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Why healthcare does not win votes

It has been an interesting past few weeks, with the build-up to the elections in full fervour. Varied parties, myriad issues, a plethora of 'healthy' demands - the conversations, scrutiny and analysis have been like never before.

Dr Rana Mehta        Last Updated: April 4, 2014  | 16:53 IST
Why healthcare does not win votes
Rana Mehta , leader (healthcare) at PwC India.

It has been an interesting past few weeks, with the build-up to the elections in full fervour. Varied parties, myriad issues, a plethora of 'healthy' demands - the conversations, scrutiny and analysis have been like never before.

Even as we cry hoarse over corruption, investments and development, one element quintessentially missing from public discourse, in print and television discussions, and in social media too, has been a discussion around healthcare. It is a strange situation where many Indians perhaps know more about 'Obamacare' than about their own country's healthcare challenges and prerogatives. But the truth is, there is a lot of activism around healthcare that needs to be brought to public attention, in much the same way activism around corruption has.

Not healthy

Almost 1.5 million children under 5 years die every year in India and half a million die within a month after birth. According to UNICEF estimates, one in every three malnourished children in the world lives in India, and almost 50 per cent of all childhood deaths are attributed to malnourishment. Only 43.5 per cent of the Indian population has access to safe drinking water. The World Bank estimates that 21 per cent of communicable diseases in India are related to unsafe water. Adding to this issue is the sanitation crisis; 814 million Indians do not have access to sanitation services.

According to World Bank, India spends 3.9 per cent of its GDP on provision of healthcare facilities, which is equal to the GDP expenditure of Kazakhstan and Algeria. Comparatively, developed countries like the US and the UK have an expenditure of 17.9 per cent and 9.3 per cent of GDP, respectively. The public expenditure on healthcare in India stands at 31 per cent, indicating that majority of expenditure is borne by households out of their pockets.

On the other hand, most of the developed nations witnessed post-welfare healthcare reforms, driven by their governments and political parties. While in the US, cost of care was the leading driver for its healthcare agenda and became a primary presidential election issue in 2012; in the UK it was equitable access that led the way. The unrest in the country over inequity led to the government-sponsored National Health Service (NHS), the largest publicly funded health service in the world. The NHS is based on the principle of availability of affordable healthcare to all.

While the US and the UK being welfare states gave healthcare that kind of status, it is understandable that Indians still do not comprehend healthcare as a national issue as a majority of its population is still grappling with basic needs of housing, food and drinking water. The same can be supported by Maslow's hierarchy of needs model, which places the physiological needs of food and water at the bottom of the pyramid, while safety needs like healthcare are secondary and are desired by individuals only after the primary needs are met.

The India innovation spectrum

A glance through Center for Health Market Innovations (CHMI), an online platform that promotes and lists inclusive and innovative healthcare models globally, is encouraging.

It shows that developing countries are leading the way as far as healthcare innovations go, with India ahead of the pack with 250 such solutions that are helping people in the remotest corner of the country access quality healthcare, against the eight in China and 54 in South Africa. CHMI is supported by the Bill & Melinda Gates Foundation, the Rockefeller Foundation, UKaid and other global partners, and is working towards bringing governments, non-governmental organisations, social entrepreneurs and private companies together for development of the healthcare markets across the globe.

One such project is Healthline 24x7, which provides a comprehensive database to patients for selection of the most suitable healthcare provider, diagnostic centre and medicines, based on parameters selected by patients. Another program, School Health Annual Report Programme (SHARP) has been working in the field of health education and medical and clinical and immunisation services for school children since 1998.

Why the young should care

Most of these innovations are being led by young, enterprising individuals. This is heartening to see. Culturally, youngsters in our country may be driven to join a gym, but are not quite aware of other aspects of healthcare, including healthcare insurance. But what the young in India need to realise is that while India is poised to become the world's youngest country by 2020, with an average age of 29 years, the benefits India enjoys in terms of its population distribution will taper off by 2050 when a huge chunk of the population will fall in the 60+ age bracket, and health facilities will be needed to cater to the disease pattern of an ageing population.

Healthcare - In no man's land

Today healthcare is neither the prerogative of the government nor the private sector in India. The common man has to fend for himself. By inclusion of preventive healthcare and sanitation in the list of eligible CSR (corporate social responsibility) activities, the government has again shifted responsibility of healthcare delivery to the private sector. But with the population ageing in the next decade, India becoming the diabetic capital of the world, and increased incidence of cancer, the government will have to take the onus of providing affordable and quality healthcare. Therefore, the responsibility shifts to the people. And it is with citizen activism that we will be able to bring healthcare to the fore for the government and also for corporate, like citizen activism has for issues like corruption. Only then will healthcare win votes.

(The author is Leader Healthcare at PwC India)

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