As the government moves ahead with its CMP commitment to treble the public expenditure on healthcare to 3% of GDP by 2010, it would be worthwhile to examine the constraints faced by the sector and devise remedial measures while there is still time. A review would be especially helpful in the context of mounting evidence from both developed and developing countries that larger funding of health services is not always the answer if the problems have more to do with efficiency of policies and institutional skills than with basic infrastructure. What is the state of healthcare in India? According to a nationwide survey of facilities conducted in 591 districts by the government in two phases (in 1998-99 and 2003-04) and presented to Parliament last week, more than 90% of the country?s district hospitals (DHs), first stage reference units (FRUs) and community health centres (CHCs) had their own building, equipped with electricity and operation theatres. Four-fifths had their own facility for the sterilisation of instruments. But when it came to the finer details of functional ability, the picture was far less reassuring. For instance, gynaecology as a facility was available only at about one-third of all CHCs, about half the FRUs and three-fourths of the DHs, while regular blood supply was available only at about one-tenth of the CHCs, quarter of the FRUs and less than two-thirds of the DHs. There are also primary health centres (PHCs), and the facilities at these have been on a downslide, with only around four-fifths staffed by a qualified medical officer. Only around one in seven PHCs had a female medical officer on duty, down from the ratio recorded earlier. Other declines include the availability of such instruments as infant weighing machines and deep freezers.
Money was surely provided for all those things at some point or the other. It is quite clear, then, that it could be highly wasteful to simply increase the rupee allocation on healthcare without putting in place a reliable mechanism to see the funding transformed into satisfactory outcomes. With healthcare mostly in the hands of the states, the Centre would have to motivate them to take more innovative approaches. Perhaps a system of accountability devolved to the smallest democratic unit, such as the panchayat, would help. But even this would have to be accompanied by a public awareness campaign.
