Successive governments promised to transform the healthcare system, but little has changed on the ground, especially for the poor. Central allocation remains around 1% of GDP. States’ Health allocation has risen marginally or remained stagnant or declined— average of 4.4% of the annual health spending of India’s 17 largest states. The Union territory of Delhi and Rajasthan are the only two states where health outlay has increased by 2%. Most states feel there is no need to allocate more. The highest OPD footfall across Bihar hospitals was 11,418 in 2013-14, which fell to 9,102 in 2015 after drug availability plummeted in government facilities because of a scam in the purchase of medicines in 2014. Lack of fund allocation has forced the poor to seek treatment privately, further perpetuating poverty. Most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance. This has led many households to incur Catastrophic Health Expenditure (CHE) which can be defined as health expenditure that threatens a household’s capacity to sustain. One study found that over 35% of poor Indian households incur CHE and this reflects the detrimental state in which Indian health care system is at the moment. Whopping 63 million people are faced with poverty every year due to “catastrophic” expenditure over healthcare which neutralizes the gains of rising income and various government schemes aimed to reduce poverty, according to the health ministry.
As per a study conducted by Punjab University in the state of Punjab, data gathered from both secondary and primary sources suggests that the benefits promised to the poor in the form of free treatment in government hospitals after the setting up of Punjab Health systems Corporation, have not reached the target groups. Mainly two factors, namely, ignorance among the poor for free treatment, and complex and cumbersome procedure for getting and renewing of the yellow cards are constraining the access of the poor to public health care services. The poor in the absence of adequate access to government hospitals mainly depend upon the unorganized private sector hospitals for health care. These hospitals are dominated by untrained doctors/quacks. The dependency of the poor on private hospitals takes away around one fourth of their income. The benefits of super specialty hospitals have also not reached the poor. Factors such as elite orientation of the management, lack of awareness among the poor for free treatment and ineffective regulatory mechanisms are the major stumbling blocks.
Recent incidents of Shame
The plight of the following families underscores human apathy and a basic failure — the breakdown of poor healthcare in India. Recent media reports bring shame to the health care: i)A man in Punjab earning 150/- per day is asked to deposit Rs. 5000/- for one unit of blood, ii)A man in Odisha’s walked 6 km with his seven-year-old daughter’s body as the ambulance transporting them to the hospital left them midway after learning that the girl had died, iii)A man lost his ailing 12-year-old son on his shoulder after the state-run hospital in U P sent him to a children’s hospital, 250 metres away, without providing an ambulance, stretcher or wheelchair, iv)A man was forced off a bus with his five-day-old baby and mother-in-law, after his ailing wife died in the vehicle in MP v) With his sobbing daughter in tow, a tribal man in Odisha carried his dead wife for more than 10km because he had no money for transport and the government hospital, where she died, refused him an ambulance. vi) a tribal woman was found carrying her dead child in a bag in Sagar district because she had no money for transport. viiThe Damoh government hospital made news in June when district collector’s mother died because she couldn’t get timely treatment.
Public Health Foundation (PHF) of India says
In the overall process of political prioritization, health gets the short shrift since needs and grievances are wrongly perceived to be individual. More so health issues do not please the vote banks. India a country of 1.3 billion people is short of 5 lakhs of doctors. It has a doctor-population ratio of 1:1,674, against the recommended 1:1,000. Shortage apart, absenteeism remains high even in facilities where doctors, nurses and health workers are posted. Lack of skill among the qualified doctors is a high point of discussion and improvement. Specialists are not available at all. Only one in five doctors in rural India are qualified, says a WHO report on India’s healthcare workforce, highlighting the problem of quackery for the poor. The report found close to one-third of those calling themselves allopathic doctors educated only up to class 12. Also, 57% of the practitioners did not have any medical qualification. “Primary healthcare services is the basic foundations of a good health system,” said Dr Reddy, the President of PHF. With the private sector providing 80% of outpatient and 60% of inpatient care and patents pushing up the cost of medicines, out-of-pocket spending on health is steadily growing, pushing people into poverty.
The Lancet, a medical journal, advised a radically new architecture for India’s healthcare system. “This system must address acute as well as chronic healthcare needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework,” it said. While the expectation of the people is rising, the services are dwindling. Resultantly news items like ‘PGI doctor slapped, ‘Bengal doctor beaten up’, ‘Hospital ransacked by angry relatives’, ‘AIIMS doctor assaulted by patient’s relative, Karuna hospital burnt after patient’s death.…. continue to make frequent headlines. This is further denying healthcare to the poor.