Rural India’s poor healthcare is a reflection of our economy Aug 17, 2015

Rural India’s poor healthcare is a reflection of our economy

It has rightly been said that India resides in its villages. Rural India is the mirror of our economy. Healthcare is an imperative prerequisite for human development and is an inseparable component for the overall well-being of mankind.

India bears the load of roughly 17.5 % of the global population, one-fifth of the world’s share of all diseases, one-fourth of maternal conditions, and one-fifth of nutritional disorders.  Apart from this, one cannot deny the fact that India has achieved truckloads in advancing healthcare and overall health standards over the past six decades.

Public financing of healthcare sector and budgeting schemes for a healthy rural India is important, but seldom written about or taken seriously by our worthy policymakers. After all, access to healthcare is essentially dependent on how healthcare has been financed.

There are some countries that have universal or near about universal access to healthcare. In such nations, the health financing systems are single-paper systems, in which a single, fairly autonomous public agency is responsible for financing the health sector.

Alternatively, in some cases, few centrally coordinated agencies under the overall supervision of an apex body that pools manpower and financial resources to finance healthcare. There are many developing and under-developed countries such as Cuba, Brazil, Ghana, Lesotho, Thailand, Sri Lanka, etc. that follow this format of financing healthcare services.

A large part of the financing comes from public funds like taxes or national insurance. Strangely, it is only in countries like India and a few other third world nations which are still stuck to out-of-pocket payments to access fundamental health services and regrettably, a universal access to healthcare is a mysterious dream.

The much-hyped Union Budget for the period 2015-16 allocates no more than Rs33,152 crores to finance the health sector. It is a crying shame that this government decided to spend only about a per cent of its Gross Domestic Product (GDP) whereas in 2013-14 it was 1.3 %, four per cent of its entire expenditure against 4.3 %  in 2013-14 and 17.8 % of the total social sector expenditure when compared to 18 % in 2013-14, for a crucial sector like healthcare.

Our policymakers ought to realise that the greater the proportion of public investments, the greater the access provided to crucial healthcare services. It comes off as no surprise that a nation that spends only a meagre share of its total social sector expenditure on healthcare has a shamefully poor equity in access to very basic healthcare services vis-à-vis developing nations like Thailand, Nepal, and Sri Lanka.

Even in a poor state like Bangladesh, public finance accounts for roughly between 30 and 60 per cent of total health expenditure. Economics is all about trade-offs, which apparently our policymakers are oblivious of. They set aside Rs2,46,727 crores for defence, which is exclusive of another Rs62,852.6 crores provided to the Ministry of Defence (MoD).

The menu of choice between guns and medicines is way off-centre – so much for protecting our borders.

The recent initiatives for developing our healthcare have been satisfactory. The ‘Swachh Bharat Abhiyan’ launched with much fanfare on October 2, 2014 which aims at attaining an open-defecation-free India by October 2, 2019 is a promising idea. It aims at providing hassle free access to toilet facilities to all households in villages as also initiating solid waste management activities in Gram Panchayats to augment hygiene.

Introducing new schemes with ambitious targets is like indulging in fancy hyperbole because where will the money for achieving these targets come from?

It’s clearly not business as usual for our health sector. There needs to be a calibrated focus to address disparities in budgetary allocations, disparities within and among states and regions, there is an inevitable need to bring health services under the umbrella of universal health coverage.

Our policymakers cannot seek refuge under the veil of statistics and figures. They ought to focus on devising schemes that focus on special requirements of susceptible, hardest-to-reach populations and the marginalised sections of society. Health workers and medical professionals in rural areas ought to be adequately remunerated, lest they indulge in malpractices.

They need to wake up to the reality that affordable lifesaving medicines and procedures continue to remain inaccessible to a vast majority of our population. All these challenges can only be confronted when the policymakers accept the fact that healthcare infrastructure is as essential, if not more, as physical infrastructure for the development of our economy. Hence, it is important to substantially boost the public expenditure on the health sector as in developed countries of the world.

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