Fund Crunch In India's Public Health System

Although the Indian public health has shown significant improvement in decreasing the maternal and infant mortality rate, many health-related issues have been pushed to the backburner. India is far from meeting international health standards.

Hyderabad: The novel Coronavirus is sending shock waves across the world. The smallest of infective agents are questioning the existence of human beings. The virus is posing a severe challenge to powerful nations like China. It is disturbing the world economy. In the current scenario where superpowers like the US and European Union are unable to contain the virus outbreak, the condition of developing nations like India is questionable. In the wake of this situation, we need to revisit the public health scenario of India which has a population of 130 crores.

Although the Indian public health has shown significant improvement in decreasing the maternal and infant mortality rate, many health-related issues have been pushed to the backburner. India is far from meeting international health standards. There are serious differences in the availability of medical systems and services in different states. A healthy population is an integral part of the nation’s economic development.

That is why many countries worldwide are investing a large percentage of their GDP to build public health systems. India ranked 141 among the 190 surveyed countries in the World Health Index survey. In the wake of COVID-19 tremors, there is a need to discuss loopholes in the existing systems and reevaluate the precautionary measures.

The recent Union Budget allocated INR 69,000 crores, which is 1 per cent of the total GDP to the health sector. These funds are grossly insufficient to tackle any of the present healthcare challenges. We are still far from allocating 2.5 per cent of GDP to health as suggested by the Planning Commission in 2011. In September 2018, Prime Minister Modi launched the Ayushman India program to safeguard the nation’s health. The government described it as the largest healthcare scheme in the world. It provides an insurance cover of INR 5 lakhs to eligible poor families. According to the socio-economic survey, about 10 crore poor families who constitute 40 per cent of the nation’s population are eligible for this scheme. To date, 72 lakh people have benefited from this scheme. But the scheme covers only a select few ailments.

The government has aimed to establish 1.5 lakh health centres by 2022. So far, even a quarter of this target was not reached. A report released by the National Health Mission, the highest body responsible for the implementation of Ayushman India, highlighted the gaps between various regarding insurance payments. High poverty states like Bihar, Madhya Pradesh and Uttar Pradesh are utilizing lesser funds.

Kerala is the largest insurance provider in the country. The amount of allocation is less in areas with high necessity, which shows the scheme’s failure! None of the 115 districts in the country selected for smart cities mission has opted for Ayushman Bharat scheme. Private hospitals are not keen on enrolling in this scheme. Except for Maharashtra and Uttarakhand, only developed districts of the states have private healthcare providers enrolled in the scheme. According to the official census, there is only 1 doctor for every 1,456 persons. The WHO recommends 1 doctor per 1,000 people. In order to improve this ratio and increase the number of doctors, the government announced setting up medical colleges adjoining the district hospitals. Currently, there are 526 government medical colleges nationwide. Over the past 2 years, the seats in these colleges have increased to 1,00,000.

The gap between government and private hospitals is ever-increasing. About 58 per cent of the hospitals are private. 81 per cent of doctors work in private hospitals. The government wants to provide postgraduate courses under the National Board of Examination. Attempts are being made to eliminate medical education from government control. There is a shortage of facilities in government-run hospitals to provide training beyond MBBS. There is a clear shortage of trained doctors. Based on the government’s tax exemptions to the corporate hospitals, they will procure excellent medical equipment. Some of the doctors in the private sector are able to get specialized training abroad. Through the National Board of Examinations, the colleges can admit students into postgraduate medical courses. It is a harsh fact that most of these students are working as duty doctors and are being given nominal certifications.

The NITI Aayog proposed linking the district level hospitals with private medical colleges in a public-private partnership. Many private medical colleges do not have enough affiliated hospitals. The NITI Aayog also advised the state governments to allocate lands at cheaper rates for setting up of private medical colleges and hospitals. Some states have disagreements over this idea. If private medical colleges are integrated with district hospitals, there is no guarantee that the shortage of medical personnel can be overcome. There is a shortage of medical infrastructure in the country. INR 5,38,305 crores are needed to address the public health needs in the country. The Ministry of Health put this demand before the 15th Financial Commission. Yet, there have been no generous allocations in this regard. There is a need to strengthen the basic healthcare infrastructure.

India ranks 120 in the list of world’s healthiest countries. Spain ranked first in this list with Italy coming second. It is also noteworthy that Italy has the highest incidence of Coronavirus deaths after China. Among the South Asian countries, Sri Lanka (66), Bangladesh (91) and Nepal (110) fared better than India. Organizational flaws in preventing the Coronavirus outbreak are more evident. It has become clear that there are not enough virology labs in the country. Founded in 1952, the National Institute of Virology is the largest virology lab in India. It has been credited with many wonderful pieces of research on viruses in association with the WHO. It is the only organization in the country which comes to rescue in case of a viral epidemic. In fact, there is a need to establish such an organization in every state. Since the blood samples from all states are sent to the NIV, there is a delay in containing the outbreak. Labs like these can help detect the viruses, and analyze the root cause.

Crises like COVID-19 will continue to disrupt the nation if the government chooses to wake up from deep slumber only during a pandemic, and decide to continue their lackluster efforts in improving public health. Demonetization and GST have already hit the domestic pharmaceutical industry. In the current circumstances, the pharma industry needs large scale incentives and investments. The R&D needs to be put on the fast track too. Currently, China is supplying the majority of the raw material for many drugs. It is not advisable to rely on China for these imports in the present scenario. There is a need to promote the domestic pharma industry to increase mass production. Public health and development are two sides of the same coin. Therefore, policymakers should recognize the need to reinforce systems that address the challenges faced by the nation's health sector, instead of waiting for a crisis to strike.

Recently, the National Sample Survey Organization report revealed that Indians were more prone to infectious diseases than citizens from other nations. The contagious diseases included malaria, viral hepatitis, dengue, chikungunya, measles, meningitis, typhoid, elephantiasis, and tuberculosis. The government must allocate enormous funds to address these diseases. In the face of tremendous fund crunch to tackle the existing diseases, how much more funds are needed to combat the deadly COVID-19? The governments must realize at least now, that there is a need to allocate massive funds to strengthen the ailing public health sector in India.