Editorial: In pursuit of elusive good health

The India Health System Review is part of the WHO’s Health Systems in Transition profile, and it offers a broad perspective on the nation’s health system. The study said even economically well-off people faced hurdles in accessing proper healthcare services during the coronavirus crisis. A significant portion of the challenges to our healthcare milieu comes from chronic underfunding. This has prevailed despite greater levels of tax devolution from the Centre to States. Even measures implemented to regulate private players leave a lot to be desired, owing to lax implementation. India is also buckling under the pressure of non-communicable diseases. Today we are known as the diabetes capital of the world as well as a hotspot for hypertension.

It may be noted that due to the rising cost of basic healthcare, two-thirds of all healthcare spend in the country is made up of ‘out of pocket’ expenditure, especially on medicines. This is ironic as the nation has been pitched as the pharmacy of the global South. Our prowess in pushing out vaccines for COVID has done little to make other medicines even remotely affordable to the masses.

Inaccessibility to healthcare facilities and life-saving drugs has pushed over 55 million people into poverty due to financial troubles incurred on account of healthcare spending. A little less than 20% of Indian households have experienced penury, thanks to debilitating expenses incurred in treatment annually. Some of the top medical institutions are also concentrated in urban India. So, citizens are short-changed in access to medicines, vaccines and medical equipment in government hospitals, a narrative that Tamil Nadu is striving to change. The weak procurement and logistic chains have also exacerbated this situation in the public health space.

So how do we overhaul our public health system? Our health research budget is minuscule as compared to the US that allocates 2.2 per cent of its GDP to this sector, while the UK allocates 1.7% of its GDP. In India, it is 0.02% of the GDP, at a time when it needs to be around 5% of the nation’s health budget (Rs 83,000 crore as per budget estimates 2022-23).

We must double the spending on public health, as contributed by both the Central and States, over a period of five years, thereby hitting the target of 8% of government expenditure, compared to the current 4-5%. Focussing on resources, governance and quality control of public health services is also a must. Financial management must be foolproof to ensure funds allocated are used in an optimum manner. This week, it was reported that the Centre was preparing a common platform to handle procurement of medicines for all central agencies. The objective is to drive down prices of medicines, apart from maintaining the quality of drugs.

These measures would fall short in the absence of a well-trained workforce, which requires more emphasis on learning and development. We also must talk about regulating the private sector. There is room for improvement in the implementation of the Clinical Establishments Act and Rules. Proper regulation could help standardise quality as well as costs, not to mention introduce transparency and accountability for the safety of patients, as well as clinical outcomes.