Santosh Kumar Mohapatra
The fire at SUM Hospital in Bhubaneshwar, which claimed 25 lives and left hundreds injured, has exposed lacunae in the healthcare management system. It shows that fire safety ranks very low among priorities of hospitals.
The root causes of the tragedy, though, are being barely discussed. Some are demanding the closure of the hospital, which will do no good. If anything, it would only derail the careers of some employees and the future prospects of some students. It would only further weaken the health sector.
Instead, the management should be coerced to take remedial measures. SUM Hospital as well as other private hospitals and government healthcare institutions should be made to stringently adhere to rules and regulations to avoid recurrence of such mishaps.
The SUM Hospital mishap is but a reflection of the malaise that has afflicted the healthcare sector of the country. Since the country adopted neo-liberalism, the government has exposed the healthcare sector to be operated at the whims of private parties and weakened it.
States and regulators need to play a major role in reining in companies in the interests of the public. But with the state retreating from welfare activities and the rise of crony capitalism, regulatory failure is deeply entrenched in the market economy.
National Human Rights Commission has pointed out that among the 568 hospitals in Orissa, only three have fire safety clearance. It shows the laxity of regulatory bodies, which is not confined to them. India continues to be among the worst performers in health.
The healthcare infrastructure of Orissa and that of the country is in a shambles and the number of hospitals and doctors is not in proportion with the population. Orissa has only one doctor for 12,932 citizens against the national average of one doctor per 1,700 citizens; the World Health Organisation (WHO) stipulates a minimum doctor to people ratio of 1:1,000.
The plight of India’s healthcare system is reflected in the recent Global Burden of Disease (GBD) study which covered 33 health indicators. GBD analysed the progress of each country in achieving health-related sustainable development goal (SDG) by creating an overall SDG Index score.
India was ranked 143rd among 188 countries in the index released in September citing challenges including high mortality rate, prevalence of malaria, lack of hygiene and air pollution. India was ranked right below Ghana (141) and Comoros (142), and much below countries such as Sri Lanka (79), China (92), Syria (117) and Iraq (128).
The National Health Accounts data for 2013-14 recently released by the health ministry after almost a decade presents fresh evidence that India continues to have a lackadaisical approach to ensuring universal health coverage. India’s healthcare system is among the most privatised in the world, poorly regulated and accessible only to those with above-average incomes.
Despite rapid economic growth over the past two decades, successive Union governments have failed to invest generously in healthcare. India’s public expenditure on health is among the lowest in the world, which compares poorly with even sub-Saharan Africa.
While India spent 4 per cent of its GDP on health, the share of public expenditure in it was only about 1.15 per cent, compared with 3 per cent in China and 8.3 per cent in the United States. The share of state governments, which are largely responsible for the provision of healthcare, is estimated at 0.75 per cent of the GDP.
The out-of-pocket (OOP) healthcare expenditure of Indians, which is the money individuals pay on their own rather than being covered by insurance or health benefits, is an estimated 69 per cent of total health expenditure (THE) in the country — among the highest in the world.
Dr Himanshu Sekhar Rout, HoD of A&A Economics, Utkal University, Bhubaneswar, conducted a study covering four districts of Orissa and found that gender bias exists in household health expenditure in the state.
Growing medical expenses are among the leading causes of indebtedness among the poor in India, according to a recent NSSO survey. The survey found that 86 per cent of the rural population and 82 per cent of the urban population is still not covered by any scheme, public or private, to support health expenditure.
The affluent and powerful can afford healthcare at both private and government hospitals of renown. But those of the middle class have no choice but to burden themselves with loans to pay exorbitant medical bills at corporate hospitals.
The poor cannot even borrow to meet their medical expenses. The only alternative left with them is to sell property or perish.
No nation can become a superpower with a crippled healthcare system that is becoming expensive and unreachable by the day.
The author is an Orissa-based financial columnist.
