Strengthening India’s Public Health System Need of the Hour

Strengthening India’s Public Health System Need of the Hour

  • Health
  • by Anjela Taneja, Shamaila Khalil, Agrima Raina
  • 13 May, 2020

According to the Global Health Security Index[1], 2019 (which measures the country’s pandemic preparedness) India ranks at 57 out of 195 countries; much lower than the world’s global Covid-19 hotspots China (at 51) and Italy (at 31). The response to this ‘emergency’ is being steered by India’s public health system - the same system that has been plagued with decades-long chronic under- funding and side lined.

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Chronic neglect of the public health system: India’s public investment in healthcare is one of the lowest in the world. India allotted 1.28% of GDP as health budget in Financial Year 2018, as compared to the national target of 2.5%. As a result, there is only one government doctor for every 1445 Indians, much lower than the WHO’s prescribed norm of one doctor for 1000 people. The availability of government beds is abysmally low with only 0.7 beds per 1000 population[1]. This lack of resources have also put India hurdles in India’s Covid response. The Integrated Disease Surveillance Programme (ISDP) which was once considered to be India’s first line of defence against epidemics continues to struggle for manpower and resources. Similar reasons were responsible for poor quality data of Health Management Information System (HMIS), as outlined by Comptroller and Auditor General (CAG) report in 2017.

The legacy of favouring the private sector:  While the public sector has languished, the private sector has grown exponentially over the last decades[1]. The government has offered exorbitant discounts for land for building private hospitals and gave other subsidies and tax rebates. Immediately before the start of the epidemic, Niti Aayog had proposed that private health should take over government-run district hospitals. Instead of investing in the public healthcare system, the government had entered into partnerships with the private health players. A substantial ‘private’ health infrastructure has been created using taxpayers’ funds.

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The taxpayers themselves have had to pay unreasonably high prices for receiving care. Overcharging and unethical practices by private players to maximise profits has often hit the headlines. Rising healthcare costs pushes early 5.5 crore[1] Indians below the poverty line every year. The poor and vulnerable are often denied treatment by private players. This points towards the urgent need to regulate the private health sector to protect the health and rights of patients in the country.

The public Sector to the rescue: At this time the crippled public health system, equipped with a weak arsenal is shouldering the great responsibility for blunting the COVID-19 outbreak. On the other hand, the privileged private sector which constitutes nearly 70% of healthcare system has latent role during this crisis. While privatisation of government district hospitals was on the cards a few months back, several state governments have instead moved to temporarily ‘nationalize’ the private health sector to address the COVID-19 crisis. Andhra Pradesh, Rajasthan, Chhattisgarh, Madhya Pradesh and Uttarakhand have ordered the taking over of private hospitals.[1]

The need for an umbrella right to health: As India’s health system struggles to respond to the potential scale of the disaster that Covid-19 unleashed, it might be time to ponder whether it is time for India to legislate a core minimum responsibility of the state in the form of a right to health. This would be critical to ensure effective systems to avoid similar situations in the future and make communities more resilient during public health emergencies going forward. While the courts have 

Building back better: The PM Narendra Modi allotted Rs. 15, 000 crore[1] for improving the healthcare system. However, most of this money would be spent on importing safety PPE equipment, testing kits, ventilators and other such items which are urgently required to combat COVID-19 outbreak. It will not be enough to address the historic gaps in the public healthcare sector.  India needs a greater push to build back a better health system as part of this emergency.

There is no alternative to infusing significant new resources into the public health system. This includes a substantial increase in the public health budget, ramping up human resources and other infrastructure and improvement governance to ensure quality health care. No amount of strategic purchasing or outsourcing to private actors can replace a robust public health system- for everyone, but particularly for India’s poor and the lower middle class. At the same time, the private sector that dominates health care in India needs to be regulated to play a greater public function like it has been forced to play at this time of crisis. Enhanced transparency, accountability and patients’ rights are essential in both to achieve the goal of universal healthcare. It is time for everyone in India to truly enjoy the right to quality healthcare.

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[1] https://www.businesstoday.in/current/economy-politics/coronavirus-lockdown-covid-19-pandemic-public-healthcare-system-doctors-nurses-patients/story/400039.html

[1] https://frontline.thehindu.com/dispatches/article31182787.ece

https://www.indiatoday.in/india/story/uttarakhand-government-private-hospitals-coronavirus-1658985-2020-03-24

https://economictimes.indiatimes.com/news/politics-and-nation/andhra-pradesh-to-take-over-private-hospitals-to-tackle-covid-19/articleshow/74922440.cms?from=mdr

[1] https://www.thehindubusinessline.com/economy/rising-healthcare-costs-push-55-cr-indians-below-poverty-line/article24116816.ece

[1] http://www.cbhidghs.nic.in/showfile.php?lid=1147

[1] http://www.cbhidghs.nic.in/showfile.php?lid=1147

[1] https://www.ghsindex.org/about/

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