Skip to main content

Unsafe water, poor sanitation, malnutrition frustrate govt’s healthcare thrust

By Moin Qazi*
The Indian economy has made rapid strides in recent year but its abysmal health system remains an Achilles heel and has impeded millions of people from sharing the gains of India’s new prosperity. India has a laggardly record in its healthcare coverage. In per capita terms, adjusted for purchasing power, the public expenditure on health is $43 a year, compared to $85 in Sri Lanka, $240 in China and $265 in Thailand.
European Nations spend ten times more and the United States spends twenty times. According to the Insurance Regulatory and Development Authority (IRDA), the Indian Government’s contribution to health insurance stands at roughly 32 percent, as opposed to 83.5 percent in the United Kingdom. India’s high rate of out-of-pocket expenses for health stems from the fact that 76 percent of Indians do not have any health insurance.
The country has a similarly low ranking on several important health indices. The dwindling budget allocation for public health care in one of the fastest-growing populations of the world starkly reflects the misplaced priorities of the Indian government. These are all really depressing statistics but this year’s budget and health-related policy reforms is some good news.
Poverty and ill-health are, indeed two sides of the same coin. An effective healthcare system is a powerful antidote against poverty. Families from the ‘vulnerable sections of the society’ struggle to pay for healthcare and are likely to fall into the never-ending trap of poverty. This coupled with the lack of basic health infrastructure in rural and remote areas aggravates the health conditions of the poor, leaving them in a perpetual state of poverty.
In a major step towards providing universal health coverage, the government announced a National Health Protection Scheme, popular as Modicare, covering ten crore poor and vulnerable families, which is around 50 crore people – about 40 percent of the population. The healthcare plan would offer up to 500,000 rupees or about $7,860 of coverage per family each year. The move is revolutionary as most people have no health insurance. The healthcare trajectory that Modicare is plotting is to free people from the worry of medical costs.
In recent years, the government has also capped prices of critical drugs and medical devices and increased health funding. Several studies have demonstrated how societal factors—caste, gender, sexuality and other marginalizing social tradition —shape not just the occurrence of diseases, but also the access to care. The cry for universal health is a cry for social justice and not just a fight for health rights. TB has now at least gone from being a death sentence to a manageable illness. The government has been building awareness of malaria by popularising blood tests wherever any one has fever. Similarly, polio has now been virtually eliminated. Mosquito nets and repellents are being liberally used even in remote villages.
Comprehensive health care, including for non-communicable diseases and maternal and child health services, and free essential drugs and diagnostic services, are to be provided at health centres. These two plans are part of the ‘Ayushman Bharat’ scheme to address health holistically, in the primary, secondary and tertiary care systems. The plan would require an estimated 110 billion rupees ($1.7 billion) in central and state funding each year. The government estimates the cost of insuring each family under the new scheme at about 1,100 rupees ($17.15). The government could also partly use the funds raised from a newly imposed one percent health cess on taxable incomes, and the health scheme would also benefit from the planned merger of three state-run insurance firms announced.
The government’s health policy does little to prevent poor health in the first place. Unsafe water, poor sanitation, malnutrition, and lack of proper housing undermine health which is partially eclipsing the achievements of government’s interventions for alleviating poverty. Poor people are dying from diarrhoea, pneumonia, under-nutrition, malaria tuberculosis and this is the result of poor hygiene and sanitation. Preventive and curative services need to go together.
Experience shows that health programmes pay enormous economic dividends. Good quality and affordable health care is the foundation for individuals to lead productive and fulfilling lives and for countries to have strong economies. For every dollar invested in childhood immunization, developing countries realize $44 in economic benefits. But funding is not the only difficulty, says Jean Drèze. “There are issues of management, corruption, accountability, and ethics and so on. The main problem is healthcare is way down the political agenda.”
India’s low levels of insurance penetration are a potential damper on its growth, with as many as 70 million people slipping into poverty each year due to sickness. According to the ‘India State-level Disease Burden Report and Technical Paper’, there has been a massive increase in disease burden on account of non-communicable diseases. It also showed a Disability Adjusted Life Years (DALY) rate increase from 1990 to 2016 for diabetes at 80 percent, and ischemic heart disease at 34 percent. DALY measures years of healthy life lost due to premature death and suffering. The average Indian’s life expectancy is about 68 years which definitely shows some improvement as compared with the past, but globally the progress is still dismal.
According to WHO’s findings last year the density of doctors at the national level was 79.7 per 100,000 population. This is very poor in order to accommodate the needs of 1.3 billion Indians. In an attempt to find relief from misery and pain, patients are left with little alternative than to turn to the private sector which comprises both legally trained and illegal doctors ,with quacks abounding in huge numbers in remote rural areas. People perceive that quality is better at informal providers even though the latter often mishandle common ailments .Private health care providers are rapacious and notorious for shoddy treatment ;they provide kickbacks for irrational drug prescribing referrals, and unnecessary pathological tests and treatments.
The infrastructure for delivering primary health care has a three tier system with Sub Centers, (SCs) Primary Health Centers (PHCs) and Community Health Centers (CHCs) spread across rural and semi urban areas. The tertiary care comprising multi-specialty hospitals and medical colleges are located almost exclusively in urban regions. Sub-centre is the first contact point between the community and the primary health care system T. it provide spublic health services such as immunization, curative care for minor ailments and is responsible for tasks relating to maternal and child health, nutrition, immunization, diarrhea control and communicable diseases . It employs one male and one female health worker, with the latter being an auxiliary nurse midwife (ANM). The only redeeming feature turns out to be the committed cadre of Auxiliary Nurse Midwife, ANM, at PHCs and their sub-centres along with Accredited Social Health Activists, ASHAs – the frontline health workers.
PHCs serve as referral units for six SCs and have a qualified doctor and four to six beds. CHCs serve as referral units for four PHCs. Each CHC has four specialists — one each of physician, surgeon, gynaecologist and paediatrician — supported by 21 paramedical and other staff members. It has 30 indoor beds, one operation theatre, X-ray and labour rooms and laboratory facilities. It provides emergency obstetrics care and specialist consultation.
Population norms per centre for the plains are 5,000 for SCs, 30,000 for PHCs and 1,20,000 for CHCs. There are 1,56,000 SCs, 25,650 PHCs and 5,624 CHCs as per the Rural Health Statistics, 2017. The system is well designed and should normally deliver good services. However, due to a shortage of resources, the SCs, PHCs and CHCs have had less than adequate infrastructure, overworked staff and inadequate incentives for the staff.
It ought to be strengthened with public investment by supplementing their services from the private sector with a contractual mechanism that reviews the performance periodically.There are around 734 district hospitals across the countries which provide secondary health care. Additionally, there are around 300 other women’s hospitals at the district level which are powerful nodes in India’s healthcare network and can be revitalized to boost the health infrastructure.
The apathy of the government is reflected in a rather poor prognosis for the health system. Primary Health Centres (PHC) in villages are supposed to screen and feed medical cases to specialized hospitals in districts and further on to state-level specialized hospitals, but PHCs do not exist in many villages, only about one for every twenty villages, and wherever present, they are so overstretched that the “access” system is broken at the first mile. India also needs to reform the governance of public healthcare. There must be a transparent and seamless ‘continuum of care’ across the spectrum from village to sub-health centre, primary health care, sub-district hospital and the district hospitals.

*Member, NITI Aayog’s National Committee on Financial Literacy and Inclusion for Women



Mental health: We talk of poverty figures, but not increase in suicides since 2014

By IMPRI Team Highlighting  the issue of mental health and addressing the challenges involved, # IMPRI Gender Impact Studies Center (GISC) , IMPRI Impact and Policy Research Institute, New Delhi organized a panel discussion on Institutional Support for Mental Health and Wellbeing under the #WebPolicyTalk series The State of Gender Equality – #GenderGaps . The discussion was chaired by Prof Vibhuti Patel, Visiting Professor, IMPRI and Former Professor, Tata Institute of Social Sciences (TISS), Mumbai . The distinguished panel included – Prof Anuradha Sovani, Former Professor and Head, Department of Psychology, and Former Dean, Faculty of Humanities at SNDT Women’s University, Mumbai and National Core Committee member and Ethics Committee Chairperson, Association of Adolescent and Child Care India ; Dr Soumitra Pathare, Director, Centre for Mental Health Law & Policy at Indian Law Society, Pune ; Dr Swati Rane, Founder CEO at SevaShakti Healthcare Consultancy, Mumbai and Founder V

How India, Bangladesh perceive, manage Sunderbans amidst climate change

By IMRPI Team The effects of climate change have been evident, and there have been a lot of debates around the changes to be made locally to help and save the earth. In this light, the nations met at the COP 26 conference recently. To discuss this further, the Center for Environment, Climate Change and Sustainable Development (CECCSD) , IMPRI Impact and Policy Research Institute, New Delhi , organized a panel discussion on “COP 26 and Locally Led Adaptations in India and Bangladesh Sunderbans” under the #WebPolicyTalk series- The State of the Environment – #PlanetTalks . The talk was chaired by Dr Jayanta Basu, Director, Non-profit EnGIO, Faculty at Calcutta University and an Environmental Journalist, The Telegraph , ABP . The Moderator of the event, Dr Simi Mehta, CEO and Editorial Director, IMPRI , started the discussion by stressing the talk on the living conditions of people living in the Sunderbans Delta from both the countries, i.e. India and Bangladesh. According to the report

NEP: Education must shift away from knowledge, move to teaching students

Dr Anjusha Gawande* The Education sector in the globe is changing dramatically. Many manual jobs may be captured over by machines as a consequence of multiple spectacular advances in science and technology, including the machine learning, and artificial intelligence. A professional workforce, particularly one that includes mathematics, computer science, and data science, as well as multidisciplinary competencies in the sciences, social sciences, and humanities, will be in incredibly popular. As a result, education must shift away from knowledge and toward teaching students, how to be creative and transdisciplinary, and how to innovate, adapt, and process information differently in innovative and rapidly changing sectors. The education development agenda at the global level is represented in Goal 4 (SDG4) of India's 2030 Agenda for Sustainable Development, which was adopted in 2015. Ministry of Education has announced the National Education Policy 2020 (NEP 2020) on 29.07.2020. In J

Dishonesty, corruption, manipulation and sustainable growth of mediocrity

By Arup Mitra* The theory of mediocrity would suggest that the meritorious who are always small in number as a nature’s gift will be dominated by a vast number of mediocre as the latter cannot withstand the inferiority they suffer from. By subjugating the merit, they derive a pleasure of having established their superiority. Such processes are functional in all spheres in life though the field of art is the worst sufferer. An artist mind is most sensitive and those who are meritorious in this lot possess exceptionally different traits. This makes them more vulnerable and, on the other hand, it paves the path of the mediocre to cast their shadows all around. Unjust and strong criticisms are sufficient to detract many. In developing countries, the modes of subjugation are many. Individuals do not hesitate to take recourse to criminal means as the subconscious prevalent with vengeance, accesses easily the outlets for execution. The lack of civility and the power of money form a unique com

Migrant problem during Covid and the role of equality for cohesive development

By IMPRI Team  The covid-19 pandemic has deepened the pre-existing inequalities across socio-economic groups, the distressing images of migrants’ exposure remained attached in our minds but not a lot has changed in terms of data collection and policy making since then to understand the role of equality for cohesive development. Cohesive development also means that human beings should respect the boundaries of nature which they cross at their own peril and the peril of other living beings on earth. In lieu to this, The State of Development Discourses – #CohesiveDevelopment, #IMPRI Center for Human Dignity and Development (CHDD) , #IMPRI Impact and Policy Research Institute , New Delhi organized #WebPolicyTalk with Prof Amiya Kumar Bagchi, on The Role of Equality for Cohesive Development. The session is inaugurated by Ms Mahima Kapoor, researcher and assistant editor at IMPRI. Ms Mahima Kapoor extended her gratitude to the speaker, moderator and the discussant. The moderator for the eve

Parallel govts: How unity of various streams of freedom movements took shape in India

By Bharat Dogra  In one of the most inspiring examples of highly courageous spontaneous actions based on the unity of people, parallel governments were formed by freedom fighters in several parts of India in the course of the Quit India Movement in 1942. Although generally four such leading efforts have been identified in Satara (Maharashtra), Talcher (Odisha), Tamluk (West Bengal) and Ballia (Uttar Pradesh), there were some other smaller efforts as well such as those in Bhagalpur (Bihar) and Gurpal (Balasore, Odisha). It is very interesting to see in most of these efforts (also very significant for understanding the freedom movement) that there was constant merging of the various streams of the freedom movement, with more militant activities openly taking place with the help of quickly mobilized militias and this being combined with various constructive programs emphasized by Mahatma Gandhi such as anti-liquor efforts and anti-untouchability movements. In addition we see actions in

West Bengal police inaction in immoral trafficking case of a Muslim woman

Kirity Roy, Secretary, Banglar Manabadhikar Suraksha Mancha (MASUM) writes to the Chairman, National Human Rights Commission, on Muslim woman victim trafficking, police inaction, and need immediate rescue: I am writing to inform you about a case of illegal trafficking and profuse police inaction regarding the same of a marginalized Muslim teenager named Anima Khatun (name changed), daughter of Mr. Osman Ali. The victim and her husband had been residents of the village Daribas, under Dinhata police station Cooch Behar district since their marriage in 2014. Six months following their marriage, Anima Khatun along with her husband, sister-in-law, sister-in-law's husband as well as her in-laws shifted to Delhi in search of work. They stayed there for 2 years after which they all came back to their native village. They stayed at their native residence for about one month and then they went back to Delhi. In Delhi, Anima was in touch with her family till the next six months, after which t

Impact of climate change on Gujarat pastoralists' traditional livelihood

By Varsha Bhagat-Ganguly, Karen Pinerio* We are sharing a study[1] based learning on climate resilience and adaptation strategies of pastoralists of Kachchh district, Gujarat. There are two objectives of the study: (i) to examine the impact of climate on traditional livelihood of pastoralists of Gujarat state; and (ii) to explore and document the adaptation strategies of pastoralists in mitigating climate adversities, with a focus on the role of women in it. In order to meet these objectives, the research inquiries focused on how pastoralists perceive climate change, how climate change has impacted their traditional livelihood, i.e., pastoralism in drylands (Krätli 2015), and how these pastoral families have evolved adaptation strategies that address climate change (CC)/ variabilities, i.e., traditional livelihood of pastoralists of Kachchh district, Gujarat state. Pastoralism is more than 5,000 years old land-use strategy in India; it is practised by nomadic (their entire livelihood r

Bangladesh sets shining example of communal peace, harmony in South Asia

By Dr. Abantika Kumari Bangladesh is made up of 160 million people who are multi-religious, multi-ethnic, and multi-lingual. The Constitution of Bangladesh guarantees all citizens the freedom to freely and peacefully practice their chosen religions. Religious minorities make up roughly 12% of Bangladesh's present population, according to conservative estimates . Hindus account for 10% of the population, Buddhists for 1%, Christians at 0.50 percent, and ethnic minorities for less than 1%. As an example of how people of different religions can live together, cooperate together, and simply be together, Bangladesh is regarded. Bangladesh is a country that values religious liberty, harmony, and tolerance. Bangladesh's population is made up of a diverse spectrum of religious groupings and ethnic groups. Such communities and groups live in harmony, putting aside their differences and learning to embrace and respect the diverse and diversified culture that has contributed to Bangladesh

Political leaders' actions are causing decontextualisation of democracy

By Harasankar Adhikari In India, does democracy become a matter of prescription, i.e., to follow the footpath left? Isn't it, in some ways, the adoption of certain prescribed procedures and mechanisms, such as timely election and populist schemes for the poor, etc.? In some cases, acts of government and governance turn democracy into a myth. It is full of political party-based agendas. This continuous hegemonic practise creates a conditional situation for the people of India. People elect their representatives who are not their representatives. They are only representatives of a particular political party that nominated them in the election. Democratic decentralisation of power is undoubtedly a unique step towards the grass roots. But a Panchayat member has no free will to act without the party’s instruction and approval. Michael Saward, a political philosopher, defines democracy as a matter of correspondence in state-society relationships. But India’s parliamentary democracy is un