In her record 160-minute long speech, Union Finance Minister Nirmala Sitharaman presented the Budget for fiscal 2020-21 that made all the right noises but lacked a solid action plan. The Sensex tumbled by over 1,000 points in the intra-day trade. Finance minister Nirmala Sitharaman allocated Rs 69,000 crore, inclusive of Rs 6,400 crore for Jan Arogya Yojana, to healthcare in Budget 2020. This marks an increase from last year when she allocated Rs 62,659 crore. This, unfortunately, would not be enough, India should be spending at least 2% of the GDP on healthcare if it wants to improve the overall condition of the ailing sector.
According to The Lancet 24 lakh Indians die of treatable conditions every year, the worst situation among 130 nations. Currently, the world’s second-most populous country, India accounts for 20% of the global disease burden with a high infant mortality rate of 40 deaths per 1,000 live births. More Indians die of poor-quality care than due to a lack of access to healthcare. India added 450 million people over the 25 years to 2016, a period during which the proportion of people living in poverty fell by half. This period of rising prosperity has been marked by a “dual-disease burden”, a continuing rise in communicable diseases and a spurt in non-communicable or “lifestyle” diseases, which accounted for half of all deaths in 2015, from 42% in 2001-03.
Forty-six million children remain stunted in India and 25.5 million are defined as wasted, meaning they do not weigh enough for their height. The perils of stunting do not always correspond with the economic or political realities of a country. India, a country undergoing an economic boom, comes to a close second in children with stunting after South Sudan, a country that continues to face significant economic impediments. Close to 40 percent of Indian children are stunted because of a lack of adequate nutrition. The country risks missing out on the benefits of Demographic Dividend — economic growth that results from changes in the age structure of the country’s population.
The Supreme Court has declared healthcare to be a fundamental right under the constitution. However, historical public spending of just over a percent of GDP on healthcare has ensured that the country’s healthcare need has remained underserved and left for the private sector to service. The fundamental aspect of healthcare — primary healthcare — is in shambles. There is only one primary healthcare center (often manned by one doctor) for more than 51,000 people in the country.
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India is short of 50,00,000 doctors to fulfill the WHO norm of a 1:1000 doctor-population ratio. As many as 90 percent of people in India — if they get any health care at all — go to government-run hospitals, where care is free but far less sophisticated. The mortality rate is much higher in government hospitals compared to private ones because patients on average are poorer, malnourished and arrive at the hospital in later stages of illness. Very few receive preventive care. Compounding the issue, an astounding 70 percent of the Indian population still resides in rural areas and has very limited access to health providers.
Out-of-pocket (OOP) health expenses drove 55 million Indians–more than the population of South Korea, Spain or Kenya–into poverty in 2011-12, and of these, 38 million (69%) were impoverished by expenditure on medicines alone, according to a new study. In India, outpatient care is the largest contributor to OOP spending. The high out-of-pocket expenses in India stem from the fact that 76 percent of Indians do not have health insurance. 7% of Indians fall below the poverty line just because of indebtedness due to health expenses. This figure hasn’t changed in a decade. As a result, about 23% of sick cannot afford healthcare.
The government should have increased GDP spending on par with other developing countries, there is an estimated shortage of 160,000 additional hospital beds. There are only 0.65 doctors, 1.3 nurses and 1.3 hospital beds per 1,000 people in the country. The desired requirement by 2034 for every 1,000 people is 2.5 doctors, 5 nurses, and 3.5 beds – and to achieve this standard, an investment of around $245 billion would be required. The patient-to-medical bed ratio is probably even more abysmal; there are only 1.3 beds available for every 1,000 people, significantly below the WHO-defined benchmark of 3.5 beds per 1,000 individuals. The Indian healthcare infrastructure, to say the least, is heavily overburdened.
According to a 2015 study by PricewaterhouseCoopers (PwC), the country will need 3.5 million beds, 3 million doctors, and 6 million nurses by 2035. This means a potential investment of nearly $245 billion in the traditional healthcare delivery infrastructure over the next two decades.
The National Health Profile 2018, an annual report released by the Central Bureau of Health Intelligence, elaborates that due to a lack of focus on preventive oncology in India, over 70 percent of cancers are diagnosed only after reaching stage III or IV when treatment is more difficult and less likely to succeed. Consequently, the cure rate is low, the death rate is high, and the treatment of advanced cancer costs three-four times more than the treatment of early cancer. Small wonder, then, that India’s number of cancer-related deaths ranks among the world’s highest. Last year, 784,821 people succumbed to cancer in the country.
Source: The Times of India