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Health is wealth: Liability for government

Jaswant Kaur Jaswant Kaur
26 Jul 2021

Last week, we witnessed a joke being played out in the Upper House of Parliament. No one can forget the misery and the helplessness almost everyone faced just three months ago when the country was reeling under the strenuous second wave of Covid-19. Yet, the government mocked at those who lost their lives due to the shortage of the life-saving gas – oxygen.
Instead of paying homage to the departed souls or learning lessons from what failed us, Dr. Bharati Pravin Pawar, who holds a coveted post in the ministry of family and health welfare, said that “no deaths due to lack of oxygen has been specifically reported by any state or Union Territory.”
India has lost close to 4,20,000 lives during the last one and a half years. It is no news that almost every newspaper and television channel carried reports of people dying due to shortage of oxygen in April and May, this year. In fact, when certain hospitals in the national capital were on the verge of losing their buffer stock, social media were used extensively to wake up the administration from its deep slumber.
Those who had a hospital bed with an oxygen cylinder were considered lucky. At least they had a chance of survival! In fact, that was one of the factors, which helped in consoling people and keeping their spirits up when everything looked so gloomy, when everyone saw death so closely. It was certainly one of the worst crises mankind had ever witnessed.
At a time when the government was playing truant, the Supreme Court had to intervene and direct the Centre to increase the oxygen supply, not only to Delhi but also to other states in a transparent manner. How could Dr. Bharati forget that just two days before this order, 12 persons and a doctor had died at Batra Hospital and 25 lost their lives at Jaipur Golden Hospital in Delhi because of oxygen shortage?
On a personal front, almost everyone was struggling to make arrangements for oxygen for their friends, relatives or colleagues. In such a scenario it does not redound to the credit of the government to play with the emotions of the people, who form this country, to whom they owe their existence. 

Heavens would not have fallen if Dr. Bharati had accepted the fact that the government underestimated the implications of the second wave. After all, what has happened has happened. It cannot be undone. A statement giving details of the preparedness of the government to handle the third wave would have given everyone some peace of mind.
Be that as it may, nothing will change the sad truth that the number of people who lost their lives is way beyond the officially declared figure. In fact, Covid-19 should have raised an alarm bell for the government to prioritise the health sector and re-strategise to meet the needs of the people, especially those at the bottom of the pyramid.
A report published by Oxfam India has already set the tone for this conversation. ‘The Inequality Report 2021: India’s Unequal Healthcare Story’ shows how different states coped with Covid-19. It reiterates the popular demand of increased spending on the health sector in terms of the Gross Domestic Product. It established the truth that the states which spent more and which strategically made efforts to reduce inequalities, had a lesser number of confirmed cases of Covid-19. They also had comparatively higher rates of recovery.
In other words, these states present an apt case for an in-depth study and introspection. So, what kind of inequalities does the report speak about?
Essentially, it has laid bare the inequalities amongst the social groups, gender-based inequalities, regional disparities, religious and wealth-based inequalities. It shows how people belonging to the general category have an edge over those coming from the scheduled castes and tribes when it comes to availing of better health facilities. 

Similarly, religious majorities have better access to health infrastructure than the minorities. It goes without saying that those who have higher net worth, too, have the capacity of spending more on healthcare.
The report shows a trend of increasing dependency on the private healthcare system than the public health infrastructure. It is a pity that sub-health centres, primary healthcare centres (PHCs) and CHCs, which serve as the backbone of the Indian healthcare system, either lack adequate staff or equipment or are non-existent in remote regions or villages.
In fact, we have a shortfall of 43,776 (23 per cent) Sub-centres, 8764 (28 per cent) PHCs and 2865 (37 per cent) CHCs. It is certainly a statement on the public spending on healthcare, which is hardly 1.16 per cent of the GDP (both Centre and states taken together). In fact, the Union government spends hardly 0.26 per cent on health. It is a far cry from the goal of 2.5 per cent of the GDP. In such a scenario, people even from the lower strata of society are left with no other option than to avail of expensive health facilities offered by the private hospitals. 

In fact, 70 per cent of India’s population that stays in rural regions have just 40 per cent of the total hospital beds. Perhaps, the government wants people to rely on private healthcare alone.
This has certainly increased the out-of-pocket expenses (OOPE) on health. In fact, it stands at close to 65 per cent in India, which is very high, compared to the global average of only 18 per cent. A large chunk of income of an average household goes towards meeting health expenses. One can imagine how an urban poor from the slums or a rural farmer would be spending this kind of money.
The report shows that around 20 per cent of the OOPE are met through borrowing. The remaining are incurred from the hard-earned savings of the people or even sale of assets. People in the rural regions have a high dependency on loans while those in urban cities dig deep into their savings when faced with a health emergency.
Over 63 million people are dragged to poverty every year only to meet immediate healthcare expenditure. This estimation has been made by none other than the ministry of family and health welfare. Incidentally, it is the same ministry where Dr. Bharati is posted.
In the name of universal health coverage, the government has come up with Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, a health insurance plan with a target of reaching out to 50 crore people. It is clearly one of the largest health insurance schemes in the world. But is it sufficient to meet the needs of the people? Another question is whether the money spent by the government is sufficient to achieve this ambitious target?
The report points out that, “initially, Rs 6400 crore was earmarked for this scheme, which was reduced to Rs 3200 crore. The National Health Authority reports that as on October 5, 2020, there have been 1,08,99,888 hospital admissions under this scheme”.
Like most other health insurance schemes, it covers only expenses incurred during hospitalisation. The out-patient expenses are not covered under the scheme. In other words, the health insurance cover is not a guarantee for taking care of the entire medical cost. 

On an average, Rs. 2394 is spent as OOPE per hospitalisation. Not only this, the expenses during hospitalisation are much higher than the claims paid under the policy. The report points out that the average medical expenditure per hospitalisation is Rs. 16,676 and Rs. 26,475 in rural and urban setups respectively against which Rs. 11,545 was released from the insurance companies as the final claim. In other words, the insurance is grossly inadequate to meet the hospitalisation cost of an individual.
Apart from this, the report says that the country has only five beds per 10,000 people, which has come down from 9 per 10,000 as per the 2010 human development report. In fact, ours is the lowest when it comes to BRIC nations, even below the neighbouring Bangladesh. There is only one allopathic doctor against 10,189 people. Of course, the likes of Baba Ramdev do not like allopathy. However, it is the only effective way of giving immediate relief when it comes to general ailments like fever, pain, vomiting or diarrhoea. We have only one state-run hospital against 90,343 people! Hope Dr. Bharati would now understand why there is a need for deep introspection.
The report also highlights other health indicators like maternal mortality, infant mortality, immunisation and their direct connection with inequalities prevalent in the Indian society.
Health is not even considered a fundamental right. The judiciary might have passed various judgements upholding the people’s right to health. But it has not nudged the government to rethink and modify its policies. 

In fact, health is a state subject when it comes to the seventh schedule of the Constitution. This is one of the biggest anomalies which needs to be rectified. The founding fathers may not have imagined a situation like the one Dr. Bharati has created. In the current scenario, it becomes easy for the Centre to shed its responsibility albeit conveniently.  

(The writer, a company secretary, can be reached at jassi.rai@gmail.com)

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