Indians are living longer than ever before, but they’re not leading healthier lives. Life expectancy in India shot up by almost seven years for men and more than a decade for women between 1990 and 2013, but chronic diseases such as diabetes and lung ailments have added to the years of people living with illness, reported the Global Burden of Disease study in August 2015.
Since Independence, India’s communicable diseases-centric approach had led to the neglect of lifestyle disorders, which account for more than half the country’s annual deaths. Now that people are living longer, the challenge is to ensure they lead healthier lives. Heart disease, chronic obstructive lung disease, cancers and diabetes have replaced infections as the leading cause of disease and death, pushing up medical bills for a population that largely pays for its own healthcare. India’s public health spending is among the lowest in the world. Of the total health expenditure of 4% of GDP, the government spends 1.3%, compared to 3.1% in China, 4.7% in Brazil, and 8.1% in the US, shows World Bank data.
Further cuts in the 2014-2015 budget outlays and spending has experts fearing India’s already overburdened public health system is headed for collapse. Already, the private sector provides 80% of outpatient and 60% of inpatient care. Add to that patents pushing up the cost of medicines and the rising out-of-pocket spending on health.
The NDA’s draft National Health Policy (NHP) 2015 acknowledges many of these shortcomings and focuses on disease prevention, early diagnosis and access to care. It sets a target of increasing public spending to 2.5% of GDP until India builds the human resources and institutional capacity needed to utilise increased funding and strengthen primary care.
The way forward is to consolidate existing initiatives to make delivery more efficient and improve accountability. Overlapping health policies and programmes (National Nutrition Policy, National Population Policy, National Aids Control Programme, to name a few) run by different ministries need to be integrated to improve quality and reach. A major shift is reimagining public hospitals as part of a tax-financed system where treatment is not free but pre-paid by public insurance. Currently, less than 17% of the population has health insurance cover, with more than two-thirds funded by the government.
Expanding insurance coverage, providing free medicines and diagnostics, promoting inexpensive generics, strengthening primary health by engaging both public- and private-sector providers to deliver services paid for by universal health insurance, will make healthcare delivery more inclusive.
The biggest hurdle in the expansion of services is the shortfall in nurses, physicians and specialists. More than 900,000 doctors are registered with the Medical Council of India and close to 50,000 new doctors graduate from 398 medical colleges each year, but it’s not enough to care for India’s 1.26 billion population. Most doctors and nurses end up working in urban centres, where they go to train or work. Almost all specialised care is in and around urban hubs, which have three times more hospital beds than villages, where 70% of the population lives, says the annual report of the ministry of health 2015.
This mismatch leads to thousands of villagers moving to cities for medical treatment each day, with the cost of travel, loss of employment and treatment driving 63 million into poverty each year. To meet this challenge, the draft policy draws on traditional systems of medicine to strengthen primary care at the grassroots.
Given this expanding pool of service providers, both public and private, the Centre needs a strong regulatory system to enforce accountability and high quality. That, along with streamlining of existing programmes, will help track outbreaks, disease patterns and service shortfalls to enable swift responses. The draft NHP offers the path to universal health assurance. Its effectiveness will depend on how targets are set and accountability defined.