By Jisha Krishnan
Published on 28, April, 2018
The story of my birth has always caused me certain trepidation. As a child, I remember asking my mother, “Were we so poor?” You see, I was born in a nondescript, over-crowded government hospital. All because I arrived a couple of days earlier than expected and the ‘good’ private hospital my mother was registered at was a little too far to reach comfortably, especially in the middle of the night.
Incidentally, data from the latest National Health and Family Survey (NHFS-4), conducted in 2015-2016, validates my apprehension. Over 55 per cent of households in India don’t use public health facilities. In fact, only 42 per cent Indians in urban areas and 46 per cent in rural areas opt for government medical care.
Tell me why
As per NHFS-4, the top three reasons for not availing of public health facilities in India are: Poor quality of care (48.1%), lack of nearby facility (44.6%), and a long waiting time (40.9%).
What my mother remembers distinctly from her childbirth experience – she was back home in less than 24 hours - is how there were so many women all over the hospital floor in different stages of labour. Perhaps, it’s shortage of resources, or inadequate infrastructure, or simply, overworked staff…the fact of the matter remains that there is a lot to be desired in terms of healthcare quality at government hospitals and medical centres in our country.
The ground realities in rural India are worse, with many villages not even housing a primary health centre (PHC). Of the 25,650 PHCs in the country, 15,700 have only one doctor each, while 1,974 centres function without a single doctor.
In terms of doctor-patient ratio, the World Health Organization (WHO) finds that India has only about 79.7 doctors – including allopathy, Ayurveda, Unani and homoeopathy practitioners – for every 100,000 citizens. How can we even expect to meet the ever-growing medical needs of 1.3 billion people?
Cause & effect
The public expenditure on health in India – pegged at 1.5 per cent of the GDP – is considered among the lowest in the world. The ambitious National Health Policy 2017 said that it aims to increase the health expenditure to 2.5 per cent of the GDP by 2025. Is that really good enough for a country where 63 per cent of health costs are borne out of pocket by hapless individuals?
Incidentally, even services available at the public facilities are not always affordable, even if cheaper than those at private medical centres. According to NFHS-4, the average out of pocket expenditure per childbirth in public health facility is Rs 3,198. It’s slightly higher (Rs 3,913) in urban India and lower (Rs 2,947) in rural parts of the country.
When it comes to insurance, NFHS-4 found that only 29 per cent of households have at least one member (20 per cent of women aged 15-49 and 23 per cent of men aged 15-49) covered under health insurance or health scheme.
The bitter pill
Simply put, the diagnosis of India’s ailing healthcare system is far from encouraging. On the other hand, experts predict that the Indian healthcare market will be worth US$ 280 billion by 2020. The question to ask is: How can this change the lives of the average Indian? Can it make public healthcare more accessible, affordable, and appealing?
Perhaps, there’ll be a day when we’ll have faith in India’s public healthcare system, when delivery at a government hospital won’t cause any trepidation.