Mumbai: India spends less on health care, at 3.9% of total government expenditure, than Kenya, Guatemala, Bangladesh, Angola and Azerbaijan.
The number is from World Health Statistics 2006, a report published by the World Health Organization (WHO).
For those looking for silver linings, the report has one—India ranks a little higher than Nigeria, Azerbaijan, Pakistan and Burundi. The low government spend means that most Indians have to fend for themselves when it comes to health care. Poorer Indians spend a large sum of their money on food and clothing, leaving little that can be spent on medicines or the like.
“Even now, health expenditure as a percentage of gross domestic product (GDP) is about 1%, while in most developed countries, it would be around 6%. Many concerned groups and individuals in the country have been long arguing for health expenditure to be at least around 3% of GDP,” said Dr K.D. Rao, head (health economics and financing), Public Health Foundation of India, an organization that works in the area of public health policy.
Health economists said that India has among the lowest ratio of public to private health expenditure in the world.
“Even though the government consistently talks about reducing the inequities in availability of health care, the commitment has remained only on paper,” said Prashant Raymus, a researcher with the public health body Centre for Enquiry into Health and Allied Themes (CEHAT).
Even countries with per capita incomes comparable to India (around $720 or Rs 31,680) such as Senegal ($710) and Mongolia ($690), spend more on health care, both as a percentage of GDP and as a percentage of total government expenditure.
Senegal spends about 9.3% of its total government expenditure and 5.1% of its GDP on health; Mongolia spends 10.3% of its total planned expenditure and 6.7% of its GDP on health care. Low government spends on health care would affect the poor even more, said Rao. “They would be forced to seek higher cost curative health care in the private sector in the absence of an accessible and well-functioning public sector health system or forego treatment altogether,” he added.
According to recent government regulations, access to public health care is only open to those people who hold BPL (below the poverty line) cards.
This closes the door on a large proportion of India’s rural population that, while poor, simply don’t have the cards to show that they earn less than Rs10 a day.
The latest Budget did see the government trying to set things right.
It raised the spending on health care in 2007-08 to Rs14,363 crore (4.5% of the total spending) from Rs11,688 crore.
“The Government of India has initiated its efforts to increase spending from 0.9% to 2-3% of GDP. These efforts to increase government spending and to improve the health care delivery is reflected in the recently launched National Rural Health Mission (NRHM),” said Dr S. Habayeb, WHO representative to India.
In 2005, the government launched NRHM; the allocation for this was increased from Rs8,207 crore in 2006-07 to Rs9,947 crore in 2007-08 in this year’s Budget.
Experts argue that a more concerted effort is needed to improve the health care situation in the country.
“It needs to be said that increasing health allocations in absolute terms will not, in itself, ensure that resources are better or more equitably allocated to the sectors or areas that need them the most,” said Rao.
It is important to ensure that higher investments and allocations are made in areas that have so far been relatively neglected and have poor health outcomes, he added.