Poor medical infrastructure, insufficient public health services, and unmet healthcare needs persist in the country.
Every year, millions of Indians are pushed to the brink of financial ruin by medical emergencies, but as India gears up for the third phase of Lok Sabha polls, health remains conspicuously absent from the election manifesto of most political parties .
Many of these parties are uninterested in prioritising commitments on health in their poll agenda. Healthcare has suffered in the absence of adequate allocations in the Union budget under successive governments.
The result is that election after election, medical infrastructure and services leave a lot to be desired. Public health issues have traditionally not been a prominent poll agenda in India due to various factors. The most vocal sections of society ‘the educated middle class’ often do not access public health services, instead preferring the private sector. Hence, demands to improve government health services are not raised strongly.
Health still remains absent from the election manifestos of political parties because for most people, lack of employment, low income, absence of social security and rising cost of living assume priority. These affect daily lives unlike health issues that become critical only when one falls ill and unable to work.
Healthcare system in India has undergone a transformation from its initial government- funded structure to a privatised and corporatised healthcare system and underfunded public sector wherein 80-85 pc of outpatient and more than 60 per cent of inpatient care is provided by the private sector. This transformation has resulted in a system where the most vulnerable segment bears the brunt.
India has a heavy disease burden with a WHO recent report stating that the country accounts for one-fifth of the total deaths occurring from stroke and ischemic heart disease, especially in younger adults.
More than 57 per cent of women (15-49 years) and 67 per cent of children (below 5 years) are anaemic, according to the data of National Family Health Survey 5 . Not only that, the NFHS data points to a wide incidence of hypertension and diabetes, while an ICMR report says that India will have 29.8 million cancer patients in 2025. It is to be noted that Ayushman Bharat scheme needs to be re-envisioned. The IMA feels that the government hospitals should be funded directly by the government and the PMJAY should be exclusively used for strategic purchase from the private sector. The pricing of services should be based on independent scientific costing on a district level basis.
The Public Health System on which most poor and lower middle classes depend suffer from insufficient infrastructure and persistent shortfall of the public health workforce. Private health care is unaffordable. As a result, out of pocket expenditure continues to be high. Budgetary allocation for health consistently remains low and has not achieved 2.5 per cent of GDP as recommended under the national health policy 2017 and 15th Finance Commission.
Allocation for health has remained stagnant at around 2 per cent of the union budget in the last few years, according to the centre for budget governance and accountability. Despite it being known that investment in health brings back higher returns in GDP, there is no electoral dividend as the impact is indirect and delayed. According to the healthcare experts, people are keen to get the right treatment from the available health system, at any cost only when they fall sick. When people are healthy and are not acutely sick, individually or even collectively, they don’t seem to feel the need for health care. Thus, demand and struggle for health care in the future remains un-articulated.
Dr Naresh Purohit (Executive Member- Federation Of Hospital Administrators. The views and opinion expressed in this article are those of the author)
