Budget 2018: India's Healthcare crisis is holding back national potential

Hospital in Mumbai File picIndia has the worlds highest population of stunted childrenndashshort for their agendashand the countrys failing primary healthcare and overburdened tertiary care are illequipped to handle the crisis of childhood malnutrition leaving India unable to fulfil its national potentialThis is the backdrop against which Finance Minister Arun Jaitley will present his governments last full budget before the general elections in 2019Although Indias stunting rate has declined nearly 10 percentage points in a decadendashfrom 48 in 200506 to 384 in 201516 an estimated 48 million Indian children are still stunted At a time of declining economic growth and jobs these children may have a greater disadvantage over those in other emerging nations with lower malnutrition and better healthcare In addition Inadequate public healthcare and healthcare expenses push an additional 39 million people back into poverty in India every year this 2011 Lancet paper saidStunting is the percentage of children aged 059 months whose height for age is below minus two standard deviations from the median of the World Health Organizations WHO Child Growth Standards It reflects chronic undernutrition Countries with high rates of stunting are likely to be less prosperous according to a recent reportUntil the federal government in India takes health as seriously as many other nations do India will not fulfil either its national or global potential said a November 2017 editorial published in the Lancet a medical journalIndia spends 14 of GDP on health less than Nepal Sri LankaThe Centres allocation for health rose 24 to Rs 47353 crore in 201718ndashfrom Rs 38343 crore in 201617 This is 115 of Indias gross domestic product GDP Including the expenditure by states India spends 14 of its GDP on healthNepal spends 23 of its GDP on health while Sri Lanka spends 2 data showThe National Health Policy NHP envisaged an increase in health expenditure to 25 of Indias GDP by 2025Without significant increase in its healthcare budget Indias health targetsndashreducing its infant mortality rate from 41 deaths per 1000 live births in 201516 to 28 by 2019 and maternal mortality ratio from 167 deaths per 100000 births in 201314 to 100 by 20182020 and eliminating tuberculosis by 2025ndashseem difficult to achieveMore than seven in ten Indians are not covered by insurancendashIndians are the sixth biggest outofpocket health spenders in the lowmiddle income group of 50 nations as IndiaSpend reported in May 2017 As many as 525 million Indians were impoverished due to health costs in 2011ndashalmost half of the worlds impoverished population annuallyndashFactcheckerin reported in December 2017Indias 48 mn stunted will grow up to be less healthy and productiveIndia has the highest population of children stunted low height for age due to malnutrition at 482 millionStunting is a proxy for overall cognitive and physical underdevelopment according to a September 2017 report published by the Bill and Melinda Gates Foundation Stunted children will be less healthy and productive for the rest of their lives and countries with high rates of stunting will be less prosperousIn 2015 nearly two in five Indian children 39 were stuntedndashshort for their age In South Asia only Nepal 41 and Pakistan 45 have a larger proportion of stunted children than India IndiaSpend reported in July 2016Adults who were stunted at age two completed nearly one year less school than nonstunted individuals according to this study conducted by University of Atlanta in 2010Similarly a study of Guatemalan adults found that those stunted as children had less schooling lower test performances lower household per capita expenditure and a greater likelihood of being poor For women stunting in early life was associated with a lower age at first birth and more pregnancies and children according to this 2008 World Bank studyA 1 loss in adult height due to childhood stunting is associated with a 14 loss in economic productivity according to World Bank estimates Stunted children earn 20 less as adults compared to nonstunted individualsIt is my suggestion to the government of India to work with us on stunting Jim Yong Kim president of World Bank said on his visit to New Delhi in June 2016 This is the bottom line if you walk into the future economy with 40 of your workforce having been stunted as children you are simply not going to be able to competeIn 2017 at least 316 infants died in Indias district hospitalsInfant deaths in district hospitals dominated the headlines in 2017ndashat least 316 infants died in four states last year Indias failing healthcare system stacks the odds against a childs survival even before she is conceived an IndiaSpend investigation in September 2017 showed Governmentrun community and primary health centres are dysfunctional while tertiary care institutes both private and governmentrun are overburdened and mismanagedIndia improved its infant mortalityndashdeath of children before the age of onendashfrom 57 deaths per 1000 live births in 200506 to 41 in 201516 but is still worse compared to poorer neighbours such as Bangladesh 31 and Nepal 29 and the African countries of Rwanda 31 and Botswana 35Despite reducing malnutrition maternal and childhood malnutrition is the leading cause of disease in India causing 15 of Indias disease burden IndiaSpend reported in November 2017India spends as we said 14 of its GDP on healthPrimary healthcare failing tertiary care centres overburdenedIn 2016 subcentres were 20 short of human resources while primary and community health centres were 22 and 30 short respectively according to the 2016 Rural Health Statistics RHSMost functioning rural health facilities in India lack basic infrastructurendash29 of subcentres did not have regular water supply 26 lacked electricity supply and 11 did not have allweather roads connecting them according to the 2016 RHS dataPrimary health centres PHCs are supposed to be the first point of contact between the village and a medical officer Each PHC is manned by a medical officer and 14 paramedical staff and is supposed to be equipped with an operation theatre six beds essential laboratory facilities and a pharmacyWhile 63 of primary health centres did not have an operation theatre and 29 lacked a labour room community health centres were short of 815 specialistsndashsurgeon gynecologists and pediatricians15 lakh Health Sub Centres will be transformed into Health and Wellness Centres Jaitley said in his budget speech last year he didnt dwell on how the change in the name will improve health services or quality in the subcentresIn 2014 58 Indians in rural areas and 68 in urban areas said they use private facilities for inpatient care according to the 71st round of the National Sample Survey on health indicating the declining confidence in Indias public health systemIn 2013 India launched the National Health Mission NHMndashthe countrys largest public health programmendashto achieve universal access to healthcare by strengthening health systems institutes and capabilitiesNational Health Mission includes National Rural Health Mission and National Urban Health Mission that work for strengthening rural and urban health system maternal and child health and communicable and noncommunicable diseasesThe allocation to NHM declined from 57 of the health budget in 201617 to 56 in 201718ndashdespite an absolute increase from Rs 22197 crore to Rs 26690 croreOnly 68 of the funds demanded by states under NHM were approved by the Centre in 201516ndashthe year for which latest actual expenditure estimates were availablendashaccording to a 2017 analysis by Accountability Initiative an Delhibased public policy research institute This is excluding the northeast and union territoriesYet the beneficiaries of Janani Suraksha Yojanandashsafe motherhood interventionndashwere low in many states with the high infant mortality ratesFor instance in 201516 only 61 of mothers in Madhya Pradesh 54 in Bihar and 66 in Assam had benefited from the JSY programme under NHM according to Accountability Initiative Assam Bihar and Madhya Pradesh had the third fourth and fifth highest infant mortalities in 201516With inadequate and illequipped primary and secondary care many Indians turn to the overburdened tertiary care centres often as the last resortThe budget for Pradhan Mantri Swasthya Suraksha Yojanandashthe Prime Ministers Health Protection Schemendashincreased 103 from Rs 1953 crore in 201617 to Rs 3975 crore in 201718The scheme aims to reduce regional inequalities by increasing access to tertiary care facilities by upgrading district hospitals and setting up new All India Institutes of Medical SciencesThe 201718 budget also saw a 155 rise in the allocation for establishing new medical collegesndashfrom Rs 1293 crore in 201617 to Rs 3300 croreWhile this is in line with the 2015 recommendations of the standing committee on functioning of AIIMS the committee also noted the tertiary care institutes are facing mammoth patient load because they are catering to primary and secondary health needs of patients because of poor primary careIn 2016 three in five deaths were from lifestyle diseasesNoncommunicable diseases NCDsndashsuch as cardiovascular diseases hypertension chronic obstructive pulmonary disorderndashwere responsible for 618 of deaths in India in 2016 up from 379 deaths in 1990 as IndiaSpend reported in November 2017While the allocation for noncommunicable diseases increased 72 from Rs 555 crore to Rs 955 crore only 57 of funds demanded by states were approved by the Centre according to Accountability initiativeIndia has a NRHM national rural health mission hangover said Subhojit Dey part of the Global Burden of Disease project and cochairman of the Cancer Interest Group at Delhis Public Health Foundation of India an advocacy Maternal and child health and communicable diseases have been Indias priority until now he told IndiaSpend in September 2017Public health infrastructure should be reconfigured to tackle noncommunicable diseases Srinath Reddy public health expert told IndiaSpend in an interview in January 2018 From the perspective of chronic disease management and risk reduction from providing sporadic care for infectious diseases continuous care has to be infused in the health system especially at the primary and secondary level because tertiary care can be still about acute careMental health still largely ignoredAllocation to the National Programme for Mental Health has been stagnant for the past three years At Rs 35 crore the programme received 007 of Indias 201718 health budgetThis is despite the fact that an estimated 1020 million Indians 12 of the population suffer from severe mental disorders such as schizophrenia and bipolar disorder and nearly 50 million 5 of populationndashalmost equal to the population of South Africandashsuffer from common mental disorders such as depression and anxiety as IndiaSpend reported in September 2016Despite 15 suicides every hour and 133623 suicides in 2015 India is short of 66200 psychiatrists and 269750 psychiatrist nursesToday nearly 70 of the meagre mental health spending goes to mental institutions Ala Alwan Assistant DirectorGeneral of Noncommunicable Diseases and Mental Health at the WHO told the Quint If countries spent more at the primary care level they would be able to reach more people and start to address problems early enough to reduce the need for expensive hospital careSwagata Yadavar is an analyst for IndiaspendCatch up on all the latest Mumbai National and International news hereDownload the new midday Android and iOS apps to get updates on all the latest and trending stories on the go