Public health fiasco

The government may not want to concede it, but the country seems headed towards one of its worst outbreaks of vector-borne viral and other diseases. While the deadly dengue has already swept across 19 states, claiming nearly 4,000 victims, the less fatal but equally debilitating chikungunya has struck 1.3 million people in 11 states, a sizable number of them in Kerala. Another fatal disease, Kala azar, endemic in Bihar and adjoining regions, is reported to have assumed epidemic form again. Even malaria, which was nearly wiped out once, has staged a dramatic comeback, even as polio too threatens to do so, despite the campaign for its eradication. Meanwhile, leprosy, tuberculosis, typhoid and a host of other contagious diseases have been having a free run.

One immediate cause for worry is that dengue is no longer confined to the north, nor chikungunya to the south. Both have travelled into new territories. This makes the fight against these diseases tougher, especially as both are caused by viruses disseminated by a common vector, the Aedes mosquito, and have several symptoms in common. The failure to control these diseases is due primarily to the apathy of successive governments when it comes to public health. Though the country has one of the largest private-sector, individual-oriented health care infrastructures in the world, and one that is attracting even foreign patients, its public health sector is hopelessly inadequate and dysfunctional. The expenditure on public health has plummeted from 1.3 per cent of the gross domestic product (GDP) in 1990 to 0.9 per cent now, and is among the lowest in the world. As a result, the ratio of public to private health expenditure in India has dropped to 1:4, against 2:3 in China and 1:3 in even Pakistan. This is tragic in a country where the cost of private health care is prohibitive for the common man.

Though the country produces a large number of doctors, thanks to subsidised medical education, it is miserably short of public health personnel. Much of the public health infrastructure, comprising primary health centres, community health centres and public hospitals, is starved of staff and medicines. As a result, no more than 42 per cent of children receive essential immunisation. The situation is bad in even cities and large towns, and of course much worse in the rural areas. Though the finance minister talked about the National Rural Health Mission in his Budget speech, not much action has ensued. It is no wonder then that some recent studies on farmers' distress have listed health expenditure among the causes for rising indebtedness and consequential suicides. It is imperative that the public health system be revamped. The national common minimum programme of the UPA government stipulates raising public health spending from 0.9 per cent of GDP to 2 and even 3 per cent. There has been little action on this promise, though half the government's life is over.