A déjà vu moment from Odisha this week once again put the spotlight on the unacceptable gaps in India’s public health delivery.
Gati Dhibar carried his dead five-year-old daughter Sumi on his shoulder for 15 km from the Palahada Community Health Centre (CHC) in the Angul district in Odisha to his village for cremation after he was couldn’t get a hearse at the hospital. Too poor to pay for transport, Dhibar’s plight echoes two similar incidents in Odisha last year – one in Malkangiri district where a man walked six km with his seven-year-old daughter’s body after the ambulance taking them to the hospital left them midway after learning that the girl had died, and the other in the Kalahandi district, where a man carried his dead wife for more than 10 km after the government hospital, where she died, refused him an ambulance.
Similar gut-wrenching reports from other states underline the breakdown of India’s public health system, which continues to struggle with budget cuts and human resource shortfalls. At 1.26% of the GDP, India’s public health spending is among the lowest in the world, with Centre’s share steadily decreasing compared to state spend. In 2009-10, the Centre’s share of the total public health expenditure was 36%, which came down to 30% in 2014-15.
This makes India’s annual per-capita health spend at USD 16, compared to Australia’s USD 4,070, Canada’s USD 3,991 and Sri Lanka’s USD 45. Low public spending forces people to pay for expensive medicines and treatment at private hospitals, which account for 70% of health delivery. As a result, healthcare costs push 63 million people into poverty each year. Health is a state subject, with wide disparities existing in delivery and access to treatment across states, and rural and urban population. Delhi remains India’s best performing state, where the average spending is 10.1% of its total spending since 2010-11.
Dana Majhi, a poor tribal from Odisha who drew sympathy after he had to walk over 10 km carrying his dead wife on shoulder, is now a millionaire with donations and help pouring in, including from Bahrain’s Prime Minister.
(Virendra Singh Gosain/HTPhoto)
Increasing the budget outlay is not enough if states do not have the human resources or the infrastructure to improve healthcare. One allopathic doctor in a government hospital serves an average population of 11,528 people, shows data from the National Health Profile 2015. This means that if you live in a village or small town and need emergency surgery, the district government hospital is the only place where you are likely to find qualified help.
Shortage apart, absenteeism plagues many health centres with no shortfalls of doctors, nurses and health workers. With healthcare professionals having the option of treating patients at private clinics, many spend more time and energy moonlighting than they do working at the hospital.
Government hospitals are overcrowded and lack resources to meet the growing demand for services, more so in smaller towns and villages. To treat a population of 1.25 billion, India has 20,306 hospitals with 6.75 lakh beds, with only a third of the beds serving rural India where 60% of the population lives.
Adding to the problem is the lack of regulation to determine accountability and quality standards of clinics in many part of India. Only one in five doctors in rural India are qualified to practice, said a World Health Organisation report on India’s healthcare workforce. The report found close to one-third of those calling themselves allopathic doctors were educated only up to Class 12 and 57% did not have any medical qualification.
What India needs a robust regulatory framework to ensure accountability and quality care. The UPA’s Rs 24,000-crore national health protection scheme provides a health insurance cover of up to Rs 1 lakh to the poor is a start, but it’s roll-out needs to be accelerated to ensure families do not continue to suffer Dhibar’s fate.
India’s track record in polio eradication has shown that states can deliver results. The problem is that this doesn’t happen routinely and programmes need to be run on a “mission mode” to show results. Realising this, the Centre has named its flagship programme to boost universal immunisation coverage ‘Mission Indradhanush’. The results show. Since its launch in April 2015, an unprecedented 2.1 crore children were vaccinated, of which 55 lakh were fully immunised in 497 districts across 35 states/UTs
The right to health is a fundamental right and not a favour doled out by successive governments at the Centre and the state. With elections being held in the five states of Uttar Pradesh, Uttarakhand, Goa, Punjab and Manipur this year, it’s time people used their vote to demand their right to health.