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.