Beyond glittering india

 

 

Paranjoy Guha Thakurta

Educator and Editor,

Realpolitik

The yawning disparities that exist between India and Bharat and between the rich and the poor are perhaps nowhere as evident as in the delivery of health-care. The reality is, however, complicated. Even in cities, the divide between the facilities provided by privately-owned hospitals and those that are publicly-owned is stark. That’s not all. In the country’s reputed All India Institute of Medical Sciences, there will be a noticeable difference in the way a Union minister or an MP is treated in comparison to what the proverbial aam admi can hope to get. Despite these complexities and inter-state disparities, certain aspects of the reality stand out.

Urban India’s private hospitals – that are as spick and span as a fancy five-star hotel – were built on land that was given for a pittance with the promise that the poor would also be served free, if not, at highly subsidised rates. The truth is that the underprivileged rarely, if ever, visit such hospitals. Public hospitals are, by and large, in a mess. The smaller the town, the chances are that the situation is worse. As for Primary Health Centres (PHCs) in villages, the less said the better. But again, the huge inter-state gaps should not be ignored.

A Reproductive and Child Health Survey conducted in 2003 by the International Institute of Population Studies, Mumbai, found that while 80% of the PHCs in Gujarat, Maharashtra, Sikkim and Tripura were well equipped, the proportion was less than a quarter in Orissa, West Bengal, Rajasthan and Bihar and even lower (10-20%) in Chhattisgarh, Jharkhand and Uttar Pradesh.

It is common knowledge that the best medical institutions in India churn out doctors for the developed world, especially countries like the United States and the United Kingdom. Whenever suggestions are made that doctors, whose education is subsidised by the government, should compulsorily spend time in rural areas, a huge hue and cry is raised about alleged infringement of the budding medical practitioner’s democratic rights. Nobody seriously disputes the fact that the country’s health-care systems need drastic overhauling. The government used to spend more per person during the 1950s and the 1960s than it does at present. The National Rural Health Mission (2005-12) is an articulation of the Union government’s intention to increase public spending on health from 0.9% of India’s Gross Domestic Product (GDP) to 2-3% of the GDP. India’s less developed and smaller neighbouring countries have better health care system than large parts of the country.

Only Kerala has a health care system that is comparable to that in the US. In 2003, the Human Development Report of the UNDP pointed out that Kerala’s heath indicators are similar to those of America, “despite a per capita income 99% lower and annual spending on health of just $28 a person”. Outside Kerala too, there are incredible success stories in a sea of near hopelessness – for instance, the 50-year-old, government-managed Maharaja Yashwantrao Hospital in Indore now functions so well that patients from private hospitals move there.

India’s pharmaceuticals manufacturing industry is one of the few industries which is bigger than its counterpart in China. Yet the fact is that the Indian pharma industry produces and sells huge quantities of the kinds of drugs we don’t really need: cough and cold mixtures and digestive aids are two examples. Drugs that have been banned in many countries of the world are freely sold in India.

Even as the mainstream media often talks of botox, plastic surgery, spas, ayurvedic massages and health tourism, the majority of Indians are denied basic health-care facilities. The National Sample Survey Organisation has found that 28% of those surveyed in 2004 identified financial reasons for not availing medical facilities; the proportion was 20% in 1995-96. Researchers like Ramesh Bhat have found that the mere existence of private health-care does not ensure better quality of care. Surveys on prescription behaviour of private medical practitioners show that doctors often prescribe excessive, expensive and more risky medicines.

The short point: the best Indian doctors are on par, if not better, than the best in the world. But most of them serve the rich. The overwhelming majority of the people of the country, especially those living in rural areas, have to depend on inadequately-equipped health centres and low-paid doctors, para-medics, traditional healers, if not quacks. Chak de India!