Healthcare in ICU

The New Year has started on a positive note. Amid all the feelings of sadness, anger and despondency following the gangrape and torture of the 23-year-old student in a moving bus in Delhi and her eventual death, there are flickers of hope. India’s young men and women are making it abundantly clear that they will fight hard for the basics, like safe and secure public spaces, not just in Delhi, but also in many other cities across the country.
It is easy to be dismissive about urban rage and street agitations. Sceptics ask if the issues which agitate urban young men and women will resonate equally with those living in villages? They also point out how quickly street protests of the past, when young men and women were out in large numbers in 2011 and 2012 protesting against graft in everyday life, fizzled out.
But all the cynical arguments notwithstanding, something is changing. Today, the urban youth, especially women, many of whom hail from “village India”, are saying they will not settle for sops and statements.
On balance, this activism for the basics is a good thing. India is rapidly urbanising and is predominantly young. Over 31 per cent of the country’s billion-plus population now lives in cities and towns. The young are aspirational, wherever they live. Without the basics, their aspirations remain unfulfilled. An unacceptably large number of young people do not have access to the basics, be it safe public spaces, education or healthcare.
Affordable healthcare forms the foundation on which individual and national aspirations soar. India, however, has always been a paradox, where impressive economic growth, a thriving pharmaceutical and biotechnology industry, and super-speciality hospitals co-exist with some of the most disheartening health indices in the world. The vast majority of Indians continue to pay for healthcare out of their pockets. Health minister Ghulam Nabi Azad has said publicly that ill health pushes nearly 39 million Indians into poverty every year and around 30 per cent in rural India do not go for any treatment due to financial constraints.
This week these stark but widely-known facts were brought home to me again when I was talking to a family living in one of South Delhi’s resettlement colonies. They have taken a loan of `2.5 lakh to pay for the treatment of their elderly father. Their first port of call was Safdarjung Hospital. The queue was too long and the family did not have any “connections”. As the health of the old man deteriorated, they had no choice but to take him to a private hospital. The family had to borrow money to pay the hospital bills. The man was in a critical state and died this week. It will take years and many sacrifices to repay the debt.
The story strikes a chord as India is debating the next wave of health reforms and weighing the pros and cons of different health financing options to narrow the gap in access to affordable healthcare.
2013 will be critical year. It will show the shape of healthcare to come. Over the past year, there have been several official statements suggesting that India is moving towards universal health coverage (UHC). We are not likely to get there overnight but there are promising signs that healthcare is becoming more of a political priority in India.
Consider the following — the expansion of healthcare is one of the top priorities of the 12th Five-Year Plan which has just been finalised. The health budget is likely to go up substantially. The draft 12th Plan (2012-17) document envisages increasing total public funding — plan and non-plan — on core health from 1.04 per cent of the GDP in 2011-12 to 1.87 per cent by the end of 2016-17.
Several new initiatives have been envisaged during this period. The health minister and the Prime Minister have said that free generic drugs will be made available through all public hospitals in the country to help in “reducing out of pocket expenditure of the poor”.
There is also growing awareness among policymakers about the social determinants of health.
In the 12th Plan, there is increased emphasis on nutrition, safe drinking water, sanitation, housing and education, especially education of girl child, which individually and together impact health outcomes.
There are plans to launch a major health initiative for the urban poor. What’s also heartening is that a lot more attention being given to how we deal with the acute shortages of doctors and other medical professionals.
All these are good signs. Now for the challenges. The key question relates to timelines and political commitment to monitor how plans translate into action on the ground. The proposed health reforms are likely to take place against the backdrop of a polarising discourse in the country on the role of the state in healthcare. To what extent can the private sector help and how best can public-private partnerships be leveraged? Answers to these questions will shape the proposed health reforms.
Then there are proposed structural changes in the public health delivery system. Prime Minister Manmohan Singh in his last Independence Day speech announced formation of a National Health Mission. The health ministry is reported to be not too enthused by the idea of a unified country-wide health mission under which flagship programmes like NRHM (National Rural Health Mission) and other disease-specific initiatives are subsumed. How will it play on the ground? As of now, it is not even clear whether the National Health Mission will be a virtual mission, consisting in practice of the NRHM and the NUHM (National Urban Health Mission), or whether it will be an entirely newly structured mission.
One of the critical issues facing policymakers is inequities in healthcare. Wide disparities in spending and outcomes persist across different states of India. Health is a state subject and poorer states spend much less on healthcare.
Addressing all these challenges may seem a gargantuan task. But it’s not asking for the moon. Indians are simply seeking the basics — a proper healthcare system that is affordable for everybody and accountable. That is the birth-right of every citizen.

The writer focuses on development issues in India and emerging economies.
She can be reached at patralekha.chatterjee@gmail.com [2]