Why in News?
In the second COVID-19 wave there have been several shortcomings in the health system of our country which have been exposed by it.
Syllabus–GS 2: Health
- We are all, unfortunately, seeing very clearly the devastating second wave of the Covid-19 tragedy and its impact on health care systems of the nation and the ripple effects this can have on virtually all other aspects of life.
- This unprecedented crisis has highlighted how India remains badly placed to tackle the rapid spread ofthe second wave ofcoronavirusdespite several reforms and increase investments in the healthcare sector.
- Moreover, the significant inefficiency, dysfunction, and acute shortage of the healthcare delivery systems are leading people to struggle to save their lives.
- More than 80 percent of the population still does not have any significant health insurance coverage and about 68 percent of the population has limited or no access to essential medicines.
- The low level of public spending on health is the main cause for the poor quality, limited reach, and insufficient public provisioning of healthcare.
India’s worsening Situation: –
- With 5.5 hospital beds per 10,000 population and 8.6 physicians per 10,000, the country’s healthcare sector is not equipped for such a crisis.
- The number of beds per 10,000 is used as an indicator of health infrastructure in general and the poor bed availability points to India’s failure to expand its health infrastructure in keeping with the growth in population.
- India, which is the world’s biggest vaccine maker, expanded its inoculation program to include everyone above the age of 45 to be inoculated.
- But so far it has vaccinated only about one in 25 people compared with nearly one in two in Britain and one in three in the United States.
- The poor state of health can be understood by the data of World Bank on Health systems across the world.
- World Bank data reveal that India had 85.7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 58 in Bangladesh, 100 in Sri Lanka and 241 in Japan),
- It had 53 beds per 1,00,000 people (in contrast to 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan)
- 7 nurses and midwives per 1,00,000 people (in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan)
- Current situation is a direct result of the low public health expenditure.
- According to Centre for Economic Data and Analysis (CEDA), Ashoka University, shows that this has been stagnant for years: 1% of GDP 2013-14 and 1.28% in 2017-18.
- Health is a State subject in India and State spending constitutes 68.6% of all the government health expenditure.
- Because the Center is the key player as major bodies like ICMR etc are under its control so the onus lies on centre.
- The interactive graphic shows the inter-State variation in per capita health-care expenditure in 21 major States and how this has changed from 2010-11 to 2019-20. Kerala and Delhi have been close to the top in all the years.
- Bihar, Jharkhand and Uttar Pradesh, States that have been consistently towards the bottom of the ranking in all years, are struggling to cope with the pandemic.
- Odisha is noteworthy as it had the same per capita health expenditure as Uttar Pradesh in 2010, but now has more than double that of Uttar Pradesh. This is reflected in its relatively good COVID-19 management.
- India has among the highest out-of-pocket (OOP) expenditures of all countries in the world.
- The World Health Organization estimates that 62% of the total health expenditure in India is OOP, among the highest in the world.
- Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Odisha have a high ratio of OOP expenditures in total health expenditure.
- Thus, the most vulnerable sections, are the worst victims of a health emergency.
Government’s role critical
- The inter-State variation in health expenditure highlights the need for a coordinated national plan at the central level to fight the pandemic.
- Centre controls major decisions of health , including additional resources raised specifically for pandemic relief, PM CARES Fund.
- Data by CEDA shows that first round of vaccination was biased as it showed Inter state disparity, which was neither explained by the case load nor by the share of eligible (45+) population.
- Centre can bargain vaccines for a good price from vaccine manufacturers in its capacity as a single large buyer and benefit from the economies of scale in transportation of vaccines into the country.
- These could be distributed across States equitably in a needs-based and transparent manner.
- Distribution of constrained resources (medical supplies, financial resources) can internalise the existing disparities in health infrastructure across States.
- Author argues that decentralized management exacerbates the inter state inequalities as the richer states can compete better in procuring resources.
Following suggestions would help tackle pandemic properly:
- Pandemic Preparedness Unit” (PPU) by the central government, which would streamline disease surveillance and reporting systems;
- coordinating public health management and policy responses across all levels of government;
- formulating policies to mitigate economic and social costs,
Way Forward: –
- We all must acknowledge that the second wave is real and adopt a revised control strategywith strict compliance to Covid -19 protocols in every possible way.
- If these measures are not taken, the number of cases will continue to rise, and many lives will be lost.
- Poor people are at higher risk of death because they cannot access and/or afford advanced care to save their lives.
- In short, failure to act decisively now will have a doubly deadly impact on the millions of impoverished persons in India.
The central government needs to deploy all available resources to support the health and livelihood expenses of COVID-19-ravaged families immediately. After this wave, bolstering public health-care systems has to be the topmost priority for all governments: the Centre as well as States. Comment.