ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Accumulation of Poor Health Infrastructure

India has to substantially scale up its health infrastructure to protect lives and livelihoods.


“The situation in India is a devastating reminder of what the virus can do,” said World Health Organization (WHO) Chief Tedros Adhanom Ghebreyesus at a virtual briefing in Geneva last week. He was speaking in the context of the WHO survey findings which noted that one year into the COVID-19 pandemic around 90% of the 105 countries surveyed reported disruptions in essential medical services. But disruptions would be a mild word in the context of the developments in the major Indian cities, including the national capital Delhi, as the second wave of the pandemic, exposed the massive gaps in health infrastructure, despite the heroic efforts of the medical personnel to make the best of what was available.

Of course, no country can fully protect itself from pandemics of such a massive dimension with the virus mutating and transmitting even faster than in the first wave. But unfortunately, unlike the first phase, when the country was caught unprepared by the pandemic, the disaster in the second phase was human-made, wrought by the lack of any preparedness, whether it be in ensuring adequate raw materials for vaccines, containers and canisters for transporting oxygen, personnel for virus testing or adequate medicines, beds and other facilities. The failure in preparedness is beyond any rational justification, because the governments had almost a year to make adequate preparations and roll out back-up plans and yet did not fully focus on the need to do so. Tens of thousands were left to fend for themselves with the government dragging its feet even on diverting the required oxygen for medical use or for seeking help of friendly governments to secure supplies and other emergency aid. Almost overnight, all the talk of the country being the pharmacy for the world dissipated into thin air. To add to the woes, the central government even stooped down to discriminate between states in making adequate vaccines available.

A callous attitude to health by the central and state governments has been a historical factor. For decades, policy experts have pointed to the need for raising public expenditure on health from 1% of the gross domestic product (GDP), to 2% or 3%, but to no avail. In contrast, countries like China have been spending around 2% of the GDP on health since almost two decades ago. And there are countries like the United States (US), which spend around 8% of the GDP on healthcare. The low government spending on health in India ensures that almost 70% of health spending is out-of-pocket spending by individuals, one of the highest in the world.

Apart from low spending, another reason why India’s basic health infrastructure remains laggard is that many of the early health programmes focused more on eradication of dreaded diseases like malaria, tuberculosis and polio and on reduction in maternal and infant mortality rates. Consequently, the development of general health infrastructure suffered. For instance, in the case of hospital beds, India has 1.4 hospital beds per 1,000 population, whereas it is as many as three beds in Sri Lanka and the US and around four beds in China. Similarly, in the case of primary health personnel, while the WHO recommends one doctor per 1,000 population and one nurse per 300 population, India manages with only one doctor for 1,511 people and one nurse for 670.

And the huge disparities in state government spending on health only make matters worse. While the per capita health expenditure in Bihar was `617 in 2018–19, it was `2,048 in Kerala and `6,207 in Goa. Consequently, while Kerala, Goa and Karnataka have three to four hospital beds per 1,000 people it is lower than one in Bihar, Odisha, Assam, Jharkhand and Madhya Pradesh. Similarly, while Kerala has more than five doctors, nurses and midwives per 1,000 people, the number is lower than one in Bihar and Jharkhand.

Thus, it is no surprise that an index of effective coverage of universal health services in 204 countries for 1990–2019 showed that India’s effective coverage of universal health services was only 47, as compared to 51 in Bhutan, 54 in Bangladesh, 65 in Brazil, 70 in China and Iran, 73 in Cuba, 82 in the US, 86 in Germany, 91 in France and 96 in Japan. So universal health coverage in India is not only half that of major rich economies, it is also lower than of countries with even lower development than India in many cases.

And it is not that the government is unaware of the large gaps in health infrastructure and the immediate need for funds. In fact, in a memorandum submitted to the Fifteenth Finance Commission, the Ministry of Health and Family Welfare has estimated the total funds needed to spruce up healthcare at `5.74 lakh crore, of which the bulk of `5.13 lakh crore was just for providing primary healthcare. And the Finance Commission only conceded `1.06 lakh crore over a five-year period which works out to just 0.1% of the GDP.

Given the inability to make available the needed funds for basic healthcare, the Government of India has sought to compensate by giving a larger role to the private sector in the health sector and pushing health insurance schemes. But this is unlikely to reduce the shortage of basic facilities given the substantial disparities of income across regions and social groups. What we need today is adequate infrastructure facilities, benchmarked to the best in the world in terms of physical infrastructure, health personnel and medical products, with back-up plans to scale up the network at short notice. Any shortcomings on this front will cost the economy dear, as the pandemic has shown us not once but twice.


Updated On : 2nd May, 2021


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