FIXING PUBLIC HEALTH SYSTEMS ISN’T A CHOICE

The recent tragic and unacceptable deaths of children in the BRD Medical College in Gorakhpur has angered many. In part, what further inflamed the popular mood was the inability of the governments – both at the Centre and in the State – to grasp the difference between natural deaths and those caused by negligence. Instead of showing remorse and quickly acting to sort out issues of blame and matters of medical emergency, the political managers of the Bharatiya Janata Party and its phalanx of ministers spoke in contradictory voices and proffered conflicting explanations. Questions about the lack of oxygen, the failure to pay bills in time, a cover-up effort with a police raid and a certain air of arrogance, all that added up to complicate the tragic deaths and the grief overwhelming the hospital wards in Gorakhpur.

The most striking observation from the children’s deaths in Gorakhpur, however, is that an inherited policy failure turned into a political liability for the otherwise smug BJP government. The politics of death is always fatal for any ruling dispensation and Gorakhpur might not be an exception — unless, politics is quickly redeployed and reoriented to correct flawed policy.

What happened in Gorakhpur was shocking, but not without precedent. New-born children and infants routinely die around the country for reasons that are systemic and rooted in years of neglect. From inadequate financial resources and a shortage of qualified doctors to the lack of accountability and poor regulation of medical practices; successive governments have failed to plug the systemic deficiencies that threaten to make India the “sick country” of the world.

While more will be written in Hindustan Times as part of a deeper investigation into the state of healthcare in India, sample this for now:

For decades, we have talked about increasing government spending on healthcare to 2.5% of the country’s gross domestic product (GDP), but it continues to hover around 1.3%. China, with a GDP five times that of India, spends more than 3% of its national income on public health. That means an average Chinese gets 10 times more than an Indian does in government spending on health. The numbers for developed countries like the US and the UK are even higher.

Government spending in healthcare in India is split 2:1 between the states and the Centre. Given the states’ ability to raise new revenues are limited, the onus of any significant growth in public health spending rests largely on the Centre. It is worrying that the Centre’s health spending has remained largely unchanged in real terms – at around ₹15,000 crore annually – for the past eight years.

Worse, salaries and health campaigns are cornering more and more of what the government spends on health. According to former union health secretary K Sujatha Rao, the share of salaries in the health expenditure of all states increased from 47% in 2007-08 to 55% in 2011-12. The combined share of medicine supplies, equipment, hospital infrastructure and maintenance fell from 20% to 15% during the same period.

It would be safe to assume the share of salaries has risen further following the implementation of the Pay Commission report, and that resources for subsidised medicines and in-patient treatment have shrunk through these years. At this rate, we aren’t far from a situation when government hospitals will run out of medicines, equipment or facilities to treat patients. The Gorakhpur tragedy was perhaps the strongest warning in this respect.

Fixing the public healthcare system is not a choice we have. It has to be done here and now. Ignoring it, or being in denial, will have serious consequences for India’s economic ambitions. For hundreds of millions of Indians living on the margins, falling sick is a double whammy. They lose wages, a loss that is compounded by healthcare costs that a dysfunctional public healthcare system fails to take care of.

It is time policy makers and political parties stopped treating public spending on health as just welfarism. Spending on healthcare is also investing in growth.

CHINA SPENDS MORE THAN 3% OF ITS GDP ON PUBLIC HEALTH. THAT MEANS AN AVERAGE CHINESE GETS 10 TIMES MORE THAN AN INDIAN IN HEALTHCARE SPENDING