by Dr Sanjeev Kenchaigol
The World Health Day, this year is focussed on the theme, ‘Depression-Let’s talk’. The World Health Organisation (WHO) states that about 300 million people around the world live with depression. India stares at equally grim figures of 10 million people suffering from depression every year.
Although a relevant theme, one cannot see the issue of depression in isolation from various deprivations related to poverty and high pace of urbanisation, especially when looking at India. Unfortunately, India does not have the luxury of looking at depression solely, especially since the country’s huge populace is in constant deprivation of healthcare facilities.
With rampant poverty and inequalities backed up by large rural and urban divide in our country, the state of our health services requires urgent attention. If we deconstruct the multiple health hazards that rural and urban populations go through, as some research studies reveal, the urban population is a little better off than their rural counterparts. But both, the rural and urban folks equally require universal healthcare coverage that they are deprived of as of now.
High out-of-pocket expenditure
Sadly the poor are forever pushed to extreme poverty owing to enhanced out-of-pocket expenditure (OOP) to meet their healthcare requirements. OOP is as high as 60% in India, even as it is only around 15-18% in the developed world.
The government’s efforts over the decades to provide universal and affordable healthcare for every Indian regardless of level of income, caste, gender, ethnicity and religion have been remarkable. In this respect, if we look back, public healthcare in India has grown over the years, where an authentic independent India’s Public Health Policy statement goes back to the 1980s, when, for the first time, a document on National Health Policy came into being in 1982. Now, after more than three decades, India has witnessed dramatic changes in its political economy and state of governance, and the state of health sector also has gone through notable changes.
Particularly, the macro-economic reforms that the country adopted in the 1990s has influenced the entire regime of the health policy making and it’s functioning. It also paved the way for private sector to play an important role. The substantive health policies that appeared in last two decades have allowed for private sector entry into disbursing health services along with the public sector, through its Public Private Partnership (PPP) model, aiming at Universal health coverage. The 2005 National Rural Health Mission (NRHM) was a big step towards achieving this goal.
Primary healthcare
A High Level Expert Group (HLEG) comprising of several experts and well-known academicians submitted its report in October 2010, and emphasized on the aspect of primary health care. The group suggested that with available resources, government should aim at providing universal health coverage.
The situation of primary health services in India is quite abysmal. The union budget 2017 proposed a provision of about 15 lac sub centres for primary health care in rural areas. If transformed into reality, this will benefit millions of poor with malnourished and stunted children, pregnant anaemic women, and among the poorest of the poor who cannot afford private health services.
Poor health infrastructure
In India, the health infrastructure still remains poor, where lack of manpower and dismal state of physical infrastructure in thousands of primary health centres (PHCs) tend to hinder the health of millions.
As millions of Indians are suffering from multiple health hazards and remain bereft from health services to deal with these problems, there are lofty expectations from the government’s initiatives, including Universal Health Coverage (UHC).
The recent National Health Policy 2017 approved by the government has big aspirations on providing better healthcare for all. Ironically though, the public spending in the health sector till now accounts for a dismal 1.2% of total GDP - and while the present government is aiming to increase this to 2.5%, developed nations spend a whopping 4-5% of their GDP on the health sector.
About a decade ago, a study survey report conducted in the drought hit districts of Maharashtra by journalist P Sainath revealed a heart wrenching overview of poor and debt ridden farmers who could afford neither public nor private health care services. His report stated:
Ill health has taken its toll. Neither, at their (elderly farmers’) advanced age, can work and earn a living. But health comes at a price. A price they and countless millions like them cannot pay. In Waifad (a study region), they bid us a cheery goodbye. "If you want to know about health," says one, "look at our farming. Then you'll know. We are all on saline drip, us farmers. Two years from now, we'll be on oxygen."
Ten years since that report, the situation remains largely unchanged: Even today in the average Indian village, the poor cannot dream of getting a free medical check-up anywhere in their vicinity.
The big bang theory of providing Universal Health Coverage to all, without a strong political will, won’t hold water.
Dr Sanjeev Kenchaigol is a program officer with the participatory governance research group at Public Affairs Centre.
(Note: Views expressed are the author's own.)