Saturday, Jan 28, 2023

A low priority called health

Poor Indians are forced to look towards the private sector for healthcare. Bhutan and Ethiopia spend more than India does.

Shah Alam Khan Increase in spending on healthcare, formulating relevant health policies and making the healthcare system accountable are some of the urgent necessities. (Representational Image.(Source: Thinkstock)

Ratna Devi and her nine-year-old daughter Seema (names changed) came to AIIMS, New Delhi. There was a large tumour on Seema’s knee. It had been thriving on the little girl for a year. The family was from Rajasthan, around 400 km from Delhi. The father was a farmer who owned a small piece of land, barely enough to sustain a family of six.

The tumour was treated initially at a private hospital in Jaipur, which prolonged the treatment, bleeding the family white. After it was found that the tumour was inoperable, Seema was sent to AIIMS with a small piece of paper that noted, “referred to a higher centre”.

The initial treatment of the tumour cost the family Rs 20,000 that was borrowed from the village moneylender at exorbitant interest. This now threatened the family’s only piece of sustenance — the small patch of land. Seema’s treatment in Delhi necessitated that the land be sold off.

The girl’s limb was amputated at AIIMS and she was advised chemotherapy. But the family was not able to sustain living in Delhi, so Seema could not go through the complete process of chemotherapy. Without chemotherapy, I am sure, Seema would not have made it beyond one season. The hospital records showed that Seema was lost to follow-up. For me, she was murdered.

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Seema’s story is not a one-off in this country. An article published in The Lancet on June 26 reveals the tragedy of India’s healthcare system in more objective terms. It evaluates the role of private players in the healthcare system of countries. The article brackets India with Nigeria in the group of nations with a “dominant private sector”. At the time of our “tryst with destiny,” we were made to believe that India was committing itself to socialist principles of governance. What went wrong that private players are predominant in the country’s healthcare sector? Or was it that healthcare was purposefully left “unattended” so that private enterprise could run amok? Or perhaps, healthcare as a vital investment was — and is — beyond the imagination of the country’s rulers?

The Lancet article slots Sri Lanka (along with Thailand) in a group where the “private sector compliments the universalist public sector”. The private sector’s share in healthcare in India is an astonishing 78 per cent in urban areas and 71 per cent in rural areas; in Sri Lanka the share of the two sectors is nearly equal. What is more chilling is that public-funded healthcare insurance schemes in India, like the Rashtriya Swasth Beema Yojana, give more than 80 per cent of their reimbursements to the private sector. Simply put, money from public coffers is finding its way to private lockers through legitimate systems.

Poverty caused by expenditure on health has doubled in India in the past 15 years. Out-of-pocket health expenditure in India accounted for 6.8 per cent of household resources (and 12.1 per cent of non food expenditure) in 2011-12. It does not need rocket science to understand that health is a vital resource for a nation. Healthy people contribute physically and intellectually to a nation’s well-being. Unfortunately, however, health ranks low in the priorities of our rulers. At 1.3 per cent of the GDP, public spending on healthcare in India is lower than some of the poorest countries of the world. Bhutan and Ethiopia spend more on health than we do.


The UN Population Division’s World Population Prospects reveals that Bangladesh has a better infant mortality (IMR) rate than India — 31 versus 38 per 1,000 live births. Nepal’s IMR is even better — 29 per 1,000 life births – while Sri Lanka’s IMR is better than a number of Western countries — eight per 1,000 live births. The fact that even war-ravaged Iraq has an IMR of 27 per 1,000 live births speaks volumes of the shambles in which the Indian healthcare system finds itself.

The strengthening of private healthcare at the cost of the public sector has had disastrous consequences. Seema’s story is that of every poor Indian family which is forced to look towards the private sector in the absence of a robust public health system. In a country like ours, where caste and economic stratification play vital roles, the public sector should be dominant in healthcare delivery. But private health providers have usurped what was a wonderful healthcare delivery infrastructure, on paper.

Increase in spending on healthcare, formulating relevant health policies (in a country where deaths due to diarrhea are more than deaths due to SARS) and making the healthcare system accountable are some of the urgent necessities. But private health providers are here to stay.


Whether we let them thrive at our cost or make them realise that they need to complement and not surrogate the public health care system is a choice we need to make urgently.

First published on: 30-09-2016 at 00:02 IST
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