The Hindu Business Line : Not a healthy sign

In a recent advertisement in a national daily, a reputed hospital chain promoted its "birthing boutique", which promises five-star luxury and home comforts along with modern operation theatres, neonatal ICU, and best doctors for the soon-to-be mothers. This is just one example of leading Indian healthcare institutions, equipped with the latest technological advances, aggressively promoting their capabilities.

Paradoxically, this is happening in a country where an estimated 1.36 lakh maternal and one million newborn deaths take place each year, according to the recently released `World Health Report 2005 — Make Every Mother and Child Count'. India has the third highest maternal mortality rate at 407, below Timor-Leste (800) and Nepal (415) in the South-East Asia region. At 68, it has the second highest infant mortality rate in the region. The report places India in the list of 51 countries showing slow progress in maternal and child health.

These alarming figures expose the inverted pyramid that the Indian healthcare system has turned into. The top is laden with treatment facilities comparable with the best in the world and at the bottom rung is a situation where there are only an estimated 1.5 beds per 1,000 people, comparing poorly even with countries like China, Brazil and Thailand that have an average of 4.3 beds per 1,000.

The country boasts of an emerging healthcare sector marked by highly rated, technologically advanced private healthcare systems. In fact, it is now attempting to position itself as a much sought-after `medical tourism destination', attracting foreigners with its low-cost, world-class medical treatment. According to a Confederation of Indian Industry (CII)-McKinsey study of last year, medical tourism can contribute Rs 5,000-10,000 crore additional revenue for upmarket tertiary hospitals by 2012. In fact, medical tourism will account for 3-5 per cent of the healthcare delivery market in this period, says the study.

India is believed to have the potential to attract one million tourists per annum, generating up to $5 billion. Treatment costs in India start at around a fifth of the cost of comparable treatment in the West, the study says. A heart surgery that would cost $30,000 in the US would cost only $6,000 here.

The significant cost advantage as well as diagnostic services are encouraging top Indian super-speciality hospitals to aggressively woo foreign patients. However, these "low-cost" treatment facilities are way beyond the means of the average Indian in rural areas who often does not even have access to basic healthcare.

The great public-private divide or the rural-urban divide is glaringly apparent here. Healthcare expenditure in India currently stands at 6.1 per cent of the GDP and is increasing. According to the CII-McKinsey study, healthcare spending is likely to more than double over the next 10 years due to changing demographic and disease profiles and rising treatment costs. Of this spending, private healthcare will be the largest component by 2012, rising to Rs 15,600 crore from the current Rs 6,900 crore. The study indicates that it could rise by an additional Rs 3,900 crore if health insurance cover is available to the rich and middle class.

In addition, public spending could double from Rs 1,700 crore if the government reaches its target spending level of 2 per cent of the GDP, up from 0.9 per cent today.

What promise does this emerging scenario hold for the average Indian in the villages? Undoubtedly, rural health infrastructure has witnessed significant expansion in the 1990s. National indicators of health and healthcare have improved but these figures pale when compared to the problem at hand. According to the World Health Report, 2005, one in every three of the world's malnourished children lives in India and about 50 per cent of all childhood deaths in India are attributable to malnutrition. About 10 per cent of the 27 million infants born each year do not survive for five years.

And infectious diseases continue to be the biggest killer, a scenario unchanged since independence, according to estimates available.

Coupled with the lack of public funding for basic healthcare in the rural areas, the crux of the problem has been poor disbursal and ineffective management.

The result? Poor facilities and inadequate supplies in primary health centres are forcing people even in the rural areas to approach ill-trained but expensive private practitioners and quacks. Often it results in debt and economic ruin, apart from the patient failing to recover.

This year's Union budget has nearly doubled the allocation for centrally sponsored schemes (CSS) such as the Midday Meal Scheme and the Integrated Child Development Scheme, and launched the National Rural Health Mission with an allocation of Rs 1,860 crore.

Rather than just a higher fund outlay, the key lies in proper disbursal of funds and strict monitoring. Some State governments have notoriously low utilisation rates. According to a study by the Centre for Equity Studies in Delhi, Bihar utilised only 31 per cent of its funds, surrendering more than Rs 24 crore over the last two financial years. There has been much talk on restructuring the CSS but no significant progress is visible. With the fund flow routed through central ministries and State government departments rather than sent directly to the districts, under-utilisation is hardly a surprise. And unspent funds are as good as no funds.

Basic healthcare cannot be given short shrift anymore. If India is serious about building credibility in the global healthcare market, it has to improve its overall health indicators. Today, `medical tourism' is becoming the buzzword even with State governments. The Maharashtra government some time ago launched the Medical Tourism Council (MTC) of Maharashtra, together with the State's business sector and private healthcare providers.

India cannot build up an image of a land of good health with just the crème de la crème of hospitals. The government must accord highest priority to primary health services and improve upon the currently abysmal monitoring and evaluation system. Along with boosting the basic infrastructure and quality of services, it must also judiciously rope in the non-profit organisations that have been doing groundwork in the rural areas and are reaching out directly to the people.

Graphics by R. Venugopal

Article E-Mail :: Comment :: Syndication :: Printer Friendly Page

Stories in this Section
Promise them their childhood

Vaid on the Web

A far-sighted approach

For die-hard romantics...

Erotica and more...

Sellabration time

The fine print

A place in the real world

Not a healthy sign