Most Indians spending from pockets on health

New Delhi: India’s National Rural Health Mission is undeniably a brand that has put public heath care upfront. But does NRHM face the danger of being an end in itself? Where does it stand in the face of poor national health indicators?

India’s health scenario currently presents an appalling picture, full of contrast.

While health tourism and private healthcare is being promoted like never before, a large section of Indian population still reels under the risk of curable diseases that do not receive ample attention at the hands of policymakers.

In 2004, the UPA government of India drew up the National Common Minimum Programme, promising responsive and corruption-free governance. The ambitious NRHM programme, launched in 2005, has a clear focus to make primary health accessible to the country’s poor.

Three years down, India’s health system remains the most privatised in the world, catering to a small section of the society while the majority remain neglected.

India’s health indicators are among the worst; it has the highest number of malnourished women and children. The National Family Health Survey-III 2005-06 puts four out of every five children as anaemic, and 46% of newborns as underweight. 

What’s the progress?

To take stock, anti-poverty network Wada Na Todo Abhiyan (WNTA) and the Indian Medical Parliamentarian’s Forum (IMPF) held a discussion on April 4 to assess lessons from the ground and chart future action.

Anbumani Ramadoss, Union Minister for Health & Family Welfare, admitted that the maternal mortality rate, infant mortality rate, declining sex ratio and under nourishment were still matters of grave concern.

"The NRHM is the largest public health programme in the world, and to reduce even 1% of child mortality takes millions of personnel working together in cohesion," he said.

R. Senthil, Member of Parliament and Member Secretary, IMPF, noted that delivery of effective healthcare services to the poor remain poor due to low investments in health and increasing privatisation, with 40% of Indians selling personal assets to access healthcare.

Siba Sankar Mohanty from Centre for Budget and Governance Accountability commented that there has been a 263% increase in private 'out-of pocket' spending on health during 1996-2006. "Increase in government expenditure can impact the reduction of private spending from pockets… Even after four years, government spending on health hovers around 1%, and not 3% as promised."

Lopsided healthcare

India's spending on health resources is among the lowest in the world. This bears strongly on equitable access to health services. Coupled with lopsided allocations, with 60% of health resources focused in urban centres, the urban-rural divide is growing stronger.

There also exist policy bias and partial funding towards diseases like HIV/AIDS than curable diseases like Tuberculosis.

Healthy living is not just about curative care but preventive care as well. "The task is to make healthcare more inclusive and interlink it with safe food, water and sanitation," said Senthil.

Public health and finance expert Ravi Duggal called for changes in financing strategies, by raising the tax-GDP ratio to 35-40%, untying large funds to Panchayati Raj institutions and reining in the private sector.

Rights approach - the right approach 

Abhijit Das, member of the Advisory Group on Community Action, NRHM, said it is critical to apply the 'rights approach' in public health systems, where the state respects, fulfils and protects the rights of its citizens to basic healthcare.

People need to be made aware of their entitlements, Das stressed. Training health providers with soft skills can help improve the performance of the mission, and ease the power asymmetry between doctors and patients.

Paul Divakar from the National Campaign for Dalit Human Rights drew attention to caste biases that influence the union budget’s health and fiscal policies.

He felt that there are not enough allocations earmarked for SC/STs and there is meagre effort towards reaching sustainable health of these communities.

Addressing shortfalls

Syeda Hameed, Member, Planning Commission of India said it is important to generate awareness about NRHM among the poor.

Training midwives and reviving traditional Indian medicines can help improve health figures in rural areas, she added.

Mohanty emphasised on need for universal access to medicines and strengthening primary health infrastructure.

Amarjit Sinha, joint-secretary, Ministry of Health & Family Welfare, said the lack of resident doctors was a constraint and pointed out the need for states to allocate more funds for health services.

Global experience has shown that healthcare is equitably and universally accessible. The challenge ahead of NRHM is to help make India realise its goal of health for all its people. With of course, a greater dose of political will.