The spread of Coronavirus in India and the subsequent misery of the migrant population has exposed the underbelly of dismal healthcare in our country. There is a daily outcry of shortage of hospital beds, doctors, nurses, ICUs, absence of functioning rural healthcare centres, etc. 

It is a great pity that while our neighbouring small nations like Bhutan and Sri Lanka provide free universal healthcare for all their citizens, India is still struggling with healthcare schemes that cover only partially a small section of our population that have to struggle meaninglessly for a gold/red/blue, etc. card to become eligible for partial healthcare facility. Almost all advanced nations like the U.K, France, Switzerland, Canada and a host of others provide free universal healthcare for all of their citizens irrespective of income status. Other countries like Cuba, Hong Kong, Singapore, New Zealand, etc. also cover all their citizens with universal healthcare. Why India does not think in this direction and consider providing free healthcare for its citizens a top priority is a mystery unsolved. 

The argument that we do not have money for providing free healthcare for all is a fictitious argument because if defense requires double the budget, the money somehow is made available. Defense is top priority but citizens’ health is at the bottom of the list. If citizens are not healthy, whom are we trying to protect with the piling of armaments? 

What is the present scenario? India’s Annual budget is Rs. 27,84,200 crores (2019-2020). Out of this allocation for health sector is a mere 2%, i.e. Rs. 63,538 crores whereas the defense budget is 11%, i.e. 2,82,733 crores. Thus India’s Defense budget is five and a half times the Health budget. 

Let us see how other nations, who provide free universal healthcare to all its citizens, do their allocation for healthcare from their budget.

Country                                        Health Budget as a % of total Budget    

Switzerland                                                         34.7

Cuba                                                                     28

U.K.                                                                      19.7

Sri Lanka                                                              11

Bhutan                                                                 9

India                                                                     2                             

India’s current population is 136 crores and average annual expenditure incurred by its citizens on their healthcare is Rs. 2,465. This means that to cover all its citizens with free universal healthcare, an annual fund of Rs. 3,35,240 crores is required to be allocated to the health sector, i.e. 12% of Budget. Is that impossible? If the health of its citizens is top priority for a nation, can we give an excuse that due to non-allocation of required resources the health sector will continue to suffer? 

Indian Government’s apathy towards healthcare delivery to its citizens is borne out by the following facts as stated by Saif Kamal in Health and Life – 

“There is only one Government allopathic doctor per 10,189 people, only one Government hospital bed per 2,046 people, and one state run Hospital per 90,343 people. Out of 1 million doctors in the country, only 10% of them work in public health sector. They lack good infrastructure, proper management, dedicated staff and many other things which are required to provide reasonable and appropriate healthcare.”

Malnutrition is a serious problem in India. According to Unicef at least 3,000 children die due to malnutrition every day in this country and every year 10,00,000 children die below the age of five.

In Global Health ranking India’s position is 145th out of 195 countries, even below Nepal. Bhutan and Sri Lanka.

Medical costs are one of the primary causes of poverty in India. Around 63 million Indians fall into poverty each year because of health care bills, and 70 percent of all charges are paid directly by patients.

Due to lack of proper and adequate healthcare delivery from the state run hospitals, patients are forced to seek relief from private hospitals where the charges are abnormally high. This results in the poor patient being forced to incur very high out-of-pocket expenditure and this forces him to sell his assets, property or land and drives him ultimately below the poverty line.

When we compare Per capita expenditure on Health for various countries, we find India at the bottom of the list as shown below –

Country                                        Per capita expenditure on Health (US $)

Switzerland                                                            6,944

Norway                                                                  4,802

U.K.                                                                        3,500

Sri Lanka                                                                     71

India                                                                            35

Comparing Healthcare Expenditure as a % of GDP –

Country                                                               Percentage of GDP         

France                                                                         8.7

Switzerland                                                                 8.5

U.K.                                                                               7.9

India                                                                             1.02

A large country like India, where 70% of total population resides in rural areas, continues to be biased in its healthcare delivery in favour of the urban population. Instead of relying on preventive care and well equipped Primary Health Centres in semi-urban and rural areas, the emphasis has been on city hospitals which become overcrowded and suffer from population pressure.   

The Constitution incorporates provisions guaranteeing everyone’s right to the highest attainable standard of physical and mental health. Article 21 of the Constitution guarantees protection of life and personal liberty to every citizen. The Supreme Court has held that the right to live with human dignity, enshrined in Article 21, derives from the directive principles of state policy and therefore includes protection of health. Further, it has also been held that the right to health is integral to the right to life and the government has a constitutional obligation to provide health facilities. 

Failure of a government hospital to provide a patient timely medical treatment results in violation of the patient’s right to life.  Similarly, the Court has upheld the state’s obligation to maintain health services.

 It is therefore imperative that we make free universal healthcare for all our citizens a goal to be achieved in the nearest future. A healthy nation is a happy nation and the exorbitant amount that the rural population has to shell out today for healthcare from their meager personal earnings leading to extreme poverty can be totally avoided.

*The author is the convener of Jharkhand Nagrik Prayas.    

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