It needs smarter policies as much as increased spending
The Covid-19 pandemic has thoroughly exposed India’s healthcare-infrastructure deficiency—although the Centre and the states were able to quickly create some additional capacity, this has proved adequate only because the contagion hasn’t led to those levels of cases requiring hospitalisation as in some other countries.
Even so, Mumbai last year came close to exhausting nearly all of its hospital capacity. With infection numbers having shrunk and the vaccine rollout underway, the policy focus on addressing infra gaps may not have an immediate push. But, a Reuters report says the FY22 Budget will unveil a plan to double India’s public health expenditure and to take health spending to 4% of the GDP within four years, from the present 1.3%, India lags far behind other developing economies. In 2000, while India and China had a roughly similar level of public health expenditure (as % of GDP), by 2018, World Bank data shows, China’s public expenditure on health had risen to thrice the figure in 2000.
Spending 4% of GDP on public healthcare would undoubtedly help push down out-of-pocket (OOP) expenditure—OOP health spends pushed 55 million into poverty in 2011-12, as per an analysis of NSSO data by the Public Health Foundation of India (PHFI)—but the healthcare vision needs to go beyond increase spending. India must also focus on increasing healthcare workforce and leveraging technology for services to reach the poorest sections. While India has a doctor population ratio of 0.7 doctors per thousand people—WHO prescribes one doctor per thousand—most of this is concentrated in urban centres. In Bihar, only 0.3 doctors serve a thousand people. At the end of March 2019, the country’s rural areas were facing a shortfall of 18,000 specialists at community health centres.
One way to address this is to leverage the existing network of hospitals and health centres. In a 2011 report for the Planning Commission, Dr K Srinath Reddy had recommended setting up of nursing schools in under-served states, and linking medical colleges to district hospitals to dramatically lower costs of medical education, and ensure a greater supply of doctors in rural areas. However, little has been done in this regard. Narayana Hrudayalaya’s Dr Devi Shetty and Dr Reddy also point out the problem of over-medicalisation. Nurses in India, for instance, spend the most time looking after patients but aren’t even allowed to prescribe painkillers, whereas, in the US, 67% of anaesthesia is given by nurses. Shetty has pointed out that 35 medical colleges in Cuba train doctors for the US in just 50,000 sq ft of space; in contrast, India requires 140 teachers to train 100 medical students. There has to be fresh thinking on allowing nurses to become trained nurse-practitioners, create a larger pool of doctors and specialists, etc.
India needs a quantum jump in technology as well. While the government eased telemedicine only after the pandemic struck—imagine what it could have done for healthcare in remote and underserved areas had this been allowed earlier—it needs to partner with start-ups to use more AI and analytics. The government’s efforts on healthcare have to be about smarter policy, apart from increased spending.