Feeling The Pulse

In modern materialist religion, Health and Education are gods, and governments spend much money and words to worship them. Thanks to their interest, there are voluminous reports and statistics about health; this report tries to boil them down to something readable and comprehensible. It starts with cross- section comparisons of India with the rest of the world, of different states, of towns with villages, and some time series; they confirm known facts, such as India is one of the most unhealthy countries in the world, the south and especially Kerala are healthier than the north and the east, townsmen get more medical treatment than villagers, the rich get more than the poor, and so on. It calls for strategic action on health, and goes on to say, quite rightly, that much strategic action on health improvement lies outside medical care, for example, in letting girls grow up before they are married off, in clean water and clean environment, in persuading people to exercise, in teaching drivers to drive, and so on. If that is right, a report on health alone is a bit misdirected.
The report begins to get interesting with Sumita Kale’s essay on emerging issues, such as ischaemia, diabetes, cancer, AIDS, mad driving and mental disease. Surprisingly, two of India’s most ancient diseases, malaria and tuberculosis, figure in this list. What seems to bind together this group is that they cannot be effectively treated by drugs alone; they reinforce the starting message of the report, that doctors and medicines are not enough to keep people healthy.

Bhandari and Ankur Gupta’s essay on inputs brings out the shocking state of public health care. It had half as many doctors in 2008 as were sanctioned; surprisingly, over 56 per cent of health workers’ and 39 per cent of health assistants’ posts were vacant. Even when they were appointed, they did not turn up for work 40 per cent of the time. Doctors were absent about half the time; in Bihar, their absenteeism touched three-quarters. Of patients, over a half said doctors were not available in government hospitals, and almost a third said medicines were not available. No wonder there were 21,000 private hospitals in 2001 against 11,000 government hospitals; two-thirds of them were “not assessed”. They are smaller; still, over a half of hospital beds in Kerala, Goa, Andhra and Sikkim were in private hospitals. The figures also show that how stupid it is to apply internationally prevalent standards of body size to India; apparently, a quarter of the rich are moderately stunted if we take height-for-age, and 13 per cent if we take weight-for-height. Among urban women and among women aged 40-49, 23 per cent are fat.

The pharmaceutical industry has over 10,000 manufacturers; it is selling all over the world (except in those industrial countries that use licensing to protect their high-cost producers), and Indian drug prices are about the lowest in the world. Despite this, Sakthivel Selvaraj and Veena Nabar say the industry is “in a poor condition” and needs more competition. They want all regulators to be integrated into one big dictator. Devendra Gupta and Bhandari also plump for more regulation in an inadequate essay. In contrast, Mahal’s essay on health insurance is well thought out, perhaps because it does not drown itself in micro-facts.

In the last essay, Debroy and Mahal list 23 committees that have looked into the sector and recommended hundreds of reforms. They give a list of the actual reforms; this sector has been intensively studied and then blessed with inaction. They think this is because health ministers are politicians on the way from one opportunistic appointment to the next, the three policy pushers — finance ministry, planning commission and the PMO — have neglected health, and finally, health is just too complicated. This is a relatively brief chapter; in India, government failure hardly needs explanation. But on the whole, this report is rather thin on quality of healthcare; if it had looked into that, it might have derived some lessons on what works and what does not.

(This story was published in Businessworld Issue Dated 17-12-2012)