Spotlight
New Delhi, 12 May 2018
Inadequate Health
Facilities
ARE THE POOR
BECOMING POORER?
By Dr. Oishee
Mukherjee
India’s health sector needs
to be more focussed notwithstanding improvement of the developing social
infrastructure is an imperative need. Especially against the backdrop that the
country accounts for over 60% of over 100 million people pushed into poverty world-wide
every year due to health care spending.
This was highlighted by a
World Health Organization (WHO) and World Bank report recently, with experts
pointing out that the Government’s was under-financing health. Importantly,
this conforms to the Health Ministry’s National Health Policy which two years
back has estimated health expenses pushed 60 million people into poverty annually.
Further, it has been
found that out-of-pocket expenditure on health care drives about 4.1% of
India’s population, 60 million, to extreme poverty, forcing them to live at Rs
122 ($ 1.90) a day, the report added.
Although India has a vast
network of public funded health care institutions from primary health centres
to tertiary care hospitals, experts estimated they account for only 20% of
health care services delivered. The other 80% is managed by the private sector
where expenses are beyond the reach of even the lower middle class.
Medicines account for 60%
of health care expenses in the
country and free medicines are not available to most patients. Worse, medicines
costs are high and sometimes beyond the reach of the poor and economically weaker
sections. Think, only 44% TB patients have access to treatment and 13% Indian
children do not receive full immunisation courses.
Meanwhile the National Pharmaceutical Pricing
Authority (NPPA) revealed that private nursing homes are making profits
of up to 1737% on drugs, consumables and diagnostics which account for 46% of a
patient’s bill. The profit margins on consumables range from around 400% to
1700% and drugs which are not under price control range from 160% to 1200%. The
analysis, noted that “the major beneficiaries of profits in all these cases
because of inflated MRPs have been hospitals rather than drug and device
manufacturers”.
Additionally, the NPPA
noted that most drugs, devices and disposables were used and sold by the
hospitals from their own in-house pharmacies and patients didn’t have the
choice of buying then from outside where prices could be lower. Also, institutional
bulk purchase by private hospitals, in most cases by their own pharmacy, make
it easier for them to indulge in “profiteering on drugs and devices even
without need to violate the MRPs” since these are already inflated.”
Even the All India Drug
Action Network (AIDAN), reacting to the above disclosures by the country’s drug
pricing regulator that hospitals are ‘profiteering’ from sales of medicines,
demanded regulatory changes which would prevent hospitals and nursing homes in
unethical practices.
The Network called for a
cost-based drug pricing mechanism for fixing MRPs that takes into account
actual manufacturing costs and provides reasonable profits for companies,
distributors and retailers. It urged expanding price control to all medicines,
devices, diagnostic and treatment services. “The existing drug pricing rules
leave room for huge profits and experts want the Government to control MRPs at
the earliest”.
Clearly, this underscores
that successive Governments have done very little in upgrading and providing
healthcare facilities to major sections of the population. Indeed, judging by
present trends – the allocation in health care over the last five years – it is
a very critical situation and health conditions of the poor and the
impoverished might aggravate in the coming years with the Government remaining
a silent spectator.
Justifiably, the Government
has come in for criticism with activists urging it to increase healthcare spend
from a mere 1.3% to 2.5% of GDP. “We are disappointed by the lack of Modi’s NDA
to invest only 2.5% of GDP into healthcare by 2025 when the global average for
countries is about 6%”. World leading medical journal The Lancet observed “this
is distressing for a country which aspires to become a world leader.”
It’s another matter, among
BRICS countries, South Africa spends 8.7% of GDP on health, China 4.8% and
Brazil 3.5%.
In fact, Microsoft owner
and the world’s greatest philanthropist Bill Gates, who has been investing in
India’s health sector through the Gates foundation, stated in an interview
recently that the total spending on public health is too low. Every other
country that moved to middle income spends over 3% (of its GDP) on public
health; the corresponding figure for India is only a little over one per cent.
Most countries that moved to middle income status provide insurance --- either
through the private sector or through Government or some weird mix”.
Though the country’s
overall health burden dropped by around 36% between 1990-2016, various types of
complications in diseases have emerged and the number of people affected has
increased. Diabetes, coronary heart disease and pulmonary illness are among the
fastest growing causes of ill health, overtaking respiratory infections and
diarrhea.
The effects of global
warming have also led to diseases while water borne illnesses increased due to
contaminated drinking water and unsanitary and unhygienic conditions of living.
Add to this air pollution has exposed a large section of people to poor air
quality and increase in concentrations of pollutants in the atmosphere.
According to Global Burden of Diseases 2017, early deaths related to PM 2.5 in India are the second
highest in the world and ozone related deaths, the highest. As per current
trends, pollution is expected to intensify in the coming years, further
aggravating human health unless preventive action is taken both by the Centre
and State Governments.
Undeniably, when the Government
does not treat health as a priority area, there is little that can be done. The
time has come to start a movement in every State to appoint doctors – even on
contractual basis – to serve in semi-urban and rural areas. Rates for every
disease, operation, diagnostic and testing have to be fixed by the Government,
the rates could vary depending on the source of income. Can this not be done
immediately by States Governments?
Alas, there is little awareness
about the sufferings faced by poor people in rural areas. Even educated people
from middle income sections residing in urban areas know very little about the
threat of diseases, affecting the poor. Obviously, the medical fraternity has
to be a little more sincere in the matter and should take it up with respective
State Governments and the Centre.
Certainly, even after
seven decades of Independence this deplorable condition indicates a sorry state
of affairs in the health sector with no effective action plan to tackle the
impending crisis. The only way to retrieve the situation is to start a nation-wide campaign to focus on
increased facilities in the sector. Questionably, who will lead the movement? Especially for a new
generation of doctors? ----- INFA
(Copyright,
India News & Feature Alliance)
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