Anjela TanejaJuly 11, 2020 6:32:17 PM
India has the third largest number of COVID-19 cases in the world and we are striving to reduce its spread, conduct tests and treat those infected. However, we should also take the time to look back and analyze how things got so bad.
As we highlight the problems of the population on World Population Day, it is also important to put India's health system under the scanner and address barriers to providing quality health services to its people.
Legacy of neglect of India's health systems
For a country with a population of 1.3 billion, India continues to make one of the smallest investments in health. According , the country spends only 1.28% of its GDP on health. In Comparation, Brazil spends – 3.9%, South Korea – 4.8%, Japan – 9.2% and Germany – 9.5%. This is not just a function of finding some sort of arbitrary figure – spending is extremely low in real terms. India spends Rs. 1,657 in public year, which is R $ 138 per month or R $ 4.5 per day per person. This sucks.
As a result, people are forced to pay for their healthcare, out of pocket, which pushes almost 63 million Indians below the poverty line on a . And that number is likely to increase this year due to the COVID-19 pandemic.
Low health expenditures for the population are reflected in the low quality of access to health in India. It is ranked in 145 of the 195 countries in Access and quality of healthcare . It is below neighboring countries like Bangladesh, Sri Lanka, Bhutan and Myanmar. The dispute over hospital beds in the pandemic is a reflection that India has only . At the , Japan has 8.5 beds for 10,000 people and South Korea has almost 100 beds for every 10,000 people.
India is fighting the pandemic without basic public health services. According , 26,360 sub-centers and 1,313 primary health centers (PHC) in rural India lack a regular source of water. More than 70% in Bihar, work without a doctor and a nurse.
Due to the rapid response to COVID-19 and the blockade, essential health services, which are not directly related to the coronavirus pandemic, have been restricted. This adversely affected the poor, who depend on the public system. Child immunization in India, treatment of communicable and non-communicable diseases, including chronic diseases, have failed.
Consequences of private sector dependence
India's healthcare system is highly privatized, with 74% of hospital beds in India being . In this critical time of need, the private health sector has failed to provide not only COVID-19 treatment, but also non-COVID-10 services; some news suggest that private hospitals carry only 10% of the critical load. Official data also suggest that there was 50% in the procedures used in the Ayushman Bharat scheme due to the pandemic. Bihar, in fact, witnessed a according to then Bihar (Health) chief secretary Sanjay Kumar. In contrast, the headlines were dominated by incidents of critical patients being rejected, patient overload and serious violations of their rights. The pandemic has so far been a victory for India's public health system, which has borne most of the burden of responding to health.
Strong public health system
This pandemic created an unprecedented emergency, once in a century, public health, social and economic emergency. This strongly reminds us that a robust public health system is an essential social institution necessary for our sheer survival. In the end, it is the public health system that will be by our side in times of crisis. We must give the highest priority to strengthening, to ensure that India is ready for future health emergencies. At the same time, given the failure of the private health sector to provide universal and equitable health care to the citizens of India, we must consider regulating it, to ensure that it acts in the interests of the citizens and not in the pursuit of profits. Health problems need to be prioritized over profits, especially at times like these.
The commitment would need to start with the approval of a national legal framework for universal access to health, a commitment often articulated by the Government of India in . India's citizens need to receive health services from the government as a right, not just in the form of schemes and programs. In the absence of fair legislation, poor people and marginalized communities may not have the courage to claim their government's health rights. At the same time, the adoption of Patients' rights by Indian states and providing that provision with teeth through or other measures are essential to minimize some of the most egregious abuses. However, it is only the introduction of a universal right to health that will bridge the health care gap between rich and poor and provide a set of uniform standards for all Indian citizens in India.
It is time for citizens to come together to demand the strengthening of the public health system and the regulation of the private health sector to guarantee a healthier population and future.
The author works with Oxfam India in the field of education, health and inequality. She also coordinates the Alliance against inequality in India.
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