India & Public Health: Why Modi Govt’s 2023 Budget Needed To Prioritise Doctors?

Allocation for healthcare still needed to cross 2% of GDP despite several claims in National Health Policy in 2017.

Image: Chetan Bhakuni/The Quint

The Modi government has just released its ninth consecutive budget, praising its accomplishments as something that has never been done before in the history of independent India. In addition, the achievements particularly in the medical field, are highlighted in the Economic Survey 2022-2023.

There is no question that the increase in budgetary spending from 86,200 to 88,956 crores, the fall in maternal and infant mortality, and the vaccination against COVID-19 merit recognition. Nevertheless, do these advances require nothing more than appreciation, or is critical introspection also necessary for those domains that affect the well-being of fellow citizens?

COVID 19 Exposed India’s Fragile Healthcare System

The recent COVID-19 pandemic has exposed not only the hollowness of the Indian Public Health System but also the nature of the Indian state. The national capital of the world's largest democracy, witnessed the suffering of citizens as many died due to the unavailability of oxygen, hospital beds and lack of timely treatment.

More than five million people lost their lives, and nearly 200 million fell below the poverty line. The shortage of doctors, nurses, paramedical staff and sanitary workers was one of the significant causes making this tragedy even worse.

In 2022, when India will become the presiding nation of G20 groups and claims to become the global leader under the leadership of Prime Minister Narendra Modi, such things happening in the immediate past may be negated. However, the two recent reports have not only dented the claim of Sabka Saath Sabka Vikas but also categorically highlighted the development pathways, their nature and their impact on fellow citizens.

According to the standards established by the World Health Organization (WHO), there should be at least one physician for every 1,000 people and at least three hospital beds for every 1,000 people. The Indian government's National Health Policy from 2017, requires two beds available for every 1,000 citizens. Nevertheless, the situation on the ground is different from the coveted goal and aims of the government.

Why Govt Reports Masked Physicians’ Crunch

Currently as noted in 2021, in India, there are 9,519 patients for every allopathic government physician. The proportion of doctors in India is similar across the states. The shortage of allopathic doctors in proportion to the population, is even more adverse.

States like Bihar, Telangana, Jharkhand, Andhra Pradesh and Uttar Pradesh are significantly unacceptable. In Bihar, there are 36,938 patients for every government-employed allopathic doctor, Telangana has 30,174, Jharkhand has 19,387, Madhya Pradesh has 18,864, Uttar Pradesh has 18,861.

The recent studies on the situation of healthcare in India compiled by the Ministry of Health and Family Welfare, acknowledged that there is a dearth of human resources, hospital beds, and the number of public health facilities in proportion to the population.

The Rural Health Statistics(RHS) 2021-22 released findings that the shortage of specialist doctors in rural areas, has increased compared to the pre-Covid period. However, the government has very wittingly hidden the facts and compared the data from 2005 that show an increase in the number of doctors in the country. There were 4975 specialist doctors in 2019-20, which reduced to 4485 in 2022.

A comparison of the data from the last two rounds of RHS shows that there is merely an increase of 80 specialist doctors in 2022.

In addition, the RHS emphasises a shortage of 83.2% of surgeons, 74.2% of obstetricians and gynaecologists, and 81.6% of paediatricians compared to the requirements for the existing infrastructure. Overall, there is a need for more experts at the CHCs, which amounts to 79.5% compared to the number of specialists that are required for the current number of CHCs in the country. Looking holistically, if compared to the statistics of 2014, there is only a 0.2 per cent point improvement in the shortfall of the number of specialist doctors in India.

Public Healthcare System Is Lifeline for India’s Population

Why is the availability of allopathic doctors, specialists, and other public health cadres critical to India's healthcare system? The unavailability of doctors in public health facilities, left the rural population with no option but to avail of treatment from private health institutions.

Only 32.5 per cent of ailment treatment, 42 per cent of hospitalisation and 21 per cent of health insurance are covered by the public health system. The dependency on private healthcare facilities without a robust and functional public health institution leads them to financial hardships.

In a country like India where a significant proportion of the population still resides in rural areas and witnessing the double burden of diseases, they predominantly finance their health care expenditures through their own pockets. Statistics show that nearly 150 million people worldwide fell below the poverty line due to out-of-pocket spending.

Furthermore, in India where most of the population is not covered by the healthcare system and must pay for healthcare requirements out of their own pockets, they become even more vulnerable. Healthcare expenditure is mainly met by households (71%), followed by the government (20%), businesses (6%) and external flows (2%) (Government of India 2019). As a result, some people prefer not to seek treatment. Others, on the other hand, are still at risk of falling into poverty due to the costs involved with their medical care.

Did the Union Budget Offer Anything Substantial on Health Front?

The budgetary allocation in 2023 for healthcare still needed to cross the 2 per cent of Gross Domestic Product (GDP) despite several claims in National Health Policy 2017. Low public healthcare investment of roughly 1.97% of GDP will further result in the public healthcare system's poor performance and the rise of an unregulated and inequitable private healthcare sector in the country.

The government should allocate a reasonable proportion of GDP to the healthcare sector, establish public-funded medical colleges and nursing schools, and ensure the availability of doctors, nurses, and other staff to make our health institution functional; otherwise, the claims of Sabka Saath Sabka Vikas will be only on paper.

(Pankaj Kumar Mishra ([e-mail]) is a PhD scholar at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi. This is an opinion article and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)