Context: Recently the Government of India and World Bank signed two complimentary loans worth $1 billion to support and enhance India’s healthcare infrastructure.
About India’s healthcare sector at glance:
In the Economic Survey of 2022, India’s public expenditure on healthcare stood at 1% of GDP in 2021-22 against 1.8% in 2020-21 and 1.3% in 2019-20.
India had 7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 100 in Sri Lanka and 241 in Japan).
53 beds per 1,00,000 people(in contrast to 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan).
7 nurses and midwives per 1,00,000 people(in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan).
India has among the highest out-of-pocket (OOP) expenditures of all countries in the world- 62% of the total health expenditure in India is OOP.
According to the World Health Organization (WHO), India ranks 184 out of 191 countries in health spending.
The US spends over 16% of its total GDP on healthcare, while Japan, Canada, Germany etc. spend over 10% of their GDP on healthcare.
Health Index for states developed by Niti Aayog:
The Health Index for States developed by Niti Aayog in consultation with the health ministry and the World Bank has rankings for large states, smaller states and Union territories.
It is based on 23 health parameters ranging from mortality rate and sex ratio to functioning cardiac care units.
In 2019, Kerala was the top performer followed by Andhra Pradesh and Maharashtra.
The index results indicated that states even with a lower economic output are performing better on health and well-being.
Challenges associated with India’s healthcare sector:
Low Budget Spending: India’s public expenditure on healthcare is only 2.1% of GDP in 2021-22 while Japan, Canada and France spend about 10% of their GDP on public healthcare.
Unequal distribution: India’s health care system is concentrated in urban areas with very little presence in the rural areas where majority of the population lives.
Lack of Medical Research: In India, R&D and cutting-edge technology-led new projects receive little attention.
Low doctor-patient ratio: The doctor patient ratio in India is about 1:1500 much higher than the WHO norm ofone doctor for every 1,000 people.
Lack of Affordability: The contribution of private sector in healthcare expenditure in India is around 80 percent while the rest 20 percent is contributed by Public Sector.
The private sector also provides for 58 percent of the hospitals and 81 percent of the doctors in India.
Govt of India Initiatives to improve healthcare sector in the country:
Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): it aims to strengthen India’s health infrastructure and improve the country’s primary, secondary and tertiary care services.
Ayushman Bharat : Follows a two- pronged approach by Creation of health and wellness centres to bring health care closer to homes.
formulation of a Pradhan Mantri Jan Arogya Yojana (PMJAY) to protect poor and vulnerable families against financial risk arising out of health episodes.
Ayushman Bharat Digital Mission: aims to connect the digital health solutions of hospitals across the country. Under this, every citizen will now get a digital health ID and their health record will be digitally protected.
National Ayush Mission: it is a centrally sponsored scheme for the development of traditional medicines
Pradhan Mantri Swasthya Suraksha Yojana (PMSSY):aims to correct regional imbalances in the availability of affordable/reliable tertiary healthcare services and also to augment facilities for quality medical education in the country.
Way Forward:
There is an urgency to focus on all the three levels of primary, secondary and tertiary healthcare, it is imperative that the government look towards improving primary health care as a public good.
The lesson emerging most unequivocally from the pandemic experience is that if India does not want a repeat of the immeasurable suffering and the social and economic loss, we need to make public health a central focus.
There is also a need to declutter policy dialogue and provide clarity to the nomenclatures. India needs to move beyond the doctor-led system and Para medicalise several functions. India should focus on technology upgradation and preventive care to further its march towards healthy India.
