The State must spend more on public health

The bigger challenge is the creation of a healthcare infrastructure in rural areas

India’s public health expenditure — 1% of its gross domestic product (GDP) — might have seen a marginal rise from 0.98% in 2014, but it is still far behind that of even low-income countries which spend 1.4% on an average, reveals the National Health Profile 2018. India spends even less than some of its neighbours, countries such as Bhutan (2.5%), Sri Lanka (1.6%) and Nepal (1.1%), according to the annual report released on Tuesday by the Central Bureau of Health Intelligence. In the WHO’s South-East Asian Region, which includes 10 countries, India finishes second from the bottom, above only Bangladesh (0.4%) in health expenditure. Maldives spends 9.4% of its GDP to claim the top spot in the list, followed by Thailand (2.9%). Looking forward, India’s National Health Policy 2017 proposes raising the public health expenditure to 2.5% of the GDP by 2025. In the absence of a palpable hike in spending on healthcare, achieving the national health targets is impossible. These include cutting the infant mortality rate from 41 deaths per 1,000 live births in 2015-16 to 28 by 2019 and reducing the maternal mortality ratio from 167 deaths per 100,000 births in 2013-14 to 100 by 2018-2020, and eliminating tuberculosis by 2025.

More than 62% of health expenditure is out of pocket expense for Indians . This is the tenth highest in the world, placing us in the company of nations gripped by conflict like Afghanistan. Those at the bottom of the economic pyramid suffer the most owing to this. Catastrophic health expenses might push 63 million Indian families below the poverty line every year.

The greater challenge is the creation of a healthcare infrastructure on the ground and running it in a manner that it reaches the economically disadvantaged. A fourth of the country’s primary health centres don’t have access to round-theclock power supply, and nearly 20% don’t have water. This alone should be enough to justify the State spending more on health.