Facts:
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Physical infrastructure:
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India has 1.3 beds per 1,000 people;
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0.5 pharmacists per 1,000 people &
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0.8 physicians per 1,000 people
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This is less than half of the world average.
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Funding: Economic Survey 2020-21 observed that India ranks 179th among 189 countries in prioritizing health care in the government budget. The public expenditure on health at 1.4% of the gross domestic product (GDP) is low. E.g. it is 3.5% in Ghana.
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Disease burden: India has 17% of the world’s population but a disproportionately high share of the global disease burden at 20%.
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Quality of healthcare: Economic Survey pointed out that India ranked 145th out of 180 countries (Global Burden of Disease Study 2016) on the quality and access to healthcare.
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Doctors: India will require 2 million more doctors by 2030 to achieve a desirable doctor-to-population ratio of 1:1000.
What is the status of primary healthcare in India?
At present only 12% of primary health centres (PHCs) and 13% of community health centres are functioning. The major factor behind this is the lack of finances.
Even schemes like Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) do not cover primary healthcare services.
Why budgetary allocation for health is poor?
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With lower growth rates, and focus on spending on social indicators, health is ignored.
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Under the national health authority, as a percentage of gross health expenditure, centres share is 31% and states share 69%.
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But States have little tax collection after the GST regime.
What are the government initiatives to improve healthcare?
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ABHIM – Ayushman Bharat Health Infrastructure Mission: It will work with the National Health Mission in building public health facilities, critical care infrastructure and PHCs.
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Drug prices: 70% off out of pocket expenditure goes towards medicine. So government introduced tight control over the crisis and cut retail prices in 2018.
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Ayushman Bharat–National Health Protection Mission (AB–NHPM), 2018: It provides health coverage of ₹5 lakh per family per annum for secondary and tertiary care hospitalization to nearly 110 million poor and vulnerable families.
What is the way forward?
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Building public infrastructure. For this India needs to increase budgetary support to healthcare to around 2.5% of GDP.
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Incentivize state expenditure on healthcare: Finance commission parameters for Definition can include healthcare. Better performing states should be incentivized example Aarogyashree scheme of Telangana state.
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Learn from international best practices for example Thailand and Cuba model. Thailand passed the affordable care act and brought health insurance premiums down. Cuba focused on the best quality primary healthcare system.
What we can learn from these is the community participation in healthcare by focusing on awareness, sanitation and involving civil society. This can eventually pave the way for universal healthcare.