Sunrise of hope !
Sunrise of Hope.

If data is considered to be the new fuel, then we must tank up going forward without forgetting the wheels and the good old ‘puncture wala’, who is essential! That brings me to a common thought amongst many people, health of healthcare in India.

Today, the world has been taken by surprise, struggling and suffering due to the deadly Coronavirus – COVID19. Some countries were caught unaware and were hit early while some are being struck now or from Jan 20th 2020 as in the US theguardian.com/ and in India where the first case was reported on 30th January 2020. While South Korea took immediate action with an organized testing program sciencemag.org many other countries couldn’t prepare immediately. Few perhaps saw the trends and started preparing by checking at arrivals at Airports & possibly that’s it! As of now it’s actually amazing to see how fast the Indian Govt. and other related individuals and agencies #CovidWarriors are responding as India prepares to fight COVID19. Testing kits, hospital beds, trains being converted into wards to tackle the numbers and other facilities being mobilized are some such steps and hopefully we will be testing, testing and testing more. The procurement and manufacturing concerns regarding adequate PPE for doctors, nurses, health care workers and other #CovidWarriors continues. But I wish to remain positive here and see what’s being done now, rather than what wasn’t done but at the same time few questions definitely come to mind.

Did we miss February like never before ? I am not sure if anyone thought in early February, ‘What if it spreads, are we prepared”? Are we doing anything about it and is it enough? Do we have enough PPE’s, testing kits, beds, ventilators, data, medical preparedness etc.? These questions are not only mine. You may have the same queries and maybe one day when all this is behind us and the power of all this has lost its energy, these questions must be asked because long term planning and sensitivity to Public Health Care needs to continue so that India can have a robust public healthcare system.

Which brings me to this- not so much to Covid19 but about an approach towards priorities. Of course, India is a large nation and one can never really be fully prepared. But the question is not whether we are fully prepared or not, but are we going to do enough going forward for improving healthcare in our country? No better time than now to keep moving ahead proactively.

Naturally, the kind of numbers and diversity we have, its impossible to look into each aspect of the multitude of issues we face. However, choosing not to prioritize the Public Healthcare System is untenable for a growing economic power. Our doctors are sought after all over the world and we have efficiently trained medical professionals in urban areas. When we speak of infrastructure, we can’t boast at all. This article written not so long ago is very informative on how much India spends on healthcare. tomorrowmakers.com. Statistics in the above article are something we should be concerned about. I often wonder, in the last few decades why wasn’t Public Healthcare in a country like India been made a top priority?

Private Healthcare is quite effective but it’s expensive and not available to most in rural areas, the lower middle class and the poor. Even urban India depends on Insurance companies to safe guard against their expensive medical expenses and many do not even insure. As per this research paper by E&Y, “India has one of the world’s highest rates of out-of-pocket spending in health care. According to World Health Organization (WHO) data, the public sector in India spent just 1.46% of gross domestic product (GDP) on health care, ranking 187th among 194 countries and at a ratio about half that of neighboring China”. ey.com – pdf

As per The Oxford Economics forecast, the private health insurance market in India is to reach US$3.7b by 2021. This means that the healthcare system in India is following the route of the United States – the size of the insurance industry is increasing at the cost of the effectiveness of outcomes.

A simple Google search shows: “The FM announced an allocation of Rs 69,000 crore for the healthcare sector in the 2020-21 Union Budget, slightly up from last year. In 2019-20 the FM had announced a Rs 62,659.12 crore outlay for the healthcare sector.”
If we do some maths , 69000 ( budget ) /130 (population)=530.7
The amount allocated per Indian is Rs 530.7 . In dollar terms it is $7.2 per year per person. I am not sure if infrastructure is included in this but probably it is, Eg., building hospitals, medical education, equipment, HR, etc. Just to state an example, I just read the Delhi Government budget for 20-21, the allocation for health is approx. Rs 7704 crores for a population of approx. 2 crores which makes it a per person allocation of Rs 3852 per year. The Delhi Government is spending more than 6.5 times than the Central Government on HealthCare. However health is a state subject in the Constitution. One can get some state wise allocation on budgets related to healthcare here: prsindia.org

In Maharashtra 5,000 crore set aside for health in 20-21.The Finance Minister said that the proposed amount for total health outlay is 5,000 crore. Around 2,500 crore has been set aside for medical education. This includes construction of new hospitals, revamping of existing hospitals, medical colleges, and purchase of ambulances, he said. As reported in thehindu.com

However, the Centre also spends on health through centrally-sponsored schemes such as National Rural Health Mission (NRHM), and Rashtriya Swasthya Bima Yojana (RSBY) – the National Health Insurance Scheme. NRHM is the largest public health programme of Government of India. This may explain the difference in allocation by centre / states.

If we see the percentage of GDP which is allocated by Germany to the sector – allocating 11.1% of it’s GDP on the healthcare budget. This is shown in the response of the country to the Covid pandemic. Germany has been affected but not as badly as it’s neighbours – Italy, Spain and France. It has the highest number of hospital beds, and MRI imaging centers. oecd.org – pdf

Before I personally get lost in data which I think I already have , I believe that having the relevant strategies in place well in advance, perhaps reallocating or increasing a part of the Union Budget into healthcare could make a huge difference that could help our wonderful country in the future. Yes, we have the resilience and the patience and we can win.

I do have full faith in Public Healthcare, my two children were not born in a Private hospital but at AIIMS in Delhi with the best doctors one could ask for. If we have access all over the country reaching far flung places, local level quality of life and longevity will increase in years to come. We may have missed February 2020 but lets not miss the future.

“A good old farmer sows today and reaps later”, and now I shall end it here with another sunrise of hope and with the famous line which i personally believe in, ‘JAAN HAI, TO JAHAAN HAI’!



Photo: Rann of Kutch 2020 | Sunrise of Hope.

Special thanks to Raghav Wahi & Devika Tandon Nair for the discussions.

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