Events & Issues

New Delhi, 20 October 2014

Healthcare Policy

NEW INVESTMENT CRITICAL

By Dhurjati Mukherjee

The present Government has promised a new ‘National Healthcare Policy’, which should obviously lead to greater public investment in health care and improve the quantity and quality of standards in the country so that the masses benefit. The Government – both the Centre and States -- also has to increase its investment in health care, which unfortunately it has not done so far. And the major funding should be to create proper medical infrastructure in the rural and semi-urban areas where most of the poor people live.   

The expenditure in health has sadly shown no significant increase in spite of the deteriorating condition of hospitals and health standards in different parts of the country. The quantum of diseases has been increasing not just in rural and semi-urban areas but also in towns and cities and obviously the economically weaker sections are greatly affected.  

Add to this the prevalence of corruption in the system. The British Medical Journal recently announced the launch of a campaign against corruption in medicine that would focus on India. Besides, Transparency International had concluded that India’s health care sector is the second most corrupt organization that an ordinary citizen had to encounter (next to the police). 

Gastrointestinal surgeon, Dr. Samiran Nandy, in the BMJ identified the main reasons for corruption in medicine in the country as lack of information to users, red tape, shortage of doctors and health care supplies, inefficiency in the public sector and poor management and supervision. However, Dr Nandy has not been bold enough to point out that private nursing homes in collaboration with a section of doctors cheat the people and extract money in various ways, both in cities and also in rural and semi-urban areas. There is no mechanism of the Government to control the functioning of these nursing homes and even treatment facilities in some of these centres are of a poor standard.

Creation of a national watchdog to tackle unethical practices of doctors and of the private health sector has been voiced by many but nothing in this direction has fructified as yet. Sometimes the low income groups lose everything due to the so-called good treatment in specailized nursing homes and the end result, in most cases, is obviously not quite happy.

Why cannot the State provide health care to the poor at affordable rates? Is it due to the lack of doctors or the inadequacy of proper infrastructure in the health sector? A recent report by think tank Sraniti revealed that there is virtually no shortage of doctors at primary health centres in Goa, Kerala and Tamil Nadu. In fact, Tamil Nadu has one doctor for 789 patients and an infant mortality rate of 21 and maternal mortality of 97.

In sharp contrast, Chhattisgarh has one doctor for 6221 patients and witnesses 47 infant deaths for every 1000 live births and 260 maternal deaths per 100,000 live births. The situation is somewhat similar in Odisha having one doctor for 2500 patients, Madhya Pradesh one doctor for 2600 patients and Uttar Pradesh one doctor for around 3316 patients.  

The southern States are quite advanced in the health sector and Andhra Pradesh, Karnataka, Kerala and Tamil Nadu account for around 40 per cent of all medical colleges, thereby producing most of the country’s doctors. These States also have the best doctor population ratio. In comparison, the north Indian states of MP, UP, Bihar, Odisha and Chhattisgarh have few medical colleges, thereby having an adverse doctor population ratio.

The latest Economic Survey showed that the Central government’s expenditure on health and family welfare as a percentage of total government expenditure has been hovering around two per cent since 2008-09. As a proportion of India’s GDP, the expenditure on health is even lower at 1.4 per cent. Thus, there seems little hope regarding affordability and accessibility of medicines as around 70 to 80 per cent of the population is without any form of health insurance coverage.    

At the same time, it is also imperative for the northern States to give more attention to health care and allocate more funds for this purpose. If hospitals come up with public-private partnership, a portion of seats should be reserved for the poor, the economically weaker sections and low income groups who should pay at rates fixed by the Government. It has to be kept in mind that in most of these States the population density is quite high with a major section belonging to the poorer sections who cannot afford treatment in private nursing homes    

There are many seminars and conferences on health and the need for infusion of technology in this sector. There were reports that heart operation could be carried out within Rs 50,000 but even this has not yet become a reality till now. While recent advances in this sector are welcome and R&D efforts have to be geared up, health care as also drugs have to become affordable to meet the demands of the common man. It is in this connection that there have been suggestions for revival of public sector undertakings as such efficient enterprises would supply quality medicines at affordable prices.

One may mention here that the recent decision of putting price ceilings on 108 non-scheduled formulations comprising drugs for diabetic and cardiac ailments is no doubt a welcome sign. Moreover, doctors should prescribe Indian formulations that are less costly and BPL families and economically weaker sections all over the country should get medicines at a subsidized price – say at 40-50 per cent less price than the MRP.

Some States have, however, taken some action in this regard. For example, the universal health care group in Maharashtra has worked out a detailed plan to help the poor and the needy. The central idea of the scheme is to provide cashless health care facility to every person, irrespective of his/her economic status and the capacity to pay. In West Bengal too, the Government has set up fair price shops in Government hospitals where medicines are available at 66 per cent below the MRP.

The role of the State in delivering health facilities and medicines to the masses cannot be overemphasized. While the new Policy would definitely be welcome, it has to be ensured that more investments of the Government in the health sector are imperative, keeping in view the increase in the quantum of diseases. Doctors too have to show some dedication and sincerity in treating patients, specially the poor, and not always crave for money. The two put together could be a step forward towards a healthy India. ---INFA

(Copyright, India News and Feature Alliance)