Sunday, March 09, 2008

For better health, let's stick to the basics

The Economic Times, Gireesh Chandra Prasad, TNN

Given the state of affairs, the Economic Survey’s recommendations on healthcare might sound like truisms. But then, the truth does need to be oft-repeated. Not surprisingly, the Survey says that the central and state governments should make health insurance affordable to people and urgently improve the quality of basic services like drinking water and sanitation to address the poor health indicators of a nation of 112 crore.

Health insurance is critical in this scenario, given that it’s the poor service in state-run hospitals that forces people to seek expensive private treatment. It also is imperative that the delivery of public health services is improved. In fact, the Survey says a strategic focus on these areas should be the cornerstone of a successful policy framework for healthcare, given that state-funded healthcare for all still seems a distant dream.

India has one of the highest out-of-the-pocket household expenditures for healthcare. Then there’s the additional burden of user charges at state-run hospitals. Therefore, it is vital that innovative risk-pooling mechanisms are designed to improve access to healthcare, the Survey has said.

The data makes for depressing news. The latest figures on indicators like under-five mortality and maternal mortality rate shows that India fares worse than its more populous neighbour, China. Vector-borne diseases and epidemics are not under control.

In 2007, 940 deaths and about 10 lakh positive cases of malaria, filariasis, kala-azar, Japanese encephalitis, dengue and chikungunya were reported. Up to December 2007, 64 dengue deaths and over 5,000 positive cases have been reported while suspected chikungunya cases were more than half a lakh. Elimination of that old enemy, polio, is still not in sight with 471 reported cases last year.

Besides, there is a wide disparity among different states and urban and rural areas in access to healthcare. Life expectancy in Madhya Pradesh, Assam, Orissa, UP and Bihar, for instance, is noticeably lower than that in states like Kerala, Punjab, Maharashtra, Himachal Pradesh and Tamil Nadu.

This applies to infrastructure and medical staff too. Infant mortality rate is the highest in Madhya Pradesh while it is the lowest in Kerala. Most of the public health centres had operation theatres in Andhra Pradesh, Rajasthan and Maharashtra while the opposite was the case in UP, West Bengal and Chhattisgarh.

The Survey has recommended that there should be strategic focus on eliminating vector-borne and epidemic diseases, providing public health education, improving the urban and rural drainage system, providing clean drinking water and sanitation and a well organised garbage collection and disposal system. Mainstreaming traditional medicine would ease some burden on public health facilities.

Above all, good governance is very important in healthcare delivery. The 11th Five-year Plan envisages an investment of Rs 11.02 lakh crore at the central and state levels on social sectors. But greater allocation would not amount to much unless leakages in the system are plugged. Finance minister P Chidambaram had said on various occasions that outlay is not a constraint so long as it ensures outcomes. The government now needs to walk the talk.

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