Cataract, which is totally treatable, is a major cause of blindness in India. This reflects poorly on our public health system.

That cataract – a completely curable ailment, requiring the simplest of surgical procedures -- should be a leading cause of blindness in India once shows up our public health systems in rather poor light. According to an AIIMS study -- conducted across 24 States and 31 districts and surveying some 90,000 people -- nearly two thirds of blind Indians above the age of 50 are cataract-afflicted. The survey also tells us that 60 per cent of cataract surgeries are carried out by private players. This perhaps explains the finding that one in five cataract patients do not go in for surgery because of the cost factor.




This brings us back to the appallingly poor presence of the State in public health. The Economic Survey 2018-19 notes that “public health expenditure as a percentage of total health expenditure increased from 22.5 per cent in 2004-05 to 30.6 per cent in 2015-16”; even so, India’s out-of-pocket expenditure at over 65 per cent is way higher than not just the developed economies but also China, Russia, Brazil and Sri Lanka, which are in the 40-50 per cent bracket. Public health expenditure as a percentage of GDP remains low, at just 1.5 per cent and only marginally up from 1.2 per cent five years ago; this is a basic cause for poor health outcomes, borne out by the unflattering macro indices such as the infant mortality rate – and now the spectre of untreated cataract as a major cause of blindness.

The Survey also points out that 60 per cent of primary health centres have only one doctor, while 5 per cent have none. This also suggests that the meagre government outlay is being focused more on larger health centres, overlooking the merits of strengthening decentralised healthcare. In fact, the categorisation of health facilities into primary, secondary and tertiary care needs to be constantly reviewed in view of the changing health profile of the population. Primary health centres need to develop the capacity to wider handle a range of ailments, going beyond the usual first aid and flu; cataract should be on that list. Insurance cover in the form of central and State schemes should not be seen as a substitute for direct public health intervention.