India's Healthcare is thriving 'privately'

Here is a shocking piece of information : In terms of public spending on health, India ranks 171st out of 175 countries. In contrast, it ranks an impressive 18th in terms of private spending on health.

It is hardly surprising then that the doctor ki dukan is thriving. Nor should it be a secret any longer why the poor have not bought the argument that reforms are about pulling public money out of unproductive investments and deploying it in the social sector.

Public spending on health in India is a mere 0.9% of GDP. There are only four countries - Nigeria, Indonesia, Sudan and Myanmar - which spend less. In China, with which India is often compared, the government spends 2% of GDP on health and even Nepal (1.5%) and Bangladesh (1.6%) spend more on health. Only Pakistan (1%) in this region does almost as badly as India, according to UN data.

The picture is quite different when it comes to private spending on health. Only in 17 countries does private expenditure as a percentage of GDP exceed the 4.2% figure for India. Those who spend more than India include the US, Switzerland, South Africa, Brazil, Kenya, Cambodia, El Salvador, Armenia, Bosnia and Cyprus.

The Planning Commission's latest review of the country's health sector shows there is just one doctor for 1,800 people and one bed for 1,123 of the population. Government hospitals are in desperate need of doctors and paramedics. There is a shortage of more than 42,000 in just government-run hopitals.

Union health secretary JVR Prasad Rao is candid in spelling out what this skewed funding pattern means for the people : "With the funding so low, we can either fund doctors or get medicines or provide support service. We cannot take care of all this."

In India, the gap between government and private spending on health has seen medical entrepreneurs step in to fill the void, if only for some sections of the population. Private expenditure on health includes the money pumped in by entrepreneurs in setting up private hospitals and fees paid by patients treated there. 

Experts say private hospitals are doing because the government has not been able to do much in the sector. Those who can afford to get treatment do so privately. The rest are at the mercy of overcrowded government hospitals.

But there are promises of increasing state spending on health. In its CMP, the UPA government has promised to spend 2% of GDP on health. But this may just remain a promise. "In its 1947 resolution, the government proposed to spend 12% of the GDP on health every year. Even in the best of days, it never crossed 3.6%," Rama Baru, of JNU's Centre for Social Medicine and Community Health, points out.

(Ref: Times of India July 28, 2004)