The Fault Line Of Poor Health

Context: Analysis of critical issues in Indian healthcare paradigm and policy recommendations.

Critical issues in India’s healthcare sector

• Poor state of health infrastructure: According to the World Bank data, in 2017, India had -
  • 7 physicians per 1,00,000 people (98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka, 241 in Japan).
  • 53 beds per 1,00,000 people (63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka, 1,298 in Japan).
  • 7 nurses and midwives per 1,00,000 people (220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, 1,220 in Japan).
• Stagnant and low public health expenditure: At 1% of GDP 2013-14 and 1.28% in 2017-18 including expenditure by Centre, States and Union Territories (Centre for Economic Data and Analysis (CEDA), Ashoka University).
• Federal issues: Health being a State subject, State spending constitutes 68.6% of all government health expenditure.
  • However, states lack the expertise as main bodies with technical expertise are under central control. E.g. National Centre for Disease Control or Indian Council of Medical Research.
• Inter-State variations: States differ a great deal in terms of fiscal space because of wide variation in per capita health expenditure. According to 2010-11 to 2019-20 Health expenditure analysis by CEDA –
  • Kerala and Delhi were at the top, whereas Bihar, Jharkhand and Uttar Pradesh remained at the bottom (due to dismal health expenditure and myopic policy disregarding scientific evidence.).
  • Noteworthy performance of Odisha: Had same per capita health expenditure as Uttar Pradesh in 2010, but now has more than double that of Uttar Pradesh.
• High out-of-pocket (OOP) expenditures: World Health Organization estimates that 62% of total health expenditure in India is OOP, among the highest in the world.
  • Regressive nature of OOP: Poorest States have a high ratio of OOP expenditures in total health expenditure and it affects the poorest and vulnerable sections the worst.

Way forward

• Need for a coordinated national plan: Inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight pandemic.
  • It will address concerns like resource allocation/utilisation during pandemic similar to that of PM CARES fund, vaccine policy etc.
  • The Centre can leverage its bargaining and economics of scale advantage by floating central global tender for procuring vaccines, oxygen etc., from international market.
  • It will also address distribution of constrained resources and can internalise the existing disparities in health infrastructure across States.
  • In April 2020, CEDA proposed a “Pandemic Preparedness Unit” (PPU) under central government for following purposes-
    • Streamlining disease surveillance and reporting systems,
    • Coordinating public health management and policy responses across all levels of government,
    • Formulating policies to mitigate economic and social costs and communicate effectively about health crisis.

Conclusion

• Central government needs to deploy all available resources to support the health and livelihood expenses of COVID-19-ravaged families immediately.
• Bolstering public healthcare systems has to be the topmost priority for all governments, the Centre as well as States, in post-pandemic phase.