14 October 2008

Public Health in India

There are a number of equity related issues, rather inequities, in health in India.

India is perhaps one of the few countries where public expenditure on health is less than one per cent of Gross Domestic Product (GDP). There is a lot of variation in the public provisioning of health care - a state subject. Poor states are hard pressed for funds.

Diseases- or disability-wise specificity in states or even districts/blocks with emphasis on seasonal and subgroup (age, caste, gender or income) differences will help attune public policy to improve access and utilisation.

The question of access to and utilisation of care also needs to address the availability of caregivers. The outflow of trained caregivers (referred to as brain drain) and the growing private corporate sector will reduce their availability in the public sector.

With four-fifths of health care expenses being out-of-pocket, the increasing usage of private unregulated care that gives rise to supplier-induced demand (unnecessary medical intervention) is worrying. This, on one hand increases cost, and on the other, leads to misallocation of scarce health resources. It is not only inefficient and iniquitous, but medically speaking it compromises an important aspect – quality.

Regulation of cost and quality in the private sector should not be restricted to caregivers. It should extend to private players involved in non-clinical services and diagnostics, pharmaceutical industry, insurance providers, NGOs and public caregivers. A prerequisite for the success of privatisation is effective regulation. Policies that encourage privatisation but give regulation the go by will be detrimental.

Be it regulation or monitoring of cost and quality, access to or utilisation of healthcare, or analysis of epidemiological patterns - public health has to get out of anecdotal evidence and increasingly rely on scrutiny of ‘hard facts’. This requires the availability of real-time data in the public domain. Its analysis will help design locally relevant public policy.

For details see Srijit Mishra (2005), Public Health in India, in Kirit Parikh and R. Radhakrishna (eds), India Development Report 2004-05, Oxford University Press.

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