The Directive Principles of State Policy India contains two articles that directly
mention healthcare. Article 47 of these Directives states that, “the improvement of public
health is among its [the State’s] primary duties”. Yet a historical dearth in public spending by Indian governments has ensured that healthcare in the country is in a shambolic state. Half of all children in India experience some stunting in growth, India’s infant mortality rate is four times that of China’s, and India is also a healthcare market where private spending is astronomically high (71%). (See Gupta, et al 2010; Joshi 2017) A rollout of the world’s largest public scheme in the form of ‘Ayushman Bharat’, popularly dubbed as ‘Modicare’, has shown some positive signs by putting healthcare within the reach of approximately 500 million Indians. But to compete with the likes of other regional superpowers like China, the Indian healthcare system will need massive overhaul to be able to provide acceptable quality of treatment to the most number possible. The state of public healthcare in India retains many of the issues one would associate with a developing economy of such size. A section in the National Family Health Survey report contains fascinating statistical research into the precise problems faced by the urban and rural populations of India. This article explores these issues in further depth throughout the following paragraphs based on these numbers.
There are three forms of healthcare in India: 1) Traditional Public Health, 2) Primary Care, 3) Secondary Care. (Joshi 2017). Traditional public health encapsulates the
environmental challenges of maintaining an acceptable standard of health. These include drainage of swamps, building roads, etc. This area of healthcare has perhaps been the most neglected area of the three, so much so that the state of TPH was better under colonial rule. The high level of infant mortality can also be ascribed to the lack of infrastructure in TPH, which is solely derived from public spending since the return on investment for private corporations is negligible. (Ibid 2017) Primary and secondary care, as the names suggest, vary in the seriousness of diseases that facilities treat. The latter is primarily restricted to life threatening or chronic conditions being treated in hospitals, whereas the former includes all basic forms of healthcare provided by physicians, as well as other unqualified practitioners.
To put the state of Indian healthcare into context, only about one third (29%) of households in the country have at least one individual that is covered by a health scheme, or health insurance. (MoHaFW 2015) China, in comparison, has 95% of its population covered under some form of healthcare, while the number for Taiwan stands at 99.6%. (China Power 2019) Around half of all children under the age of five years old in India suffer from stunted growth, while the same is true for only 9% of those born in China. (Joshi 2017) Individuals also pay much more out-of-pocket (61%) in India than most other countries in the world. This abysmally high rate forced around 63 million Indians below the poverty line in 2004. (Berman, et al 2007)
The consequences of poor healthcare coverage are felt quite uniformly across socio-
economic statuses in India. The NFHS report shows that even economically developed
states like Delhi, Maharashtra, and Gujarat have very few households where at least one
member of the family is covered by either a health scheme, or have purchase a form of
health insurance. (MoHaFW 2015) Out of the children in India that experienced stunted
growth (approx. 50%), one-fourth belong to the highest wealth quintile. (Gupta, et al 2010) Besides the massive personal cost of insuring oneself, several issues related to public health facilities prevent citizens from accessing healthcare. Among these, the primary ones are the lack of good quality care, a dearth of clinics within an appropriate distance for many, and unending waiting lines. Women are particularly disadvantaged, regardless of age or marital status. They face many additional issues along with the aforementioned ones, including the need for an acquaintance to accompany them, fearing the absence of female workers, and getting permission to access treatment at all. (MoHaFW 2015) Unfortunately, the NFHS report does not detail an equivalent data for men, but that could simply be due to the lack of male-specific issues in accessing healthcare.
It is no secret that the Indian healthcare system has been lagging behind other developing nations. Even Bangladesh has made greater strides in this sector since the 1990’s, when the nations had similarly developed healthcare systems. (Joshi 2017) An
analogy from Laurie Garrett aptly describes the state of healthcare in India: “focusing on
clinical services while neglecting services that reduce exposure to disease is like mopping the floor while keeping the tap running”. (Gupta et al 2010) Traditional Public Health is the tap, while primary and secondary care is the mopping. Problems persist with all three forms, but increasing spending on TPH can have a reverberating effect on the other two sectors as well. Without that, mopping the floor, regardless of vigor, is essentially pointless.
Abhay Almal is an undergraduate pursuing Political Science at Ashoka University.
Bakshi, Parvinrai M. The Constitution of India. Universal Law Publishing, 2018.
Berman, Peter, et al. “The Impoverishing Effect of Healthcare Payments in India: New Methodology and Findings.” Economic and Political Weekly, vol. 45, no. 16, Apr. 2010, pp. 65-71.
China Power. “Is China’s Health Care Meeting the Needs of Its People?” ChinaPower Project, 9 May 2019, chinapower.csis.org/china-health-care-quality/.
Das Gupta, Monica, et al. “How Might India’s Public Health Systems Be Strengthened? Lessons from Tamil Nadu.” Policy Research Working Papers, vol. 45, no. 10, Mar. 2009, pp. 46-60.
Joshi, Vijay. India’s Long Ro ad: The Search for Prosperity. Oxford UP, 2017.
Ministry of Health and Family Welfare. National Family Health Survey. Government of India, 2015.
Raman, Kannamma. “Review: A Critique of Healthcare Policy in India.” Economic and Political Weekly, vol. 41, no. 43, Nov. 2006, pp. 4579-4583.