Editorial Today – India’s growing Health Problem

To understand importance of health sector we have to first understand Human capital India is considered as a leading nation in the world in terms of human power.

What converts a population into a human capital? Improving the health and nutritional status of the people.

Importance of health in human capital?If a population is not healthy it will not contribute to its full potential in the development of the country.

State of Health sector in India With respect to meeting its potential health outcomes and relative performance, the country has faltered.

WHO world Health Report 2016 Among South-East Asian Region (SEAR) nations, India ranks the worst in the relative inequality score for reproductive, maternal, newborn and child health intervention.

Reason for poor health condition Resource and systematic.

Other Reason for slow improvement in health parameter Out of Pocket Expenditure.

Way Forward The nature, scope and incidence of these problems naturally vary widely across the country

To understand importance of health sector we have to first understand Human capital

We all are aware that the population of India is more than a billion and it is still growing. It may overtake the population of China within the next couple of decades, eventually making India the most populous nation of the world.
Many of us believe that the population of India is a great problem thus population is quite often seen as a liability, a major hindrance to development and quality of life of the people.
But India is considered as a leading nation in the world in terms of human power. One of the major contributory factors for this global standing has been the young, educated and productive people of our country. They are contributing to the development of not only our country, but many of the foreign countries also. In this context, population is an asset for the economy, the greatest resource of the country rather than a liability.
But number of person is not the real and ultimate resource of a country until quality is not added to them.

What converts a population into a human capital?

For converting the Population into capital, the country has to invest a lot in the form of improving the health and nutritional status of the people, their education and specialized training and their overall quality of life.

Importance of health in human capital?

If a population is not healthy it will not contribute to its full potential in the development of the country. For example an unhealthy person even if highly educated and skilled would have to take frequent leave during job and during work time also it he or she will not be able to give its 100 per cent.
If women population is not healthy the children from them would also remain weak.
This population will become liability for the country rather than asset because they will not able to contribute fully in the development of the country; rather state has to take care of them.
It might result in increase in taxes as most of the countries are welfare state thus resource has to be arranged to look after the health needs of the unhealthy population.
Thus every country specially the developing and underdeveloped country needs to invest more in health sector; otherwise its population will became a liability rather than asset.

State of Health sector in India

The Indian health story has trended upwards going by the standard indicators of health. Besides significantly increasing the longevity of its citizens and keeping a check on its population, since independence, India has managed to rid itself of some major illnesses—small pox in 1975, polio in 2014, and maternal and neonatal tetanus in 2015.
However, with respect to meeting its potential health outcomes and relative performance, the country has faltered.

WHO world Health Report 2016

Among South-East Asian Region (SEAR) nations, India ranks the worst in the relative inequality score for reproductive, maternal, newborn and child health intervention.
(Relative inequality score- It is the ratio of mean coverage among the poorest populations to national average)
Child stunting, non-communicable diseases and mortality due to air pollution are other areas where the country fares poorly.
The world’s highest number of women dying in childbirth; the world’s highest deaths of children under the age of five; a health system that ranks 112 among 190 countries; one doctor for 1,700 people; 21% of the world’s burden of disease.

Reason for poor health condition

There are two reasons for this:-

Resource Related
Systematic.

Resource related

While India has the fastest growing population, and an ambitious growth aspiration, it has always had a disproportionately small health budget. In 2015, this shrank further to 1.2% of the GDP, one of the stingiest in the world.

Systematic

But it isn’t simply a matter of the centre throwing more money at the problem. A look at the systemic issues will show that the current situation could be improved even with the available resource allocations.
First, India’s health services and health personnel, besides being grossly inadequate, are inequitably distributed across and within states. Rural-urban inequalities inevitably translate into differences in health outputs. For example, there is a 63% difference in infant mortality rates and 44% difference in total fertility rates of rural and urban areas in India.
Second, despite the considerable shift in the disease burden of India from communicable to non-communicable diseases, policy plans and funding have not altered in tandem.
For example a growing urban population of overweight and obese citizens co-existing with those suffering nutrient deficiency; diseases like diabetes which have a cascading effect on cardiovascular diseases; climate change-triggered bronchial disorders and mental disorders, have now become areas of increasing concern.
Moreover according to the recently released Lancet report on adolescent health; suicide is the leading cause of death among youngsters aged 10-24 in the country. This is alarming since around 30% of India’s population falls within this group and India accounts for 15% of the global mental, neurological and substance use disorders in the world. The stigma associated with these issues coupled with a severe shortage of medical professionals in the field leads to sub-optimal health outcomes.
Third, the quality of our healthcare is in serious jeopardy due to a lack of regulation as well as well-trained medical professionals.

Other Reason for slow improvement in health parameter

Indians incurs huge out-of-pocket (OOP) health expenditure.
Private expenditure on health also includes insurance, donations and direct service payments by corporations. In India, 85.9% of private expenditure on health is OOP.

Out of Pocket expenditure

Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. It is a part of private health expenditure.
A report of the High Level Expert Group of the erstwhile Planning Commission had pointed out that 70% of the out of pocket expenditure on health are for drugs which leads to debate on the need for a free drugs programme funded by the government.
Out-of-pocket payments for health can cause households to incur catastrophic expenditures, which in turn can push them into poverty.

Way Forward

The nature, scope and incidence of these problems naturally vary widely across the country depending on economic conditions and development indicators of various states.
Eighty per cent of the 1% of GDP health allocation is raised and spent by states. In keeping with the shift towards greater fiscal devolution, there must be a dialogue about how health-spending programmes can give state governments the greatest possible control in fine-tuning their approach, based on local needs.
Policymakers after due consultation with states, must seriously reconsider improving the field of medicine and health sciences. There is also an urgent need to upgrade the curriculum in keeping with the changing disease spectrum and technological advances.
The Rashtriya Swasthya Bima Yojana, 2014, aims to redress the problem of out of pocket expenditure by expanding the health insurance cover—currently, only 17% of the total population—but its effectiveness remains to be seen.