India’s public expenditure on health is rising, but not as fast as its burgeoning population of 1.3 billion, which grow by 26 million each year
It’s not the lack of oxygen that kills hundreds of children in hospitals of Uttar Pradesh each year, it’s India’s abysmal public health delivery system.
“Gorakhpur is the symbol of the collapse of the primary health care system. Why should people be forced to travel 200km to get treated at a medical college when fever and anticonvulsant medicines, basic oxygenation and monitoring fluid balance should be available at the primary health centres and the community health centres, if not the health sub-centre?” asks Dr K Srinath Reddy, president, Public Health Foundation of India.
Deaths from acute encephalitis syndrome (AES) and Japanese encephalitis (JE) are higher in India than neighbouring Thailand because the disease is poorly managed, with most children reaching hospitals for treatment after convulsions have set in because of swelling in the brain.
“There are serious challenges and systematic failures in delivery of care during acute illness not just in Gorakhpur but across India. Many of these deaths can be prevented by simply following established disease management protocols at primary and secondary level, communicating and raising community awareness and not wasting time and resources on investigations and medications that are not needed,” says Sujatha Rao, former health secretary and author of Do We Care? India’s Health System.
Funding shortfall
India’s public expenditure on health is rising, but not as fast as its burgeoning population of 1.3 billion, which grow by 26 million each year. Resources are not just scarce but their use is often not rational and optimal.
Over the past two decades, successive governments at the Centre, and lately, the National Health Policy 2017, have promised to raise India’s public health expenditure to 2.5% of the GDP, yet the current spend hovers at 1.4%. States account for 0.9% of this expenditure, with Centre’s share being an abysmal 0.6% of the GDP.
“India’s new National Health Policy envisages health systems strengthening by increasing public health expenditure to 2.5 % by 2025 and increasing state health spending to more than 8% of their budget by 2020, but I don’t see it happening. Data shows that state expenditure still averages under 5%, with some states like West Bengal and Karnataka registering falls,” said Dr Reddy.
India’s total health expenditure as percentage of GDP is around 4.7%, with out-of-pocket spending accounting for around 63% of this spend.
Each year, 63 million people — close to the population of the United Kingdom — are pushed into poverty because of catastrophic health expenditure. They are forced to abandon jobs because of ill health or have to sell their land and assets to pay health care costs. With more than 9 in 10 people self-employed, private and employer-provided health insurance covers only a fraction of the population.
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