From the word go, the UPA’s high-voltage ministers have been all over the place with their fast forward agendas. That all of them might not see the light of day is becoming clearer after the initial euphoria. But have you noticed that the ministry that routinely stayed in the news last time around is conspicuous by its silence?
That is the Health Ministry now headed by Ghulam Nabi Azad — whose recent remark has been confined to how marrying ‘late’ and watching television can keep India’s population in check. His predecessor, Anbumani Ramadoss, a doctor himself, was all over the place playing the role of medico-political tsar — leaving the health of the nation to the tender hands of the private sector.
But we know little of what Azad proposes to do to nurse the nation back to health. He has now got an additional Rs 4,000 crore for rural health. But when you consider that the whole system has to be built up virtually from scratch, this is small potatoes.
If the state of our education system is dismal, that of our health sector is alarming. Over the last four years, indeed even earlier, nothing has been done to improve our health infrastructure. Instead of trying to get the crumbling public health system back on its feet, the government has simply sat back and let the private sector take over. As a result, the Indian health system is the most privatised in the world. Nothing wrong with this, except that with only 0.9 per cent of the GDP spent on public health, it doesn’t look like ‘health for all’ is round the corner.
No one expects Azad to unveil a 100-day plan or a fast-track health revamp. But it would be heartening to know whether his ministry is at least formulating some strategy. For each day brings ever more fearful news of our health indicators. As if being host to almost all communicable diseases in the world was not enough, India has a fifth of all new tuberculosis cases in the world, a galloping HIV infection rate and will have 60 per cent of the burden of heart disease by 2010. We could go on.
Yet, spending on health remains negligent, forcing the poor to rely on the private sector they cannot afford. Private clinics in rural and semi-urban India are a far cry from the tony ones in metros with their piped music and unctuous service. The private clinics that the poor frequent are often run by semi-skilled personnel and lack proper medical infrastructure. The result is almost the same treatment they would get in public hospitals at twice the cost. There is not a single large state that spends even Rs 500 per capita on health.
The flexible poverty line we have witnessed ever since BPL cards came into the picture becomes even more so if you take into account health expenditure. In Bihar and Uttar Pradesh, a third of those hospitalised fell into poverty as a result of spending on medical treatment and drugs. One fifth of the population that is just above the poverty line will fall below it if they face just one serious health crisis.
The ministry’s plans of incentives for doctors who opt to work in rural areas are doomed to failure. Given the state of public health clinics, it would be a rare doctor who would go to these places for love or money. The answer would be to get locally-trained personnel. But even the statutory councils for doctors and nurses in the states don’t function. And we wonder why our doctors and nurses head off abroad at the first opportunity.
So neglected has the health system been that no one even complains any more about the fact that many life-saving drugs are simply out of reach for the majority of people. Most hospitals, whether private or public, expect the patient to buy drugs for his treatment. But when drugs can cost up to 90 per cent of the total cost of treatment, it is impossible for the poor, even the middle class, to buy them.
Which brings us to what is the best way forward in this mess. For long, we have thought that preventive medicine is better than curative medicine. No arguments there. So it stands to reason that we will be investing heavily in preventives like vaccines. But that is not so. There is a severe shortage of even the most basic vaccines that are needed for childhood immunisation.
All we can hope for is that Azad will come up with some sort of prescription to inject some vitality into the health sector. Otherwise all our claims to being the next superpower on the block will sound like a sick joke.