Just as education and food have been the focus of public policy concern in recent months, thanks to the Manmohan Singh government’s agenda of “inclusive growth”, public health too must come into the focus of national policy sooner rather than later. Education, food and health are all State subjects in India’s federal system. Yet, the central government can play, and has done so from time to time, a leadership role in guiding policy. It is a pity that some of these concerns come to the fore in India only when foreign funding agencies and foreign journals choose to focus on them. There is a wealth of research and experience available in different parts of the country on which public policy can draw without having to look for either funding or approval from western donors and institutions. Ironically, at a time when private for-profit health care is booming, the neglect of public health continues. To the extent there is some focus on public health, it is largely based on western models and ideas that have little relevance for India. Given the enormous public health challenge India faces, the time has come for more locally rooted solutions.
The importance of affordable health care is underscored once again by evidence that shows that an increasingly important contributor to poverty is the burden of health care. The rising cost of health care and the increasing willingness of families to spend on higher cost health care are pushing marginal households into poverty. Around 30 per cent of rural people do not go for any treatment for financial reasons. Worse still, some 39 million people are shoved into poverty bracket annually because of poor health. While only 11 to 12 per cent of the population is believed to have any form of health insurance cover, insurance too is not an answer. The fact remains that millions of Indians still do not have access to safe drinking water and proper toilets.
While the UPA government has launched a National Rural Health Mission, few state governments are doing enough to improve the functioning of government hospitals and primary health centres. Against the estimated requirement of around 75,000 community health centres per million people, the actual number is not even half of it. Besides, most of the existing health centres are ill-equipped and under-staffed. It is largely because of the deficiencies of the public health system and poor penetration of the so-called universal immunisation programme that nearly 1.8 million children under the age of five years die annually. Worse, the disease profile is undergoing a rapid change. Some of the diseases that had, more or less, been eradicated, such as tuberculosis and malaria, have staged a comeback and several new infectious and chronic degenerative ailments have assumed threatening proportions. These include dengue, chikungunya, viral hepatitis and AIDS, among others. Regrettably, when it comes to resource allocation, the health-care sector seldom gets the priority it deserves. Total public spending on health in India is a meagre 0.94 per cent of the gross domestic product which is amongst the lowest in the world. Apart from allocating more funds to health, India needs improved governance and a more decentralised approach to health-care provisioning.