Protect and expand India’s public healthcare system: The inequality imperative
- Essential Services
- by Oommen C. Kurian
- 22 Jun, 2015
According to estimates by the International Monetary Fund (IMF) developing countries lose Rs 14 lakh crore (at current exchange rates) a year to tax cheating. Recent research covering 1500 MNCs in India showed that those with links to tax havens reported 1.5 % less profit.
This money could fund free quality public services, vital to fight poverty and inequality by putting virtual money in peoples’ pockets, as Oxfam research has shown- they do the opposite of what user charges do. With the final round of UN Financing for Development negotiations ongoing, these are crucial times to make our tax systems more equitable and efficient – for stronger public services, including healthcare.
Results of cross-national modelling in 89 low-income and middle-income countries show that each Rs.10 per-capita increase in tax revenue resulted in an additional Rs 1 of public health spending per capita while a Rs.10 increase in GDP per capita resulted in an increase of Rs.0.10.
Out of pocket (OOP) expenditures push an estimated 60 million Indians (six crore) into poverty every year. User charges still remain in the public healthcare delivery system. The overall public spending hovers at about 1% of GDP. Yet, increased health spending in rural India over the last decade is slowly yielding results.
Unfortunately, there are budget cuts and insurance-based initiatives towards Universal Health Coverage (UHC) being proposed that seem extremely worrying. A recent paper brought out by Oxfam India explores available evidence around financing healthcare for all in India and offers recommendations.
During 1986-87, about 60% of the hospitalised cases were treated by the government institutions across urban and rural areas. In 2004, it fell to about 40%, reflecting the poor public spending on health1 . However, the following decade saw focused attention on rural care, and most deliveries across urban and rural areas are now taking place in government hospitals as the following chart shows.
In a decade which saw government schemes across the country that offered incentives to deliveries in private sector facilities, this is a remarkable result.
Utilisation figures from the eighties are often quoted to argue that the poor prefer the private sector now. It however ignores the fact that this was a period when the public sector was systematically starved of resources and market principles were introduced into the system. Forgone care due to financial reasons doubled between 1986-87 and 2004, from 15% in rural and 10% in urban areas to 28% and 20% respectively.
Sharp Spending Cuts in India’s Latest Budget
The spending cuts by the centre- despite being accompanied by higher revenue share to states - are deeply concerning. The employment guarantee scheme saw a reduction of 3% in real terms. Allocations to the child nutrition scheme were cut by half. Total allocations for health was cut by about Rs. 6000 crore.
Budget for government’s mid-day meal scheme in schools was cut by 41%. The central government argues that cuts will be compensated by a larger allocation to states. The share of taxes to states has indeed increased in an encouraging step of fiscal devolution. However, researchers point out that poorer states who rely more on central support face net losses.
At the same time, the latest report from Global Financial Integrity found that developing countries lost Rs 422 lakh crore (at current exchange rates) in illicit financial flows in the last decade. India was among the top five countries in the world with almost Rs 32 lakh crore (at current exchange rates) in illicit outflows. Just to compare, India’s annual central outlay on health and rural housing put together is Rs 34,575 crore.
India’s tax to GDP ratio is among the lowest of all G20 countries, just above Mexico and Indonesia, and far below other BRICS (Brazil, Russia, India, China and South Africa) countries. In addition, national aggregate amount of revenue foregone due to exemptions by the central government is estimated to be 43.2 % of total tax revenue for the year 2014-15, at Rs 5.89 lakh crore.
This shows that there indeed are alternative sources that can be tapped in order to generate more resources for health. Moreover, the bigger question seems to be how these new alternative funds will be spent— will it be through an expansion of the public sector, or through an insurance-based, private sector dependant platform?
The situation seems grim: it is puzzling that policy advice that although flies in the face of evidence still carries weight within the government. Prof Arvind Panagariya, the Vice Chairperson of Niti Aayog –a think tank which just replaced India’s Planning Commission- suggests the following in a recent book:
Turning to medical service delivery, we recommend that rather than further expand the provision of free primary, secondary, and tertiary health care services in the public sector, the government must focus on providing financial resources to the poor for routine and non-routine care... Even so, if the government must insist on the provision of the services, it must do so on the full cost recovery basis.
It is highly disappointing that India’s policy elite refuses to learn from India’s own or the global experience about the disastrous effects of user charges on peoples’ lives. Echoing the Vice Chairperson’s viewpoint, Niti Aayog’s latest Working Paper on financing healthcare veers dangerously towards insurance-based solutions, Corporate Social Responsibility, and PPPs.
Thankfully, despite the clear focus on insurance based, demand-side financing measures incentivising access to private providers, rural public health infrastructure has been silently improving in the last decade, with remarkably positive results.
It is important to keep the momentum going, rather than allow the inadequate model of Rashtriya Swasthya Bima Yojana (RSBY) to become the foundation for India’s progress towards UHC. Oxfam India’s paper makes the following recommendations for the country’s health system:
- Government should be the primary provider of healthcare, and provision of healthcare for all should not be based on expansion of health insurance-based models focusing on hospitalisation.
- A clear roadmap to enhance budgetary spending on healthcare to 3%-5% of GDP should be drawn. Public tax-based funding and contribution from the organised sector should finance healthcare and focused funding in the form of specific central transfers should be made to promote equitable access.
- Regulation of the private sector must be a priority. Establishment of standard treatment protocols and empowerment of communities to hold the healthcare system accountable will be critical to ensure quality of healthcare in the public and private sectors.
- A comprehensive review of Rashtriya Swasthya Bima Yojana (RSBY) and other currently fragmented government funded healthcare schemes like Central Government Health Scheme (CGHS) should be conducted with the aim of future consolidation for a national programme ensuring healthcare for all.
_____________________________________________
1Still, 60% of all people from the bottom 20% were getting hospitalised in the public sector in 2004.
Help us urge the government to provide affordable medicines for all. Sign this petition NOW!
Written by: Oommen C. Kurian, Research Coordinator, Oxfam India
Photo credit: Srikant Kolari
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Oxfam India’s letter to President of India requesting affirmative action on passing Women’s Reservation Bill in Parliament.
Sep 10, 2019 | oxfamadmin
Women Representation in Political Decision Making: A Catalyst to achieving Gender Equality
Oct 24, 2019 | ursila
Will Fear of ‘Failing’ Make India Literate?
Sep 27, 2019 | ursila
WATER IS LIFE
Nov 18, 2019 | Anisha
Building bridges: The journey of a teacher par excellence
Oct 7, 2019 | ursila
Examining humanitarian aid through the gender lens
Oct 24, 2019 | ursila
The pathways to gender equality are far from straight
Oct 7, 2019 | ursila
The changing world of humanitarian work
Sep 10, 2019 | ursila
Can India be a Leader in Disaster Risk Reduction Measures in Asia?
Oct 7, 2019 | ursila
A struggle for survival: Assam Floods
Nov 11, 2019 | Anisha
Lessons to be learnt from the Gorakhpur tragedy
Oct 24, 2019 | ursila
Is Section 498A anti women?
Nov 11, 2019 | ursila
The Irresistible & Oppressive Gaze: A Survey Report by Oxfam India
Oct 24, 2019 | oxfamadmin
North East Floods: How you can help those affected?
Oct 1, 2019 | Ravi
Oxfam is responding in Assam Floods 2017
Oct 1, 2019 | Ravi
Lipstick Under My Burkha Official Trailer - Winner of Oxfam's Best Film on Gender Equality Award
Sep 27, 2019 | Ravi
Sourcing Life
Oct 7, 2019 | Anisha
MEETING TOILET TARGETS
Oct 7, 2019 | oxfamadmin
Disaster Changed Her Life
Oct 24, 2019 | Anisha
#HaqBantaHai Campaign on Access to Free Medicine: Bihar
Sep 10, 2019 | Anisha
Be The New Norm
Oct 7, 2019 | Ravi
Oxfam India’s Recommendations for National Policy for Women
Sep 27, 2019 | Ravi
The Greatest Earning: EDUCATION
Dec 5, 2019 | Anisha
Women Farmers or Labourers?
Oct 24, 2019 | Avantika
Farewell Dirty Water
Jan 9, 2020 | Avantika
Clean Water Can Save Lives
Oct 24, 2019 | Avantika
Making men an ally on women's rights
Oct 24, 2019 | Avantika
'Initially the men opposed. They thought we women were being disruptive.'
Oct 1, 2019 | Avantika
Tax havens resist reforms one year on from Panama Papers exposé
Oct 1, 2019 | Avantika
इख़्तियार
Oct 24, 2019 | Avantika
Lessons from the Grassroots
Sep 10, 2019 | Avantika
This is What Child Marriage Looks Like
Nov 18, 2019 | Avantika
Oxfam India Held Youth Festivals In Lucknow And Raipur
Sep 9, 2019 | Avantika
Oxfam at the North-East Disaster Risk Reduction Conclave 2017
Sep 9, 2019 | Avantika
Finding Solutions to Early and Forced Marriage
Sep 27, 2019 | Avantika
Silence Has No Honour
Sep 27, 2019 | Avantika
Solidarity Is Our Weapon- The International Women’s Strike
Oct 24, 2019 | Avantika
4 reasons why Oxfam supports the International Women’s Strike on the 8th March
Oct 24, 2019 | Avantika
Union Budget 2017-18: Neglected Social Sector
Sep 10, 2019 | Avantika
Putting Data at the Heart of Business Responsibility
May 13, 2019 | Avantika
Mainstreaming DRR in Local Development Plans to Reduce Aid Dependency
Oct 1, 2019 | Avantika
Union Budget 2017-18: A Look at the Health Sector
Apr 5, 2019 | Avantika
खेल - जेण्डर आधारित असमानताओं को उजागर करने को एक सषक्त माध्यम
Apr 5, 2019 | oxfamadmin
Why Brazil should not take a U-turn on its health system
Oct 7, 2019 | Avantika
Your questions answered: Oxfam’s Inequality report
Oct 1, 2019 | Avantika
Unpacking the Risks of Doing Business in India
Nov 14, 2019 | Avantika
We Never Learn
Sep 27, 2019 | Ravi
Promote men’s involvement for changing social norms
Oct 24, 2019 | Avantika
Ten years of the Forest Rights Act: Opportunity lost?
Oct 1, 2019 | oxfamadmin
Meet the Bravehearts Standing Up Against Domestic Violence
May 27, 2020 | oxfamadmin
Addressing Violence Against Women and Girls the SAARC Way: Combat Human Trafficking
Sep 10, 2019 | oxfamadmin
Oxfam India’s journey from programme to campaign
Oct 24, 2019 | oxfamadmin
सामाजिक मान्यताओं को चुनौती देता संगठन
Dec 5, 2019 | oxfamadmin
Changing The World – One Couple At A Time
Oct 24, 2019 | oxfamadmin
A Lesson on Education from Uttar Pradesh
Oct 7, 2019 | oxfamadmin
Fair Sharing of Mining Revenue for the Tribals
Oct 24, 2019 | oxfamadmin
An Open Letter to Chhotu, Munna and Bachcha
Jun 12, 2020 | oxfamadmin
Educating the Educators
Sep 27, 2019 | oxfamadmin
10 Years of Domestic Violence Act: The Way Ahead
Oct 24, 2019 | oxfamadmin
Oxfam Best Film on Gender Equality Award Gets Grand Reception
Sep 27, 2019 | oxfamadmin
Wrestling Social Norms Out
Oct 3, 2019 | oxfamadmin
The Toilet Conundrum
Oct 24, 2019 | oxfamadmin
Inequality in India: what's the real story?
Sep 27, 2019 | oxfamadmin
Making surface water safe for drinking
Oct 1, 2019 | oxfamadmin
Quality Education- The unfinished agenda of RTE Act
Sep 27, 2019 | oxfamadmin
Tale of Two Women
Sep 27, 2019 | oxfamadmin
Prioritising the Health of our Children
Oct 24, 2019 | oxfamadmin
Violence in women’s own backyard
Sep 9, 2019 | oxfamadmin
We failed yet again
Sep 10, 2019 | oxfamadmin
Providing access to iron-free drinking water
Oct 7, 2019 | oxfamadmin
Her Series - Tale of Buguru Chitamma: How a cooperative transformed fisher women into leaders
Oct 24, 2019 | oxfamadmin
Why the CAF bill conflicts with the Forest Rights Act?
Oct 7, 2019 | oxfamadmin
Renew to Live Anew
Sep 9, 2019 | oxfamadmin
What do we want: Health as a ‘Right’ or just an ‘Assurance’
Nov 18, 2019 | oxfamadmin
Oxfam International signs historic deal to move to Nairobi, Kenya
Oct 24, 2019 | oxfamadmin
Why is passing the Women’s Reservation Bill urgent?
Sep 19, 2023 | oxfamadmin
BREXIT & What It Means for Humanitarian Aid
Oct 7, 2019 | oxfamadmin
Rahul Bose: Films should be gender sensitive
Oct 24, 2019 | oxfamadmin
Portrait of a Teacher: Successful introduction of multi-lingual education for Odisha’s tribal communities
Nov 6, 2019 | oxfamadmin
Tax dodging is a crime against developing countries
Sep 10, 2019 | oxfamadmin
Signs of social risks impacting Indian businesses
Oct 7, 2019 | oxfamadmin
Tikamgarh revisited, what’s happened to the amazing fishing communities I visited in 2006?
Jan 9, 2020 | oxfamadmin
Where school means freedom
Sep 10, 2019 | oxfamadmin
Yes, Prime Minister
Oct 30, 2019 | oxfamadmin
India’s National Budget 2016-17: Missed Opportunity to Address Inequality?
Oct 1, 2019 | oxfamadmin
Free The Night
Sep 9, 2019 | oxfamadmin
Woman, Open Your Eyes…
Oct 24, 2019 | oxfamadmin
From Darbhanga to Davos: Access to Affordable Medicine Still Remains a Key Question
Dec 16, 2019 | oxfamadmin
Hoping for a Second Chance: Punita Devi
Sep 27, 2019 | oxfamadmin
Activating Youth in Lucknow to Promote Girls’ Education
Sep 27, 2019 | oxfamadmin
Change is Coming: Rani Bitti’s Story
Sep 10, 2019 | oxfamadmin
Rachna’s Fight for Justice
Oct 7, 2019 | oxfamadmin
3 Key Observations from #WEF2016 that Indian Businesses Must Take Note Of
Sep 27, 2019 | oxfamadmin
Here’s Why States Need to Provide Free Basic Medicines
Nov 18, 2019 | oxfamadmin
Update: Oxfam to Provide Shelter to 300 Households Hit by The Manipur Earthquake
Apr 5, 2019 | oxfamadmin
In El Salvador, a struggle to survive El Niño
Oct 24, 2019 | oxfamadmin
Bihar designs a 15-year roadmap to reduce risk of disaster
Feb 20, 2020 | ursila
Violence as an Effective Mode of “Indian” Communication
Apr 5, 2019 | oxfamadmin
Because it’s 2015!
Sep 27, 2019 | oxfamadmin
Let’s welcome a new dawn, minus domestic violence
Oct 24, 2019 | oxfamadmin
Data and Discrimination: Women’s Ownership of Assets in India
Oct 24, 2019 | oxfamadmin
“No Woman, No Cry!”
Sep 27, 2019 | oxfamadmin
Pushing, pulling and the power of people: new horizons for corporate responsibility?
Jan 9, 2020 | oxfamadmin
Yes bank - say to inclusive and social banking and inclusive business model
Sep 27, 2019 | oxfamadmin
Creating shared value through inclusive business
Oct 7, 2019 | oxfamadmin
TATA consultancy services – empowering farmers with mobile technology
Sep 27, 2019 | oxfamadmin
What the CSR numbers don’t tell
Oct 1, 2019 | oxfamadmin
6 important things companies need to do to be inclusive
Nov 21, 2019 | oxfamadmin
Why businesses need to invest in creating a productive population for a sustainable future
Sep 10, 2019 | oxfamadmin
Jaipur rugs – weaving the lives of the poor into the global markets. an inclusive business model.
Oct 24, 2019 | oxfamadmin
The next 15 years: highlighting the role of the private sector in development
Oct 7, 2019 | oxfamadmin
Emphasizing a human rights-based approach to inclusiveness in business
Oct 30, 2019 | oxfamadmin
Privatising Forests: A Bad Idea
Oct 30, 2019 | oxfamadmin
Adoption of Agenda 2030: 17 SDGs for 15 years
Nov 15, 2019 | oxfamadmin
Five questions about the #GlobalGoals you were too embarrassed to ask
Oct 7, 2019 | oxfamadmin
Last mile smile
Oct 7, 2019 | oxfamadmin
Social responsibility of companies should not stop at 2%
Sep 27, 2019 | oxfamadmin
In ‘campaign mode’, states flout FRA rules
Sep 27, 2019 | oxfamadmin
“I will not leave my forest. I will keep my jungle”
Oct 1, 2019 | oxfamadmin
Healthcare for all in India: When, How, and Why RSBY?
Oct 24, 2019 | oxfamadmin
Where is the nutrition? Ask pregnant women in a village of Bihar
Jan 9, 2020 | oxfamadmin
Learning to read at schools, but where are the textbooks?
Oct 24, 2019 | oxfamadmin
Progressive tax norms must underlie financing of the Sustainable Development Goals
Sep 27, 2019 | oxfamadmin
Teachers needed! Government schools are falling behind due to lack of funds
Oct 24, 2019 | oxfamadmin
“On My Second Day At School, A Kid Asked Me What Caste I Was”
Oct 7, 2019 | oxfamadmin
India’s missing girls: A tale of healthcare neglect faced by girls
Sep 9, 2019 | oxfamadmin
Should we only give attention to women’s health on International day of action?
Nov 18, 2019 | oxfamadmin
No respite for 72-year-old Sitaram, a month after #NepalEarthquake
Oct 7, 2019 | oxfamadmin
One month on, education of children still jolted by Nepal earthquake
Oct 24, 2019 | oxfamadmin
New worry for Nepal; landslides, floods may block relief work
Oct 7, 2019 | oxfamadmin
Monsoon preview in Kathmandu blows away shelters in relief camp
Oct 1, 2019 | oxfamadmin
Last mile distribution of relief supplies is biggest challenge in Nepal: Indian ambassador
Oct 7, 2019 | oxfamadmin
When Delhi’s Streets Buzzed with ‘Haq Banta Hai’
Oct 7, 2019 | oxfamadmin
Lack of water, toilets making things worse for women in Nepal
Oct 7, 2019 | oxfamadmin
Oxfam India gets government approval to respond to #NepalEarthquake in 28 hours
Apr 5, 2019 | oxfamadmin
Desperation creeping in, people in Nepal wait for aid
Oct 7, 2019 | oxfamadmin
#OxfaminNepal: “More than 60,000 litres of water has been provided till now”
Oct 7, 2019 | Avantika
Political (and some other) priorities in Nepal as of 28 April 2015
Oct 30, 2019 | oxfamadmin
#Nepal Earthquake: “The death toll has crossed 2000 and this is just the beginning”
Jan 9, 2020 | oxfamadmin
#NepalEarthquake: It is going to be a long road to recovery
Oct 24, 2019 | oxfamadmin
Money Matters!
Oct 24, 2019 | oxfamadmin
All for Education, Education for All
Oct 7, 2019 | oxfamadmin
When schools continue to exclude, can education reduce caste discrimination in India?
Feb 20, 2020 | oxfamadmin
Ensuring the right to education, forming bonds for life
Oct 1, 2019 | oxfamadmin
How can India send a spaceship to Mars but not educate its children?
Sep 30, 2019 | oxfamadmin
India wins in cricket, but losing out on education
Sep 30, 2019 | oxfamadmin
Oxfam's 'Even it up' report a must read lesson on Inequality
Oct 24, 2019 | oxfamadmin
It’s time to understand ‘womanhood is beyond maternity’
Oct 7, 2019 | oxfamadmin
The True Measure of Land's Value
Oct 7, 2019 | oxfamadmin
The “Ten-thousand Committee”: Reviving VHSNCs in Jharkhand
Oct 1, 2019 | oxfamadmin
Singing their way out of child marriage
Sep 10, 2019 | oxfamadmin
Land Acquisition bill tests government’s pro-poor stance
Oct 1, 2019 | oxfamadmin
Breaking the silence, standing tall
Sep 27, 2019 | oxfamadmin
Making a Song and Dance about Child Marriage
Oct 7, 2019 | oxfamadmin
Let’s Talk About Sex
Sep 10, 2019 | oxfamadmin
Mobile technology solutions could be a game changer for maternal health: Scribes
Sep 27, 2019 | oxfamadmin
Missing Girls: The Puzzling Domestic Violence Agenda
Oct 3, 2019 | oxfamadmin
Her Ghar: A right to residence for every woman
Oct 7, 2019 | oxfamadmin
Considering Gender: A Mediaperson’s Guide to Covering Disasters
Dec 16, 2019 | oxfamadmin
True Grit
Apr 5, 2019 | oxfamadmin
Violence against women and star power: Does their magic wand work?
Oct 24, 2019 | oxfamadmin
Having Those Difficult Conversations
Oct 24, 2019 | oxfamadmin
Day of the Man: guarding the china shop
Oct 7, 2019 | oxfamadmin
Gender parity needs to begin at home with mother’s guardianship rights!
Sep 9, 2019 | oxfamadmin
It’s a Girl!
Oct 1, 2019 | oxfamadmin
Let’s Help End Domestic Violence!
Oct 24, 2019 | oxfamadmin
A Few Good Men
Oct 7, 2019 | oxfamadmin
Promises to keep—Implementation of PWDV Act in Odisha
Sep 27, 2019 | oxfamadmin
Make 16 Days of Activism an Everyday Practice
Oct 30, 2019 | oxfamadmin
Witch-Hunting: A less talked about form of Violence Against Women
Oct 24, 2019 | oxfamadmin
Markets Also Discriminate
Oct 7, 2019 | oxfamadmin
Let’s Talk About Domestic Violence!
Oct 7, 2019 | oxfamadmin
Getting Serious about Ending Violence against Women and Girls
Oct 3, 2019 | oxfamadmin
Right to a Violence Free Life
Sep 10, 2019 | oxfamadmin
It’s all about the money
Sep 10, 2019 | oxfamadmin
‘It’s No Longer Funny': The Funding Wars That’ll Dictate Our Future
Oct 7, 2019 | oxfamadmin
Girl, Interrupted
Oct 1, 2019 | oxfamadmin
16 Pictures From Imagining Inequality That WiIl Tell You The Truth #evenitup
Oct 24, 2019 | oxfamadmin
These 8 Goals Were Set To Develop The World, But 14 Years Since, This Is Where We Stand
Dec 5, 2019 |
A Look At The Year 2029: What Kind Of Legacy Will We Leave Behind For Our Future Generations?
Nov 18, 2019 |
These 8 Goals Were Set To Develop The World, But 14 Years Since, This Is Where We Stand
Oct 24, 2019 | oxfamadmin
BRICS bank a necessary step, but needs more transparency
Sep 9, 2019 |
Short term memory and Long term needs!
Oct 7, 2019 |
A people’s budget has to go beyond...
Oct 24, 2019 |
National Shame, National Failure
Sep 27, 2019 | oxfamadmin
Oxfam India pledges its support to #BringBackOurGirls
Oct 1, 2019 | oxfamadmin
Closing the Gap on Gender: Is India up for the challenge?
Nov 15, 2019 | oxfamadmin
She tills, she sows, but she does not own
Oct 7, 2019 | oxfamadmin
Take a pause: what do the Uttrakhand floods tell us about India’s development model?
Sep 10, 2019 | oxfamadmin
Saving lives on sharp turning roads
Oct 1, 2019 | oxfamadmin
They do mind the gap
Oct 7, 2019 | oxfamadmin
Right to Education, still a long way to go.
Oct 1, 2019 | oxfamadmin
Can We Close the Gap on Women's Inequality in India?
Oct 30, 2019 | oxfamadmin
Breaking Old Barriers and Building New Alliances for Food Justice in India and Globally
Oct 24, 2019 | oxfamadmin
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