The Indian Health Care System

A bottle of mineral water costs Rs 12 in India today, two bottles cost more than what 77% of the Indian population earns every day. This is a statistic that all educated and well off Indian should remember every morning as they have their breakfast. It might help us to remember that while India has progressed in many many ways, there are countless numbers of us who still live in a way that many middle class Indians would not allow their pets to live. This is true of half the world population, but a large proportion of the world’s poor live in India and it is our responsibility to never let this slip our mind.
10 million children die due to vaccine preventable diseases, again a large proportion of these children are Indian. And 1.7 billion people in the world do not have access to essential drugs. This means that a disease that may be easily treatable ends up in a long illness or death, that too in a population least able to face up to this disaster of long periods without wages or the loss of a wage earner.
As we can see in front of our eyes, the Government health sector is crumbling. The government hospitals are in such a state that even the poor try to avoid using these facilities and spend money on private health facilities that they can ill afford. The expenditure on health in India has actually decreased over the last twenty years. The expenditure as a % of the GDP has come down to 0.9% from 1.05%.The result has been that poor people increasingly pay for their health care and their drugs, an expenditure that they can ill afford. This leads to an increased duration of illness and death in some cases as well.
These are statistics that I have talked about earlier and I would like to reiterate them as I feel that they are important to understand the problem facing the health care industry today. The government as is evident from the statistics on health expenditure has washed its hands from the business of providing health care. This does not bother the rich who can afford to pay the charges of the private health service providers. Nor does it really bother the organized labour and the army of government servants who can arm twist the government into paying its bills, if need be, in private establishments.( Have you ever heard of an IAS officer or a minister using the government health service in West Bengal if they are really ill? And please don’t tell me about Manmohan Singh . You will have noticed that all his doctors and nurses came from a private sector hospital )
The people who face the music are the faceless millions who are in this country still voiceless as well. There are more political parties in West Bengal than there are health care centres but have you ever heard of a sustained movement by any one of them to improve the health service? Would Mamata Bannerjee ever dream of going on an indefinite hunger strike in order to improve the conditions of the government hospitals? The only people who bother are medical students. They have a social conscience as students, unfortunately as soon as they achieve a man’s estate they realize that they are at the right end of the table and the shouts die down to whimpers and then to a silence that is golden in the literal sense of the term.
It amazes me that there is a conspiracy in which all the stakeholders are involved. They are the politicians, bureaucrats, doctors, nurses, health care workers and the media as well. I know that the media highlights what they feel are stories about medical negligence; every day you can read or hear of yet another government hospital that has failed in its duties. But how often do you hear of private hospitals failing in their duties? And if you do you may be sure that there will no sustained follow up. No doctor has ever been disciplined for negligence. And why should he be? If the civil service can steal the State blind, the police can be incompetent and corrupt, the organized workforce can get away with murder, literally in some cases, lawyers can think nothing of disrupting court proceedings because a member of the bar has passed away of old age or one of them has been arrested for travelling ticketless in a bus, why expect that doctors will be held responsible? And they are not and never will be in this system.
And the solution does not lie in reforming the doctors, or the nurses or the ward boys or the sweepers. It lies in reforming the system of health care. I really am unable to understand why, 60 odd years after independence the administration still cannot ensure that there are enough doctors manning the health care facilities that have been provided. Is it so difficult to make sure that doctors are posted to the health centres and hospitals and that they actually report there for work? Is it so difficult to ensure that a transparent and equitable transfer system is in place? I have worked for the government and I am sure that if this single grievance is removed it will lead to a sea change in the morale and outlook of the doctors. This in itself will not save the health care system, but it will strengthen one of its principal pillars.
It is impossible to believe that our business schools and administrative academies cannot produce a single business plan that will work ( even at 50% efficiency) in the Government health system. If the poor can spend up to Rs 15000 a year for health care per family ( as shown in one study) they can afford to spend as much in a paying system that is sensitive to their needs as against a nominally free health system that fails to deliver any treatment and is corrupt and of low quality to boot.
There are many bodies working in health care that do provide health care at affordable costs at an acceptable standard. Their only problem is that they are run by people with exceptional commitment, which will not be available in a normal Indian. However, as I said earlier, we would be grateful if they worked even half as efficiently, that in itself would give the poor a health care system immensely better that what they are now used to.
This is something that all Indians should be thinking about. It is too important to be left to the doctor’s community or to the babus. Please think about it every morning at breakfast time. “10 million children die due to vaccine preventable diseases, again a large proportion of these children are Indian. And 1.7 billion people in the world do not have access to essential drugs” AND BE ASHAMED.BE VERY VERY ASHAMED.
( See also Health Care Costs In India , posted 2nd October 2008)


Thank you for posting such a useful, impressive and a wicked article./Wow.. looking good!
Health Care

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