How far can a mother walk on foot with a sick baby in her arms? Health care must be available within that distance.
First People's Health Congress, China, 1951
Poor health care poses a serious threat to the 'superpower' India story. At present, 46 per cent of Indian children are malnourished; one half of our future adults may be weak, stunted, many of them with low IQ. Malaria, tuberculosis and HIV can make them sick, and waste away their bodies. The growing incidence of obesity, diabetes, heart disease and cancer will kill many adults in the prime of their productive life.
India faces a double burden of disease. The infant mortality rate in 2010 lingers at 50 per 1,000 births - the Millennium Development Goal of reducing it to 28 by 2015 is certainly impossible. India is also heading towards becoming the diabetes capital of the world.What ails India's health care
Good health is not just a precondition for economic growth; it is a goal of economic growth. What ails India's health care then? Of the numerous maladies, three stand out. First, public health care is insufficient - due to resource starvation - and inefficient and corrupt, due to poor governance. India spends just 1.4 per cent of GDP on public health care, compared to 1.8 per cent by Sri Lanka, 2.3 per cent by China, and 3.3 per cent by Thailand.
Second, India's health care has become predominantly a private profit business. From village-level quacks to five-star corporate hospitals, this sector is heavily curative-oriented and prone to excessive pricing. Nationally, 78 per cent of medical consultations and 50 per cent of hospitalisations are provided by this sector. Result? People are paying out heavily from their pockets - nearly 3.3 per cent of GDP, more than twice the amount the government spends. Medical expenses are the second largest factor pushing people below the poverty line. Average hospitalisation costs nearly 60 per cent of a poor person's annual income! Naturally, those who need it most cannot avail it. Not surprisingly, the Global Commission on Macro-economics and Health as well as the WHO feel the private payment is an inefficient way to finance health care.
Third, the 'people aspect' of health care - how people live and take care of their health - has been allowed to degenerate; the protective armour of disease prevention has weakened. Nutrition is poor. India's rural and urban sanitation is dismal. Consumption of tobacco, alcohol and fast foods, and lack of exercise have become major risk factors causing a mega-epidemic of diseases such as diabetes, cardiac problems and cancers. Indeed, India is manufacturing diseases in astronomical quantities. Roadmap for the future
How should we provide health care to 1.25 billion people living in nearly one million villages, hamlets, towns and cities? Should we go the way of developed countries - a doctor-dependant, hospital-based, high-cost curative care? This model costs European countries eight to 10 per cent of GDP, or when private insurance financed, 16 per cent at present. In the US, the per capita cost of health care is $6,000. Worse, the projected health care cost in European countries is about 30 per cent of GDP by 2030, 50 per cent by 2050 and 66 per cent by 2100. If current levels continue, the US will need to spend an absurd 97 per cent of GDP in 2100 on health! Such health-care models will kill our country.
Then what should India do? The High Level Expert Group - of which I was a member - appointed by the Planning Commission of India has recommended that India should aim to provide Universal Healthcare Coverage, or UHC, ensuring equitable access to health care to every citizen.
The national health-care package should be comprehensive, encompassing prevention, promotion, cure and rehabilitation - and of good quality. Its main focus should be primary health care for which up to 70 per cent of its budget should be earmarked. But it should also include access to secondary level and selected tertiary care procedures. This system should be tax financed amounting, by our estimates, to nearly 3 per cent of the GDP by 2022. Actual health care is to be provided by expanded and improved public health care as well as by the contracted in private sector. Individuals will be free to directly seek private health care if they choose and pay for it.
There are six major features of the proposed UHC
*Focus on disease prevention and promotion of healthy living
*Active planning at every level
*Every community (approximately 1,000 people) to be served by two full-time community health workers - 'Asha' (female) and 'Ashok' (male)
*Increase in the number of doctors to one for every 1,000 people and introduction of a Bachelor's degree course in rural health care
*Totally free provision of medicines
*Management reforms and innovations to run the system.
UHC cannot be ensured by the government or the private sector alone. It will need participation of both, but more important, of the people. The nation needs empowered and healthy people, not diseased and dependant people. The future of health care will be how we shape it.The author is Director of NGO Search, and has been working in Gadchiroli, Maharashtra, for 25 years
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