Resuscitate the system now

As the disease burden grows, India has to invest more in health infrastructure

Bottles of intravenous fluid hammered to the trunks of two neem trees in the eastern Rajasthan town of Dholpur are used to nurse back scores of feverstricken patients thronging the 15-bed Saipau community health centre. With close to 200 patients taking up all the space on the beds, floors, corridors and leaning against walls, hospital staff in desperation decided to use the tree canopies to provide shade to 15-20 patients.

With new infections such as dengue, chikungunya and H1N1, adding to pernicious diseases such as malaria and tuberculosis, India’s creaking public health infrastructure is coming close to collapsing. Increasing travel and migration between states has led to diseases that were endemic to some states causing outbreaks across India. In 2010, West Bengal had close to half of India’s more than 48,000 chikungunya infections, and in 2015, an outbreak in Karnataka accounted for more than two thirds of India’s more than 27,000 infections. This year, the infection crossed several state boundaries to affect several hundred people in Delhi, where only six cases were reported in 2012. For decades, policy-planners have regarded health expenditure as a non-productive social spending and kept budget outlays below 1% of the GDP. Poorly resourced public services, as the one in Dholpur, cannot meet the health needs of a growing population battling seasonal infections as well as non-communicable ailments. Most deaths in India are not attended to by medically certified personnel, and so no one knows what’s really killed them. The need to upgrade and invest more in the public health system becomes imperative to ensure people are diagnosed and treated quickly so infections are contained before they infect enough people to create a pool from where it can spread quickly.

Quality care is a must and if policy-makers have the will, India has the skill and resources to provide it. India attracts medical tourism for its high-quality, low-cost advanced care, and has emerged as the global pharmacy for inexpensive drugs and vaccines. Yet India’s low public outlay so far makes it impossible for the public sector to respond to the growing health needs of the population. What is needed now is transformational initiatives in health financing, public–private mix in service delivery, and strengthening primary care to take health to people’s doorsteps to lower inequities.