India is facing a dual burden of communicable and non-communicable diseases (NCDs). The central government’s spending on health stands at only 1.2 per cent of the GDP, a meager figure that is insufficient to deal with the high disease burden. Out-of-pocket spending has become the most common means of paying for healthcare treatment and services in India, posing a financial burden on the patients.
Health, a determinant of the social, economic and human welfare and progress of the country, is a state subject in India. With support from the central government, the states have the prime responsibility for improving public health and the standard of living of people.
As per the recommendation by the 14th Finance Commission, the transfer of taxes to the states was increased from 32 per cent to 42 per cent. This has created a wonderful opportunity for the state governments to allocate additional funds towards health in order to strengthen their overall healthcare system. Using government tax revenues is an innovative approach for healthcare financing, the benefits of which will depend on the efficiency and effectiveness with which funds are allocated and health services are delivered.
The central government has now started recognizing the role of states in expanding inventive approaches to tackle the growing disease burden. Developing coordination between the centre and the state governments is fundamental in order to successfully execute certain initiatives including strengthening of primary healthcare services, building of healthcare infrastructure and encouraging public private partnerships.
Partnership to Fight Chronic Disease is working in the similar direction through consultative processes with experts across India in order to examine new healthcare financing options from the public and private sectors to improve insurance coverage for NCDs, especially at the primary healthcare level.
The low investment on public health results in lack of proper health infrastructure especially in the rural settings, therefore forcing people to depend on the private sector for health treatment that is much more expensive.
A 2014 rural health statistics report revealed that nearly 35,000 of the 183,000 public health facilities in rural areas do not have their own premises. There is a shortage of 6,700 public health centres and 2,350 community health centres as of early 2014. Given the fact that a majority of India’s population resides in the rural areas, there are not enough qualified medical professionals to meet the rising healthcare needs of the patients. The rural infrastructure is short of 83.4 per cent surgeons, 76.3 per cent obstetricians and gynaecologists, 83 per cent physicians and 82.1 per cent pediatricians.
The inadequacy and deficit of primary health centres, diagnostic equipment and medical health professionals is also adding to the alarming NCD burden of India. Cardio-vascular diseases, hypertension, cancer and diabetes – India’s leading NCDs are all preventable diseases. However, because of the shortfall in the health infrastructure due to low spending on health, we are unable to adopt a preventive care strategy.
The low public expenditure on health is weakening India’s health systems, which has crippling effects on the patients who are faced with both, rapidly increasing medical conditions, and rising health costs. With health encapsulated in the growth story of India, it is imperative for the central and state governments to work together and better leverage the state’s increased share of the tax pool for health, formulating effective plans and policies to reduce the burden of NCDs.
Country Representative, Partnership to Fight Chronic Disease