Cardiovascular diseases, cancers,diabetes and traffic accidents are among leading causes of death and suffering in India.
Lakhs of mothers and babies also continue to die, keeping maternal and infant mortality rates, two basic health indicators, unacceptably high. The situation where health problems of the developed and developing worlds co-exist is made worse by a public health sector hobbled by perennial shortages of both infrastructure and personnel. This in turn forces most people to seek expensive and unregulated private healthcare, expensive and in many cases of questionable quality.
Public health infrastructure is wanting by even government's own assessments.This is true of subcentres at the lowest rung to community health centres (CHCs) and district hospitals. There's a shortage of about 7,000 primary health centres (PHCs). In some states, the shortages are staggering -66% in Jharkhand, 58% in Bengal and 42% in MP . Only two-thirds of the required number of CHCs are in place.In Bihar, against a need of 774 CHCs there are just 70, a 91% shortfall. Assam has less than half of what it needs, UP 40% less.
There's an even bigger crisis of health personnel: A shortfall of 2,225 doctors in PHCs, and the gap's growing bigger. Over 36% PHCs were without a lab technician, 23% without a pharmacist. There is a 53% shortfall in radiographers. Considering just the existing infrastructure, there was a shortfall of all kinds of specialists including 72.2% of surgeons, 64.7% of obstetricians and gynaecologists, 82.1% of physicians and 73% of paediatricians. In effect, even in the existing infrastructure isn't staffed. In many states, health indicators of the urban poor are far worse than their rural counterparts, revealing how underserved the urban poor are. In the mostly urban Delhi, there's massive shortage of subcentres, PHCs and CHCs.
The bulk of healthcare in India is provided by the private sector, that's meant escalating costs. In states like Rajasthan and Tamil Nadu, governments demonstrated how providing free drugs and diagnostics in public facilities could significantly bring down health expenditure. Yet, neither the Centre nor other states replicated these programmes. In the name of universal healthcare, government is being persuaded to become the payer for healthcare provisioned by the private health sector and administered by insurance companies. In most states, these insurance programmes have been riddled with corruption and inefficiencies such as the epidemic of hysterectomies done on hundreds of women by hospitals in Andhra to collect government money for the procedure. There's concern among health activists that state funds that could be used to strengthen public health infrastructure are getting diverted to the private sector.
In absolute terms, the money allocated for health by government has gone up more than 13 times from Rs 2,000 crore in 2000-01 to Rs 27,500 crore-plus in 2013-14. Yet, health expenditure is short of 1.5% of GDP though successive governments have promised that spending would touch 3%. If the promised 3% had been allotted, perhaps the public health sector could have been revolutionized to deliver quality service.
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