Feeling the Pressure Points of the Indian Healthcare System

By: Tanvi Kanchinadam

Today, India is bearing witness to the most comprehensive piece of health reform legislation the world has ever seen. This legislation, known as the National Health Protection Mission, is part of the ambitious health care agenda of Prime Minister Narendra Modi. It is aimed at covering about 40% of India’s most vulnerable population, or approximately 100 million families at the bottom of the socio-economic and caste ladder, each with a coverage of about 7,100 dollars per year. (“Cabinet Approves,” 2018).

At the surface, this seems like a dramatic step in the right direction for India. It’s true that India has never seen this kind of ambitious health care reform, but the policy specifics aim to resolve issues that are not aligned with the ground realities of the nation. WHO studies have found that India has less than one doctor per thousand people. In comparison, the United States has about 2.56 doctors per thousand people, and China has 1.8 doctors per thousand people. (Density per 1000, 2018)

More than sheer lack of doctors, healthcare infrastructure and quality of medical education in India is not equipped to handle the needs of its most underserved population. A study from Duke University found that more than 90% of medical practitioners in the state of Bihar prescribed incorrect medication for diarrhea; instead of prescribing oral rehydration salts, the majority of them prescribed unnecessary antibiotics, leading to the spread of a lethal, antibiotic-resistant bacteria, a statistic that is not uncommon in other rural areas. (Mohanan & Vera­Hernandez, 2015). Moreover, this statistic proves that the state of government hospitals and medical training in India is dire; creating a chasm of inequality through an inherent reliance on private hospitals, where procedures are dramatically more expensive than the amount a state-run hospital would charge, up to ten times that amount. (Doshi, 2018). Therefore, the healthcare needs of the most vulnerable members of the Indian population cannot be served by private hospitals, leaving them with an underserved, underfunded government healthcare system. This must be rectified. Funding the healthcare infrastructure and medical education system should be a prerequisite of addressing the healthcare needs of India’s poor, low caste communities through the NHPM­ something that India easily has the budget capability to do. Currently, India only spends about 1.4 percent of its GDP in comparison to the national average of 6 percent, making the possibility of funding government hospitals and state-sponsored medical training feasible. (Doshi, 2018).

Health policy must be focused on addressing the realities of local issues. The NHPM is eerily reminiscent of similar healthcare acts we would see in the West; healthcare acts like the Affordable Care Act rarely are coupled with the legislature focused on healthcare infrastructure or medical training. The role of the Indian government should be to assess the needs of the Indian people and use this information in policy making. Policy making is entirely dependent on this interpersonal understanding of the local people that it aims to serve. If an effective healthcare system requires accessible health infrastructure, comprehensive medical training, and comprehensive health coverage, working in tandem with each other; the NHPM act only aims at the latter. In response to criticism that without the first two factors, the program would be ineffective, the director of the program Indu Bhushan has stated that “the market will take care of that.” (Doshi, 2018). Bhushan believes that the demand for hospitals will meet the supply in the long term. There is no empirical evidence that this would be an effective approach, but even so, the long-term supply of hospitals still wouldn’t address the lack of medical training in these hospitals, which are largely supported by state-run medical schools.

What is promising about the NHPM act is its efforts to improve the health of low caste communities in India. The lowest rung on the casteism ladder is the Dalit, or Untouchable, community. Dalits have faced historical prejudice and social exile, juxtaposed with few economic means, which overall exacerbates their health inequity. This manifests in three distinct ways; lack of access to resources, poor early environment, and limited social mobility. (Kowal & Afshar, 2015). For the first time, health policy in India will specifically be aimed at this underserved population. The NHPM relies on the Socio-Economic and Caste Census (SECC) to qualify the poor, low caste, vulnerable population of India.

The NHPM is an optimistic health care model that relies on the privatization and healthcare infrastructure in its entirety. An optimal healthcare system for India would be one that has equal part government and private participation.

Originally from New Jersey, Tanvi Kanchinadam is a current high school senior at Phillips Academy Andover interested in the relationship between Global Health Governance and International Development in the context of Information Communication Technologies (ICTs), and the effect these technologies have on disadvantaged communities on a grassroots level. Tanvi is a former Berkman Klein Intern, or ‘Berktern,’ during the 2018 season, where she conducted research on the role of digital ‘grassroots media’ in progressive politics, as well as on the correlation between caste and the inequity of healthcare delivery between low and high caste communities in India. Tanvi is also the founder, organizer, and host of TEDxPhillipsAcademyAndover, an annual TEDx conference consisting entirely of student speakers. In the past, the conference has centered around themes such as ‘21st Century Citizenship,’ and ‘Our Generation’s Mission Statement.’