamental role in building capability, particularly in area of health, nutrition, water supply and has a fundamental responsibility in providing connectivity in providing roads, communication etc.
He also noted that during the last 25-30 years, with accelerated economic growth and the pressure that economic growth has brought to bear on natural resources, it has created this "new animal of ecological poverty that we have to now address".