By M.Y.Siddiqui*
Covid-19 induced pandemic since early 2020 has brought untold miseries to India with unprecedented loss of lives, livelihood, loss of jobs, innumerable/unaccounted/undercounted deaths for shortages of medicines, for lack of oxygen and inadequate beds in hospitals.
The second wave of the pandemic witnessed people dying on roads, on pavements outside hospitals, black marketing of life saving drugs and oxygen, indignity in deaths for cremation or burial of loved ones, never ending serpentine queue of dead bodies at crematoria and burial grounds, mismanagement in vaccines, deaths of more than 1000 doctors registered with Indian Medical Association, overcharging by private hospitals, glaring failure of leadership, resulting in all round collapse of healthcare.
This calls upon the government to re-look at public health care and revamp it to the advantages of people so that they may not have to meet the same fate for want of medical care in a similar situation in future.
Despite wide appreciation of frontline health warriors, their uncanny commitment and unparalleled services to the people, medical care in India collapsed during the pandemic compelling people to analyse reasons for such collapse of health infrastructure.
Since Independence in 1947, country’s defence budget went up by about 9 per cent annually making India the third largest military spender in the world in 2019; but its spending on health sector has been coming down. Government’s spending on health sector stuck around 1 per cent of GDP for about 15 years. In 2004, the federal government made a commitment to increase public spending on health by 2-3 per cent of GDP over the next five years. A similar commitment was made and reiterated in 2017 National Health Policy to increase spending on health to 2.5 per cent of GDP by 2025. Till now no significant increase in health budget has come forth.
During the pandemic, private health sector’s contribution has been negligible less than 10 per cent, according to official sources. Private health services failed to take critical load of Covid-19 patients, on the other hand, charging exorbitant rates for treating pandemic afflicted patients. Allocation for health in the Rs.20 lakh crore (US dollar 260 billion) stimulus package announced by the federal government on May 12, 2020 amounted to only 0.008 per cent of the GDP.
Since Independence, successive governments built a robust system of primary health centres in big villages, cluster of villages (in each village panchayt) supplemented by district hospitals. This system, however, collapsed due to the pressure from business lobbies, which entered healthcare system of India by 1990. Basic infrastructure in primary health care included maternal, child healthcare services. Specialised healthcare services were provided through tertiary hospitals in urban areas.
Since 1951 the number of doctors in the country has increased nine times to about 12 lakh (1.2 million) now, average growth of doctors per 10,000 population has increased only by three times. In fact, actual number of doctors is 18 lakh (1.8 million) with remaining six lakh (0.6 million) having gone abroad for greener pastures.
Additionally, India has fared poorly in its Universal Health Coverage (UHC), a barometer set by the United Nations (UN) to judge health services to people by all countries. UHC is critical to ensure that all, especially the vulnerable and marginalized groups, like women, daily wagers, homeless; migrants are cared for at the negligible cost. UN has included achievement of UHC by 2030 in its Sustainable Development Goals and proclaimed December 12 as the International Universal Health Coverage Day.
The erstwhile Planning Commission in 2010, guided by a high level expert group on UHC for India, envisioned UHC as a means to ensure that all people could access preventive, curative, rehabilitative and palliative health services of assured quality. As of now, however, it cannot be said that India has achieved any of the parameters of the UHC.
Crass commercialization from education to management is responsible for the current sorry state of healthcare. Medical education has been made expensive and corruption seeped in for undergraduate and post-graduate medical education only for people with deep pockets in the private medical institutes, which have outnumbered public medical institutes.
Such medical students or future doctors, committed professionally to the ethics and professional standards, in reality, try to recoup the investment, once they become professionally active. Corporate hospitals that lure doctors at fat salaries further muddy the waters, always under pressure to generate more medical business guided by profit of the enterprise.
Other problems that inhibit health outreach to every body include non-professionals manning drug pricing control leading to seeping corruption that help increase prices to 400-500 per cent higher than the actual drug manufacturing cost. Despite India being the pharmacy of developing nations, generic medicines are not encouraged for lack of assured quality, making a patient shell out a bigger price for a medicine which might have cost a few rupees to manufacture.
Still, all is not lost. There are way forwards in that whole medical infrastructure needs to be restructured to provide universal and cost effective medical care. Medical education should be brought hundred percent under government control and liberalized to expand medical infrastructure to bridge the gap between demand and supply of doctors.
Some other important measures needed to be taken include every certified doctor by law should be mandated to work in primary healthcare system to understand totality of people’s health problems and be empathetic to patients; introduction of fair and transparent mechanism to provide drugs at least cost to patients; prohibit by law pharmaceutical companies approaching individual doctors at hospitals to promote their products; ensure management of hospitals in government hands and not in private sector to ensure cost effective medical facilities to every citizen. All these would help India come out of vicious cycle of corruption and nepotism in health care.
Disclaimer: The opinion expressed in this article is that of the author and do not necessarily reflect the position of Indian Science Journal.
*The author is a former Director in Press Information Bureau
Image: Map not to scale; representational purpose only
