Saturday, October 2, 2010

India's dubious distinction of being first

The World Health Statistics 2010 released by WHO has placed India in an unenviable position. India has the highest number of tuberculosis (23% of world's patients), diphtheria (86% of world's patients), leprosy (54% of world's patients ), pertussis (29% of world's patients ), polio (42% of world's patients), tetanus (22% of world's cases) and malaria (55% of world's patients) cases.

It is the second highest in measles, the fourth highest in Japanese encephalitis and the 14th highest in cholera. It has the highest percentage of underweight children below the age of five years (43.5%). This is all far in excess of the percentage of the world's population (17%) that India supports. To no other country goes the dubious distinction of being first in so many arenas.

Across almost all indicators like life expectancy at birth, healthy average life expectancy, low birth-weight babies , neonatal mortality rate, <5 yrs mortality rate and MMR, India consistently performs below the south-east Asian region (SEAR) and the global averages despite health being the avowed priority of successive governments. Contrary to popular perception, this is not necessarily due to less number of doctors or nurses.

The density of doctors per 10,000 of population is about six, while the average for SEAR is only five. The global average is 14. Similarly, the density of nurses/mid-wives is 13 per 10,000 population compared with the SEAR average of 11 and the global average of 28. Lack of availability of human resources is not a cause of poor healthcare but a result of lower healthcare expenditure. In the pharmaceutical field, manpower at a density of six per 10,000 people beats the SEAR and global average of four. This is because almost 75% of health care expenditure is on drugs.

Decoding the reasons of our health situation is a complex exercise. Though well below global averages, India spends higher at 4.1% of its GDP on healthcare compared with 3.6% in SEAR. In purchasing power parity terms, per capita annual expenditure on healthcare is about $109 in India compared with $104 of SEAR. So, our health indices should have been better.

Evidently, the issue is not about the money; it is about how and where the money is spent, especially in the rural areas where over 70% of India resides. Intriguingly, there is a gross urban bias in government expenditure on district hospitals and urban tertiary centres.

The latest National Health Accounts (NHA) 2004-05 places the government expenditure on rural healthcare services and family welfare at . 52,970 million , the urban counterpart getting the lion's share at . 92,408 million. It is around . 71 per capita for rural against a far higher . 289 for urban people. Private out-of-pocket expenditure (OOPE) works out to . 777 per capita for rural and . 1,099 for urban people in that year. The ambitious National Rural Health Mission (NRHM) has done precious little to improve the rural plight.

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