Alas if only our policymakers had given top billing to healthcare sector

According to the Economic Survey 2019-20, India had a doctor-population ratio of 1:1456 that came close to the WHO norm of 1: 1000 but paled before some of the advanced countries----Australia 3.374:1000, China 1.49:1000, France 3.227:1000, Germany 4.125:1000, Russia 3.306:1000 and the USA 2.554:1000 .

In absolute terms, we had 10, 22,859 allopathic doctors registered with the state medical councils or Medical Council of India as of March 31 2017. And on the same cut-off date India had 479 medical colleges with an intake capacity of 67,218 MBBS students. As against this, we have 4000 engineering colleges in the country at the last count.

The nation’s disenchantment with medical education has as much to do with our middle class’ risk-averse culture and desire to strike it rich as quickly as possible as with the policymakers’ apathy. It is not as if engineers stick to their knitting. The crème de la crème of the engineers make their careers elsewhere. Late Professor Indiresan director IIT Madras hit the nail on the head when he said our IIT graduates end up selling soaps. Now they wind up in foreign banks and mutual funds, beckoned by fancy salaries finance whiz kids are offered. This is the classic example of internal brain drain. Doctors willy-nilly stick to their knitting.

India’s total healthcare spending (out-of-pocket and public), at 3.6% of GDP, as per OECD, is way lower than that of other countries. The average for OECD countries in 2018 was 8.8% of GDP. Developed nations—the US (16.9%), Germany (11.2%), France (11.2%) and Japan (10.9%)—spend even more. India spends the least among BRICS countries: Brazil spends the most (9.2%), followed by South Africa (8.1%), Russia (5.3%), China (5%)

Despite spending slightly less than the OECD average, the Commonwealth Fund hailed the UK National Health Service (NHS) has the best in 2017. Indeed many in the know both in the UK as elsewhere heave a sigh of relief that but for its NHS the casualties would have been higher. The insurance-driven healthcare model of the US has often been compared with the UK’s state-owned and administered NHS. The sobering lessons seem to be that while the government must stay out of business, it must firmly be in control of the healthcare sector.

COVID-19 has been the biggest leveler and humbler. Good as it is, the Modi Government’s centerpiece for the poor, Ayushman Bharat, has proved to be woefully inadequate in providing quality Medicare to the vulnerable sections of the society, for whom it is meant, during these corona times. The telling if chilling message is no amount of insurance cover is of any avail unless the requisite health infrastructure is in place.

We need to rethink our health policy starting from scratch---medical colleges. Once again the Modi government has done well to mandate NEET, a common entrance test for aspiring doctors and specialists but that by itself is no guarantee that our healthcare services would improve. COVID patients choking for oxygen proved more than ever before that a hospital not producing is own oxygen is as bad as hospitals importing surgeons from the list of freelancers.

It is not enough to mandate an attached hospital for every medical college.

Pandit Nehru the first prime minister of India realized that the public sector should occupy the commanding heights of the economy like steel and coal. Alas he had realized too that the government must be the foremost health service provider taking a cue from our past colonial masters the British.

Had we set store by government medical colleges and government hospitals aided by Indian Health Service (IHS) at the apex, we would have fared a lot better on the health front. It takes a crisis to test a country’s resources and resolve. Yawning gaps in both resolve and resources are showing up. Otherwise, we would not have landed in a situation where our youth numbering 65 percent of the population (our demographic dividend) has to bide its time anxiously for vaccination against Coronavirus.

That the vaccine hub of the world is now throwing its hat in the world market for imports shows that we did not take a holistic view of healthcare---- the vaccine industry needs upwards of 200 raw materials and consumables to be able to deliver. And it now turns out that during the best of times we smugly imported all these. But then it takes a crisis to awaken a country and its policymakers.

Click here to read columns by S Muralidharan