HEALTH

Boost healthcare funding
Azad must push for a massive increase in the public health expenditure, apart from ensuring quality of delivery
Aditi Tandon

Last year was about India’s growth story and how its economy was shining despite the odds. But even in the sheen, something was amiss. That something became clear in November 2010 when the Global Human Development Report showed India that income growths did not guarantee human development, and if nations invested sluggishly in health, they would lose the hard-earned economic gains.

This is what is happening in India. In 2010, we were among the top 10 global gainers on the Human Development Index measured for income growth, but on the life expectancy-measured index, we fell behind even Nepal, Bangladesh and Pakistan.

After five years of promised health service delivery under the National Rural Health Mission, which has spent over Rs 30,000 crore since 2005, our life expectancy at birth remains a dismal 64.4 years as against China’s 73.5, Bangladesh’s 66.9, Pakistan’s 67.2 and Nepal’s 67.5; maternal mortality rate (MMR) remains 254 per one lakh live births as against 43 in Sri Lanka and 12 in Thailand, and under-five mortality rate remains 72 per 1000 births as against Sri Lanka’s 21.

So, why is India losing 31 per cent of the human development value when tested for health indicators? The answer lies in poor and untargeted public spending in health, which needs immediate improvements; acutely skewed health indices across states and the government’s failure to rein in population.

India’s health sector is among the most privatised in the world; drug expenditure met from out-of-pocket being 75 per cent. Public funding of health expenditure remains a poor 1.2 per cent of the GDP, abnormally low for a developing country like India, which houses 16.5 per cent of the world population but contributes hugely to its disease burden – a third of diarrhoeal diseases, TB, respiratory and parasitic infections; a quarter of maternal conditions and the second highest HIV prevalence after South Africa.

Health Minister Ghulam Nabi Azad says voluntary family planning will remain the norm. Statistics show that southern states have reached replacement levels of fertility (under two children per woman). The focus, therefore, must be on the central and northern swathes. Nationally, since 70 per cent population growth will happen due to children born to reproductive age couples (51 per cent of the population), delaying age at marriage, age at first birth and birth spacing would be critical. Since poorer people see more number of children as help in old age, the government must evolve schemes to prevent child deaths.

Equally important would be to enforce a legal age of marriage for girls because healthy mothers have healthier kids. In high-population states, 65 to 80 per cent girls marry below 18 years, leading to early motherhood and a high mother mortality rate and infant mortality rate. A newborn is seven times less likely to survive if a mother dies during childbirth.

But much of the health costing would depend on the extent and quality of healthcare available in the coming times. Here medical education reform will play a crucial role. The Medical Council of India is working on a Common Entrance Test for all 299 medical colleges (158 are private and have no admission or fee regulation) from 2011, a revised curriculum and new norms to ensure quality and uniform growth of medical colleges.

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