Dynamics: power to the people

India: investing in health care

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India’s health care system is in need of urgent development. Satish Kaushal examines what needs to be done to encourage faster progress.

Transforming a health care system is a long journey, and needs to be driven by consistent political leadership over a sustained period.

The health care sector is India’s second-largest service sector. Each of the country’s 28 states and seven union territories implement both central and state-funded schemes.

However, several challenges exist:

  • Government-run facilities are far from cutting edge
  • Persistent geographic disparities between urban and rural India
  • Significantly low health care spending
  • Rising population
  • Increased wealth and rising standards of living have contributed toward more lifestyle-related diseases

A May 2010 study by the Confederation of Indian Industry found that India needs US$50b annually for the next 20 years in order to meet World Health Organization (WHO) standards. A further injection of US$82b is required to close the current health care infrastructure deficit.

Given the abundant challenges in the public health care sector, the private sector has rapidly grown in size. WHO research has shown that of total health care spending in 2011, the private sector contributed 68%, as well as providing more than 40% of the country’s hospitals.

With prices far lower than in developed health markets such as the US, the country has quickly established a fast-growing trade in health tourism as well.

Government remedies

The Government of India (GoI) has launched several programs to improve the health of India’s population:

  • National Rural Health Mission (NRHM) – To provide an accessible health care delivery system in rural India, and has recently been renamed the National Health Mission (NHM), under which health care would be provided to urban poor
  • Central Government Health Scheme – To provide comprehensive health care facilities for central government employees and pensioners, including their dependents
  • National Health Insurance Program - Targets India’s below poverty line population
  • National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke

The recent 12th five-year plan envisaged an investment increase of 322% over the previous plan, which is the highest sectoral budget increase.

Looking forward

Indian policy-makers might be advised to analyze how other emerging countries, such as Brazil, have addressed their health care needs. 

Transforming a health care system needs to be driven by consistent political leadership over a sustained period. Creating universal access has to be the primary focus, with a secondary focus on efficiency or quality.

Government also needs to choose between focusing on increasing funding for programs such as national insurance, or concentrating on providing better infrastructure, such as more hospitals and clinics, and increasing recruitment.

There should be a far closer partnership between the public and private sectors. As part of its core focus on prevention and early stage management, the Government also needs to ensure it can oversee large-scale implementation of programs. 

Placing health care at the heart of our development plans will ensure we are investing in today’s generation — and tomorrow’s.