COVID has exposed our underfunded healthcare system

Vinayak Jadhav, an 80-year old retired banker, living in Chembur, Mumbai, began feeling breathless and ill on May 12.
tapas ranjan
tapas ranjan

Vinayak Jadhav, an 80-year old retired banker, living in Chembur, Mumbai, began feeling breathless and ill on May 12. His son Viren, after preliminary examination, tried to admit him at the L H Hiranandani Hospital, in nearby Powai. The swanky, private hospital refused, insisting on a Covid test. By the time Jadhav had one done, and had tested Covid-positive, the hospital said it had no beds. The patient was finally admitted in Seven Hills Hospital, a municipal facility; but by then Vinayak Jadhav’s condition had deteriorated sharply. On May 15, he was dead. 

Sarfraz Ahmad, 35, a machinist and a resident of Etbhatti, Goregaon (East), Mumbai, fared worse. He died at home, suffering in his small slum hovel on May 30, waiting for the municipal corporation to take him to a hospital. The authorities had been notified and a health team had examined him, promising to return to pick him up on May 29. They never came. These snapshots are a telling indictment of our collapsing healthcare system. While the central government sanctioned an emergency `15,000 crore for the battle against the Coronavirus, the poor healthcare infrastructure could hardly take the load of the massive flow of Covid patients. 

Private healthcare fails
The situation has been worsened with the private health industry turning a blind eye in the fight against the pandemic. Reports from all major cities showed private hospitals turning away Covid patients. In Mumbai, the Municipal Commissioner I.S. Chahal had to issue an order commandeering 80 per cent of the private beds to ensure Covid patients did not die on the streets. Poonam Muttreja, executive director of Population Foundation of India, told that private hospitals, though they account for two-thirds of hospital beds and 80 per cent of the ventilators, are handling less than 10 per cent of the load of Covid patients.

India’s private healthcare industry is not small. It is a $280 billion industry that accounts for 74 per cent of the country’s healthcare expenditure. But it is not about rendering primary medical services. It is skewed towards five-star hospitals, and lifestyle diseases covered by huge insurance packages. It is also reflected in our failure to test rapidly and widely to detect Covid-19 cases. With just 737 government and 279 private laboratories, we are testing only 5.5 persons per 1,000 population, compared to Russia’s 124, Italy’s 85, USA’s 86 and Iran 18 per 1000. 

At a broader level, the Coronavirus pandemic has exposed India’s underfunded healthcare system. The public expenditure on health is just about 1.3 per cent of gross domestic product (GDP), perhaps the lowest in the world. Allocation for health in the Union Budget 2020-21 is just a modest increase of 5.7 per cent to `67,484 crore from the revised estimate of `63,830 crore in the previous year. In comparison, OECD’s report of ‘Health at a Glance’ shows the US spent the most on its health system, equivalent to 16.9 per cent of its GDP. France and Germany both spent 11.2 per cent of GDP, Italy 8.8 per cent, and Turkey 4.2 per cent.

No money, no will
Unfortunately, healthcare is no one’s baby. Disease and pain from lack of healthcare does not evoke strong protests. If there is a tragedy, it is the family that suffers. And, finally, it has no constituency, it’s not something that garners votes. We’ve had  ambitious announcements like the Ayushman Bharat scheme that promised universal healthcare, the wiping out tuberculosis by 2025, PPP model hospitals in 112 aspirational districts and making 2,000 essential medicines available through Jana Aushadi stores to the common man. The list goes on, but it is mostly on paper. 

On the ground, the World Health Organization (WHO) says close to two-thirds of expenditure on health in India is direct from people’s pockets, compared to the world average of 18.2 per cent. This is pushing 63 million Indians into poverty every year due to unbearable health costs. If there is a takeaway when we come out of this Covid-19 crisis, is that we have to give more money and importance to healthcare. The US spends $10,000, or over `7 lakh per person per year and it is still struggling with Covid. We in India have increased our spend from `1,008 in 2015 to just `1,944 in 2020. We can do better!

A higher investment in healthcare may not yield immediate votes, but it will certainly improve our human capital by increasing productivity, and lowering infant mortality. There is an ambitious National Health Policy in place which promises doubling health spending from the existing 1.3 per cent of Gross Domestic Product (GDP) to 2.5 per cent by 2025. This means increasing spends on the part of state and central governments by 25 per cent each year for the next 7-8 years. Or till health spending touches `8 lakh crore, up from the current `2 lakh crore. This will translate into, say, 100 hospital beds per 10,000 population (up from the 8.5 beds per 10,000), and more primary health centers. Perhaps, we will be more ready when the next health crisis strikes.

very little spending

The United States spends $10,000, or over H7 lakh per person per year, on healthcare and it is still struggling with the Covid-19 pandemic. In India, spending on healthcare has increased from H1,008 in 2015 to just H1,944 in 2020. 

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