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Healthcare and Economic Policies of India: The Deteriorating Condition of Health Standards

By: Aniket Sachan and Deepak Kumar |




INTRODUCTION:


The citizens of a country are the most important resources that a nation as a whole possess. Their good health leads to the stability and progress of the country. However, we have witnessed that even after 73 years of independence, the health standards in our country are still dubious. The status of public hospitals, the government allocation of fund towards health sector, obsolete technology and more and more privatisation has broken the spine of health sector. In many developed as well as developing countries, the situation of health sector is much better than ours because of healthcare being a subject matter of their political agenda. In India, politician resort to religion, reservation and other stuff ignoring health standards. Political ideologies play a major role in determining the health policies of the country.


India from its inception has neglected the health sector. It has focused much more on agriculture, defence and industries but never paid attention to health sector. The present government has announced to invest 2.5 % of its GDP on healthcare by 2025 but these figures do not fulfil the present requirements. Even the lower-income group countries (like Afghanistan, Sri Lanka) are investing more percentage of GDP than India. The lower and middle-income countries spent an average of 6% of GDP on health but we still fall far behind.[1] The 12th five-year plan was incorporated to achieve the objective of 2.5% of GDP spending in health sector by 2017.[2] But even at present, we could not accomplish it and we require another plenty of years to achieve that goal. It is enough evidence to prove how the government has fallen behind and not catered to people’s health.


THE CRITICAL CONDITIONS OF HEALTH CARE INSTITUTION:


The party which is in power often regard want of resources as a primary reason for not being able to cater to the needs of health sectors. However, when it comes to their matters we ironically see funds coming in name of constructing statues of leaders and historical figures. Had we used this fund in our health sector, then surely our productivity would have increased as people of a country are its biggest asset. The government budget of the year 2017-18 had no plans to deal with the rise of Non-Communicable Diseases (NCDs). To deal with the spread of chronic diseases, the government must work to provide more investment, ensuring the availability of essential drugs and must promote a balanced diet.[3] Different studies found that inadequate facilities, lack of skilled personnel, lack of adequate medicines, medical supply, and lack of readiness have encircled the Indian health system. Another concern is the government's retreat from providing health care and allowing the private sector to be more relevant at a period when public health programs are already in a bad shape.


Even in 2019, we see the lethargic attitude of several states towards ensuring primary and basic health. High rates of maternal and infant mortality, malnutrition in children and women and the absence of clinics and hospitals where the poor can receive good quality medical care are common nationwide. In UP, there was the death of children because of the want of oxygen on a repeated basis.[4] In another incident, a ten-day infant died because of rodent bites in ICU of a hospital in Bihar.[5] The nation witnessed a gruesome incident where 103 children lost their life succumbing to Acute Encephalitis Syndrome (AES) in Muzaffarpur, Bihar.[6] All these incidents result in the breach of trust of the public on these governmental hospitals.


REASONS FOR THE WORSENING CONDITION OF HEALTH STANDARDS:


After the independence of our country, the government tried to launch various programs and policies to boost up health service but the survey and studies conducted shows these efforts could not bring forth the desired objective. The reason for the low level of health standards in the country is poor quality education and people’s indifference to health in the population.


a) Lesser Amount of Allocation of Budget For Health Sector

India has increased its spending on healthcare from 1.2% of GDP (2013-14) to 1.4% (2017-18).[7] Even if the government fulfils its promise of increasing the expenditure to 2.5% of GDP by 2025, yet it would not be enough to meet the objective because the budget allocation has not increased to such great scale. According to Population Foundation of India (PFI), India currently is spending only 1.3% of its GDP on healthcare which is relatively lesser than nations which are part of BRICS. For e.g.- Brazil's health expenditure amounts to 8.3% while that of Russia is 7.1%. Among neighbouring countries of India, Afghanistan expenditure is 8.2%, while of Maldives it is 13.7%.[8] The following data shows the poor quality of health services in our country.


India, apart from having problem in allocation of health resources, also witnesses allocation of resources as urban-centric. A new report released by the Organisation of Pharmaceutical Producers of India (OPPI) states that almost 75% of dispensaries, 60% of hospitals and 80% of doctors are in urban areas and serve only 28% of the population.[9]


"Ayushman Bharat plans to provide health insurance coverage of Rs 5 lakhs per family per year in the poor rural community of nearly 50 crore beneficiaries.[10]” Nevertheless, budgetary allocation turned the table. In the year 2017-2018, the health budget was Rs 50,079.6 Crores but in 2018-2019, the budget was Rs. 52,800 Crores for healthcare which is merely a 5% increment. This falls way short of a year-on-year increase of 20% needed to meet the target of government health spending at 2.5% of the GDP by the year 2025.[11]


b) Expertise and Other Physical Constraints

Even after so many years of independence, essential expertise such as handling medical emergencies, complications of pregnancy and childbirth, treatment of acute and severe infection in children is a cause of worry. Experts in India are leaving public hospitals and resorting to private hospitals and the pharmaceutical industry for better-paid employment. Another cause of attention is that doctors employed in public hospitals are too callous. They take their duty causally. Most of the newspaper daily headlines resort to doctors not being available in hospitals and not visiting centres on time causing troubles to the common public. Due to this sorry state of public hospitals, people resort more to private hospitals. As per Medical Council of India, the global norm according to WHO is of 1:1000 doctor-population ratio but India at present is falling behind by 50,00,000 doctors. The state of affairs in our nation is that we have only 1 doctor to 1674 patients. The same situation follows for the other workforce of health industry ie nurses, chemist and pharmacist in the Primary Health Centre (PHC) and Community Health Centre (CHC) level. According to the Rural Health Survey 2016 conducted by Ministry of health and family welfare, the health centres of country are in such pitiable conditions that they lack experts like surgeons, gynaecologists, physicians and paediatricians by 84%,77%,83% &80% respectively at community health centres.[12]


c) Privatisation of Health Sector

The privatisation of healthcare is also a serious concern. We today witness many private sector clinics and hospitals not only operating in metropolitan cities but also in villages and towns. The sorry state of public sector clinics also adds to the rise in these hospitals and people are forced to these expensive clinics as they have lost trust in public hospitals. As per the data of National Sample Survey Office (NSSO) from January–June 2014, out of the survey of 1000 people, 243 of them took medical treatment from public healthcare institutions. 756 people referred to a private practitioner.[13] The private sector is now the primary source of healthcare as the data reveals that 56% of urban and 49% of the rural population, resorts to the private sector. The situation is more pathetic in states like Uttar Pradesh (80%) & Bihar (78%).[14]


d) Poor Performance of Existing Health Centres

The worldwide ranking of Human Development Index released by UNDP clearly shows India ranks at 130 out of 189 countries. This rank presents a very poor performance in our country. According to Oxfam India, 469 millions of Indians are facing serious trouble as the health care centres are facing a shortage of essential medicines.[15] The 71st National Sample Survey (2014), shows that 58% Indians in rural areas and 68% in urban areas are dependent on private facilities for health care.[16] Operation theatre was found to be absent is 63% of PHC’s, labour room was not present in 29% of PHC’s, and 81.5% specialist–surgeons and the gynaecologists were short in CHC’s.[17]


The nation suffers from the scarcity of investment and workforce. The present healthcare institutions lack proper beds. “There is a shortage of hospital beds with a dismal ratio of 0.5 per 1000 population much lower than other countries.”[18] Because of the poor governance and reckless attention of government towards funding in the health sector there is a lack of three important As which can be defined as - accountability, affordability and access.


e) Lack of Adequate Manpower in Institutions:

One of the central characters of healthcare is the human workforce. According to the survey conducted by Public Health Foundation of India, it was found that out of 10,000population there were only 20 health workers. There were a mere 31% allopathic doctors, 30% nurses, 11%, pharmacists and 9% AYUSH practitioners.[19] Generally, the poorer areas of North and Central India are badly hit. “Skilled personnels like doctors, nurses, chemists are absent in most hospitals. The physician’s ratio in India, as per World Bank report (2016), is very terrible. The ratio in India is 0.8 per 1000 population while in the Republic of China it is 1.8.”[20], shortage of specialist at rural healthcare centres amount to 81%. The 25,308 PHCs spread across India’s rural areas are short of more than 3,000 doctors.[21] Hence, it is the need of the hour to take forth concrete steps to ensure trained, competent healthcare workers. India has a significant problem with the concentration and distribution of health resources, we are quite urban-focused.

JUDICIAL INTERVENTION IN EVOLUTION OF RIGHT TO HEALTH:


The courts have also discussed the right to health care in the context of people's rights to health care. Most of the cases encircled issues involving denial of health care and facilities in these institutions. The following case laws realize the importance of the right to health and it’s importance as a fundamental right.


The Apex Court in the landmark case of Bandhua Mukti Morcha v. Union of India [22], held that the right to live with human dignity is encompassed in Art 21, and it also includes protection to health. In another case of Vincent Panikulangara v. Union of India [23], the Supreme Court stressed that in their opinion addressing public health issues should be the highest priority of State because public healthcare is indispensable to the very existence of a community. In Consumer Education and Resource Centre v. Union of India [24], the Supreme Court has held that, “the right to health and Medical care is a fundamental right under Article 21 of the Constitution; right to health has a much wider meaning which includes right to livelihood, better standard of life, hygienic conditions on workplace and leisure.”


Further in State of Punjab and Others v. Mohinder Singh Chawala [25] & State of Punjab v. Ram Lubhaya Bagga [26], Court held right to health is integral to right to life and its Government’s constitutional obligation to provide health facilities.”In Paschim Banga [27] case the problem of inadequacies in services of medical health was discussed by the Apex Court and held that Article 21 obliges the State to safeguard the Right to Life. Therefore, it is of paramount importance to preserve human life. The medical officers operating in public hospitals have a responsibility to provide medical assistance to save human life. Justice Krishna Iyer in municipal Council, Ratlam v. Vardhichand [28] decided that Article 47 mandates crucial governance requirements to make public health development a priority. In Mahendra Pratap Singh v. State of Orissa [29], the Supreme Court held that “In India, it may not be possible to have advanced health centres but definitely villagers can aspire to have a Primary Health Centre. The government is required to assist people to lead a healthy life.”

From these case laws, it is visible that the judiciary has clearly read into Article 21, Right to Life, the right to health. It, in fact, has gone deeper into the meaning of health and has substantiated the meaning of the right to life.


REMEDYING INDIAN HEALTHCARE:

The key problems that Indian health care system faces are poor management, rampant corruption, lack of manpower, shortage of budget allocation.Today the government need not only cater to the need for curbing the rise of communicable and non-communicable disease but also it has to work to reduce the increasing stress and pollution-related diseases.

The government must take urgent steps to tackle this problem of the downfall of health standards. Following methods can be adopted to stabilise the falling condition.


1) Research centres should be constructed to discover effective medicines and the promotion of generic doses should be encouraged to ensure a better response. Apart from this, there should be proper monitoring of the availability of the essential medicine list in healthcare centres.

2) The Government apart from directly investing in the health sector also need to diversify its attention to some other issue. There must be a strict regulation for ensuring clean and safe drinking water, proper hygiene, especially in the rainy season. Wide gaps exist in the enforcement, monitoring and evaluation which needs to be tackled and there must be a modification and addition of health laws.

3) India witnesses most patients suffering from diabetes, hypertension, etc. The Government must introduce new programs such as Community-wide programs and literary camps to aware the youth and people in the country so that they can also be cautious and prevent diseases.

4) The government needs to strengthen the Integrated Child Development Scheme in poor-performing states based on experiences from other successful models (like in Tamil Nadu).[30] Micronutrient deficiency control measures like dietary diversification, food fortification, nutritional supplementation and other public health measures must be incorporated.

5) Today, when the internet is readily available, new steps should be taken by the government in order to make patients medical history record easily available. The records can be linked through Aadhaar so that it can be easily operated at any place in India. For e.g.- if a person resident of Lucknow is undergoing some medication and later shifts to Delhi and take another Doctor’s medication. Then it will ease the doctor to know his antecedent and his prior medical history, thus helping him in providing medication to him because patient being unaware with medical knowledge sometimes can’t explain his previous problems and medicines which he had been taking.


Also, the government has to make some effort to win the lost trust of the public. In order to win this lost trust, there is a need to improve the quality of health care meted out in government hospitals, the dismissal ratio of patients needs to be improved. Good governance needs to be ensured. The ethical service when will be rendered inclusive of availability of essential medicines, presence of doctors etc will surely help to regain trust.

India being the signatory of UDHR, is duty-bound to comply with the provisions of UDHR. Following declaration asserts that medical care is a right of all people. According to Article 25 of this declaration,[31] “Everybody has a right of life appropriate to the health and well-being of themselves and their relatives, including food, clothes, accommodation, welfare and the social services and a right to security in case of unemployment, sickness, injury, widowhood, age or other unregulated lifestyle.”


We have seen in this paper the challenges that are to be tackled owing to the poor financing, lack of skilled manpower in hospitals, absenteeism of doctors in hospitals, low bed ratio, horrific incidents occurring in public hospitals thus resulting in people losing trust on them and resorting to private sector, effect of too much of privatisation, poor governance and rampant corruption. The healthcare sector in India is positioned at such a situation where the government need to very meticulously take steps as it would affect the future of the health sector. We have seen in this paper the challenges that need to be tackled. We have suggested the grim realities haunting the healthcare sector, how the government need to tackle it and need to improvise its healthcare and economic policies. Even our neighbours i.e. Sri Lanka and Afghanistan actually perform much better on several health indicators. We need our own solutions to our own problems, which are best suited to our population and our systems.


***

Authors are the students of Dr. Ram Manohar Lohiya National Law University, Lucknow.


[1]World Health Organization, Countries are spending more on health, but people are still paying too much out of their own pockets, (Aug. 11, 2019, 13:49 PM), https://www.who.int/news-room/detail/20-02-2019-countries-are-spending-more-on-health-but-people-are-still-paying-too-much-out-of-their-own-pockets. [2]Planning Commission, Twelfth Five Year Plan(Social Reports), (Aug. 16, 2019, 10:04AM), http://nhsrcindia.org/sites/default/files/Twelfth%20Five%20Year%20Plan%20Health%202012-17.pdf. [3] PerianayagamArokiasamy, India's escalating burden of non-communicable diseases, (Aug. 18, 2019, 11:23 PM), https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30448-0/fulltext. [4 ]Abdul Jadid, Gorakhpur tragedy: 60 children die in Baba Raghav Das Medical College in a week amid oxygen supply disruption, (Aug. 12, 2019, 16:15 PM), https://www.hindustantimes.com/india-news/up-30-dead-in-48-hours-due-to-disruption-of-oxygen-supply-in-gorakhpur-hospital/story-TwMrMJxhAZzIkn3pXcZEMN.html. [5]8-day-old baby dies at Bihar hospital due to 'rat bite', (Aug. 12, 2019, 17:21 PM), https://timesofindia.indiatimes.com/city/patna/8-day-old-baby-dies-at-bihar-hospital-due-to-rat-bite/articleshow/66436003.cms. [6]KJ Saquib, 103 children die due to acute encephalitis in Bihar’s Muzaffarpur, (Aug. 12, 2019, 19:17 PM), https://www.hindustantimes.com/india-news/100-children-die-due-to-acute-encephalitis-in-bihar-s-muzaffarpur/story-SaTYVDsvo9q3I8hWenFgUP.html [7]India’s Spending on Health Sector has grown: Nadda, (Aug. 15, 2019, 20:25 PM), https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/indias-spending-on-health-sector-has-grown-nadda/articleshow/65309487.cms?from=mdr. [8]India spends less than BRICS, SAARC nations on health, (Aug. 15, 2019, 18:56PM), https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-spends-less-than-brics-saarc-nations-on-health/articleshow/56848698.cms?from=mdr. [9]OPPI, Report on Healthcare access Initiatives, (Aug. 15, 2019, 21:13 PM), https://www.indiaoppi.com/sites/default/files/PDF%20files/Report%20on%20healthcare%20access%20initiatives%20%28For%20web%29.pdf. [10]NDTV, Budget 2018: Arun Jaitley Unveils Healthcare Plan For India's Poorest, (Aug. 16, 2019, 9:23 AM), https://www.ndtv.com/business/budget-2018-arun-jaitley-unveils-healthcare-plan-for-indias-poorest-1807341. [11]News18.com, Modi Years and the Budget: Health Spending Not Enough to Make Bharat ‘Ayushman’, (Aug. 16, 2019, 12:34 PM ), https://www.news18.com/news/politics/modi-years-and-the-budget-health-spending-not-enough-to-make-bharat-ayushman-2021979.html. [12]National Rural Health Mission, (Aug. 17, 2019, 13:40 PM), https://nrhmis.nic.in/Pages/RHS2016.aspxRootFolder=%2FRURAL%20HEALTH%20STATISTICS%2F%28A%29RHS%20202016&FolderCTID=0x01200057278FD1EC909F429B03E86C7A7C3F31&View=%7B3EF44ABD-FC77-4A1F-9195-D34FCD06C7BA%7D. [13]Narayan Lakshman, Remedying India’s healthcare colossus, (Aug. 17, 2019, 14:47 PM), https://www.thehindu.com/sci-tech/health/policy-and-issues/Malady-Nation-Remedying-India%E2%80%99s-healthcare-colossus/article14562115.ece. [14]National Family Health Survey, (Aug. 17, 2019, 16:67 PM), http://rchiips.org/NFHS/NFHS-4Reports/India.pdf. [15]Oxfam, #dawakahaq - demand the government to make essential medicines available and affordable for all, (Aug. 17, 2019, 19:17 PM), https://donate.oxfamindia.org/access-to-affordable-medicines. [16]Ministry of Statistics and Programme Implementation, 71st NSS Round: Health in India, (Aug. 18, 2019, 18:41 PM), http://mospi.nic.in/sites/default/files/publication_reports/nss_rep574.pdf [17]Swagata Yadavar, Budget 2018: India’s Healthcare Crisis Is Holding back National Potential, (Aug. 18, 2019, 14:23 PM), https://www.indiaspend.com/budget-2018-indias-healthcare-crisis-is-holding-back-national-potential-29517/. [18]KounteyaSinha, India doesn't have even 1 hospital bed per 1,000 persons, (Aug. 21, 2019, 20:14 PM), https://timesofindia.indiatimes.com/india/India-doesnt-have-even-1-hospital-bed-per-1000-persons/articleshow/10295898.cms. [19]Public Health Foundation of India, Situation Analysis of the Health Workforce in India, (Aug. 23, 2019, 13:32 PM), http://uhc-india.org/uploads/SituationAnalysisoftheHealthWorkforceinIndia.pdf. [20]The World Bank, Physicians (per 1,000 people), (Aug. 23, 2019, 13:32 PM), https://data.worldbank.org/indicator/SH.MED.PHYS.ZS. [21]Prachi Salve, Rural Doctor Shortage Up 200% In 10 Years. What should Delhi do?, (Aug. 23, 2019, 13:32 PM), https://archive.indiaspend.com/cover-story/rural-doctor-shortage-up-200-in-10-years-what-should-delhi-do-42118. [22]BandhuaMuktiMorcha v. Union of India, AIR 1994 SC 802. [23] Vincent Panikulangara v. Union of India, AIR 1987 SC 990. [24] Consumer Education and Resource Centre v. Union of India, (1995) 3 SCC 42. [25]State of Punjab and Others v. Mohinder Singh Chawala, (1997) 2 SCC 83. [26]State of Punjab v. Ram LubhayaBagga, (1998) 4 SCC 117. [27]Paschim Banga Khet Mazdoor Samity v. State of West Bengal, (1996) 4 SCC 37. [28] Municipal Council, Ratlam v. Vardhichand, 1980 Cri LJ 1075. [29] Mahendra Pratap Singh v. State of Orissa, AIR 1997 Ori 37. [30] Government of Tamil Nadu, Social Welfare and Nutritious Meal Programme Department,(Aug. 24, 2019, 23:06 PM), http://www.tn.gov.in/gosdb/deptorders.php. [31]Universal Declaration of Human Rights, art. 25.


Image Source- https://thepenngazette.com/the-state-of-the-health-care-economy/



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