The Sorry State of Public Health
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02 April 2010
By Raghu Dayal
While US President Barack Obama has given top legislative priority to health insurance reform to enable Americans to have quality and affordable healthcare, Indians have little hope of deliverance from an increasingly–unaffordable health regime.
India’s primary healthcare system is based on primary health centre (PHC) and its attached sub–centres, each of which covers 3–4 villages. The Economic Survey, 2009–10, highlights a shortage of 20,486 sub–centres, 4,477 PHCs and 2,337 community health centres (CHCs) based on 2001 population norm. Only 13% of rural residents have access to a PHC, 33% to a sub–centre, 9.6% to a hospital and 28.3% to a dispensary or clinic. About two–thirds of country’s registered hospitals are private.
A recent countrywide survey of PHCs revealed average vacancies at 18% for doctors, 15% for nurses and 30% for paramedics. Absenteeism rates in this sector average 40% across the country. A study on competence level of doctors in the PHCs found, in treating diarrhoea, that a typical doctor often recommended harmful therapies. According to a 2005 Transparency International study, healthcare services account for 27% of the bribes paid for public services in the country. Again, if public doctors miss their clinic opening timings or render poor service, they still get their salary.
The National Rural Health Mission, launched on April 12, 2005, with an annual allocation of Rs 12,000 crore – increased by Rs 2,057 crore in 2009–10 – aims at providing accessible health services to the poorest households in the remotest regions of the country. The Rashtriya Swasthya Bima Yojana claims to have covered 4.5 million below–poverty–line families by issuing biometric cards. In reality, the programmes deliver far short of their avowed claims. Public health services suffer from widespread absenteeism and indifference among doctors and paramedics in the PHCs, shortages of medicines, unhygienic conditions, complaints of rude health workers, patients compelled to make informal payments, lack of supervision and accountability, and rural folk compelled to gravitate to local private practitioners, many of them unregistered and unqualified.
Against such a pathetic supply side, the demand for medicare is enormous. Over 17 lakh children in the country die annually before reaching their first birthday. India accounts for a fifth of the global disease burden: 23% of child deaths, 20% of maternal deaths, 30% of tuberculosis cases, 68% of leprosy cases and 14% of HIV cases. Tuberculosis kills around 2 million people a year around the world; in India, the disease takes a toll of 4,21,000 lives.
The spread of Malaria was brought down to negligible proportions in the 1960s, but it struck back with 6.47 million cases in 1976; and still accounts for 2–3 million cases annually. India has a disproportionately high per–capita rate of acute respiratory infections and diarrheal diseases than the rest of the world. The infant mortality rate (IMR) per 1,000 live births was 80 in 1990, which dropped only to 66 in 2000 against proportionate Millennium Development Goals (MDG) target of 57.