India's health-care plans in jeopardy

Slowing economy throws doubt on govt promise to double spending

By Nirmala Ganapathy, The Straits Times, 21 Aug 2012

NEW DELHI - India has long been among the lowest spenders for health care in the world, something that Prime Minister Manmohan Singh promised to change over the next five years.

But as India's economy slows, that plan is now in doubt, dismaying health advocates who say too many Indians do not have access to even basic primary care.

Dr Singh had promised to nearly double public spending on health care over the next five years - from US$20 billion (S$25 billion) a year to US$37 billion a year - and provide free medicine to more than half the population.

India's Planning Commission, which oversees government budgets, now says health-care spending is likely to rise to just 1.58 per cent of gross domestic product, from 1.4 per cent currently, an addition of a little over US$2 billion.

"There are resource constraints... and other priorities," Planning Commission deputy chairman Montek Singh Ahluwalia told reporters recently.

In India, half the population cannot afford essential medicines and people travel long distances and wait for hours to get even basic medical care.

Doctors, nurses and paramedics often prefer to work in the lucrative private sector. India is a medical tourism hub, and those who can afford it get top quality private care.

Meanwhile, public hospitals and clinics struggle.

"Even doubling expenditure is on the lower side for a country like India," said Dr K. Srinath Reddy, a member of the high-level expert group set up by the government to suggest ways to give everybody medical coverage. "High out-of-pocket expenditure on health is a financial burden on many sections, not just the poor but also the middle class."

There are just 600,000 doctors for a population of 1.2 billion, way below the World Health Organisation recommendation of 2.4 million doctors for that population size, according to Technopak, a consultancy firm.

"The government is in a state of denial on the extent of the health-care challenge India faces. Currently, half of the people don't have any kind of access to primary and secondary health care," said Mr Arvind Singhal, chairman of Technopak.

Mr Singhal estimates health spending needs to go up by five times to US$100 billion.

Health-care advocates say corruption is also a problem.

The Planning Commission plans to upgrade 600 district hospitals into teaching hospitals to churn out more doctors and nurses to meet the shortage of medical staff. But even that is expected to take 10 years.

The Central Bureau of Investigation is probing a billion dollar corruption scandal in the state of Uttar Pradesh, where officials were found to be diverting money meant for rural health care into their pockets.

Because many poor, sick Indians cannot afford to see a doctor, their health problems get worse, at which point the family borrows money and falls deeper into poverty, said Mr Singhal.

"The government needs to focus on primary health care," he said. "We are looking at a crisis of amazing magnitude."