3 ways to crack healthcare challenges in India

When I saw Chitra, I assumed she was no more than four years old; she was tiny and short. Her mother was a domestic worker and their family income was under $100 a month. In reality she was over eight years old and was among 43 million children in India who suffer from “stunting” arising out of chronic undernourishment and malnutrition.

When undetected, stunting undermines the survival, growth and development of children and women, and diminishes the strength and capacity of nations. Chitra embodies what India’s healthcare system looks like today – stunted and stagnated. While Chitra is growing, she is not healthy.

Over the past decade, the Indian healthcare system has achieved several notable victories. In 2014, India was declared polio free. This is a monumental achievement, considering that India accounted for more than 50% of the world’s polio cases in 2009. In 1990, maternal mortality and under-five mortality rates were 47% and 40% above the international average respectively. Finally, life expectancy has improved from 32 years a few decades ago, to over 65 years today. On the face of it, it seems like the healthcare system is working. But a closer examination reveals dangerous fault lines that if not addressed, threaten the health of over one-sixth of humanity.

Changing India’s story

For a middle class family in India today, there is so much opportunity. Living in the third-largest economy in terms of its gross national income (in PPP terms) means that an entire generation has access to technology and knowledge that can help them change their story.

Sadly, the effects of a growing economy are lost on the healthcare system in India. The World Bank reports that 50% of economic growth differentials between developing and developed nations are attributed to poor health and low life expectancy. While successive government have committed to various development goals, no government programme has yet focused on resolving the issues related to a mismanaged regulatory climate, knowledge and infrastructure deficit, and inefficient public healthcare expenditure.

With the World Health Organization’s World Health Report ranking India’s healthcare system at 112 out of 190, what should the government focus on if they want to change the status quo?

In my view, there are three critical issues that need to be addressed immediately.

1. Lack of resources. Over 60 billion rupees, around $948 million, has been cut from the national health budget. Despite a rapidly growing economy, expenditure on public healthcare has continually contracted. India spends about 1% of its GDP on public health, compared to 3% in China and 8.3% in the United States. The 2013 study from the Lancet Commission on Investing in Health found that India would have to spend $23.6 billion annually over the next 20 years to achieve a convergence with global levels of infectious disease, child and maternal mortality rates. The government can raise these resources in any number of ways, from reallocation of subsidies to optimization of welfare budgets or by working with state governments. But a failure to raise the required funding could have detrimental effects for an entire generation of Indians.
2. Out of pocket expenditure. According to the Ministry of Health in India, each year a whopping 63 million people face poverty due to “catastrophic” healthcare expenditure, which neutralizes any gains made due to rising income and various government schemes aimed at reducing poverty. And according to the World Bank and National Commission’s report on macroeconomics, only 5% of Indians are covered by health insurance. Unless mechanisms and systems are swiftly put in place to ensure that out-of-pocket expenditure is brought down, healthcare expenditure will undo all the economic progress made by millions of Indians.
3. Bridging the skills gap. There is a severe need for skilled medical graduates, especially in rural India, which fails to attract new graduates for a variety of reasons. Investments in training and educating a skilled workforce, competitive pay and attractive living conditions (especially in rural India) will ensure that public health facilities are staffed by qualified people.

Finally, poor cleanliness and hygiene is the leading cause of the spread of over 15 infectious diseases such as diarrhoea, cholera, hepatitis, leptospirosis and malaria, to name a few.

Diarrhoeal diseases alone kill 100,000 children under the age of 11 months in India each year, making water and food-borne infection the second-largest killer of children after pneumonia.

The current government has made one significant move towards tackling this challenge by launching a nationwide campaign. On 2 October 2014, the prime minister of India officially launched the Swacch Bharat Abhiyan (Clean India Mission), a campaign to clean up the country by empowering and inspiring millions of Indians. Keeping the momentum of this campaign and ensuring its sustainability will play a big role in stamping out infectious diseases.

A healthier future

Ensuring that one-sixth of humanity is healthy appears to be an insurmountable challenge, but one that the Indian government cannot ignore.

The 2015 national healthcare policy states: “The reality is straightforward. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and on an adequate scale.” Empowering and enabling women, engaging with the private sector and civil society coupled with political will can see India set forth a new course towards a healthier, more robust population and workforce.

Author: Sanjana Govindan Jayadev, Country Head, AIFO, India. She is a Global Shaper from the Bangalore Hub.

Image: Hindu pilgrims wait in line for an eye check-up at a camp organised by a non-governmental organisation (NGO) in Kolkata January 11, 2014. REUTERS/Rupak De Chowdhuri.