It’s not the best optics for Asia’s third largest economy and a country aspiring to 8 percent GDP growth — people dying of vector borne diseases, health services crippled by lack of hospital beds, doctors in short supply, and a government looking on helplessly.
As vector species rampage across India, killing and debilitating thousands, the crisis has exposed the frailties of the health system in this nation of 1.3 billion. The capital city of New Delhi, ironically, is the worst hit, where there seems to be no respite from the viral onslaught. Chikungunya cases in this city of 18.6 million have spiraled up to over 2,600, with 1,568 of them being recorded in the second week of September, according to a municipal report, marking a massive rise of nearly 150 percent from the previous count.
So far chikungunya has claimed over 50 lives in the city (though some say government figures are fudged to underreport fatalities) turning on its head conventional medical knowledge that the disease is not fatal. There’s also a mystery fever going around with symptoms akin to dengue. Last week, when a 30-year-old Delhi resident succumbed to malaria, the city recorded its first death from the disease in five years.
The rest of the country isn’t faring any better. According to the National Vector Borne Disease Control Program, around 12,255 cases of chikungunya had been reported across India as of August 31, when the census was last done. Karnataka alone has recorded 8,941 cases, Maharashtra 839, and Andhra Pradesh 492.
Ironically, even as the medical calamity is unfolding across Delhi, its government — helmed by Chief Minister (CM) Arvind Kejriwal and Lieutenant Governor (LG) Najeeb Jung — is engaged in a bitter game of political one upmanship. The CM and LG are laying the blame for the current mess at each other’s door. While Jung is holding Kejriwal responsible for not being able to manage and control the epidemics, the latter is accusing the LG of an “uncooperative attitude.”
The warring LG and CM forced the Union Health Minister J.P. Nadda to step in and stress the need for “close coordination” between the center and states to deal with the outbreak, which has affected over 60,000 people across the country. Experts say that the viral epidemic has also amplified the political dispensation’s failure to craft a concerted strategy to deal with health emergencies.
The current situation augurs ill for a country already grappling with sundry other medical woes. According to Indiaspend.org, a data-driven, public-interest journalism nonprofit organization, millions of Indians cannot access India’s overburdened hospitals and inadequate medical facilities. The country remains nearly 500,000 doctors short of reaching the World Health Organization norm of one doctor per 1,000 citizens.
With more than 740,000 active doctors at the end of 2014 — a claimed doctor-patient population ratio of 1:1,674, worse than Vietnam, Algeria, and Pakistan — the shortage of doctors was one of the health-management failures cited by the report of a parliamentary committee on health and family welfare, which presented its findings to both houses of Parliament on March 8, 2016.
Dr Pavitra Mohan, co-founder of Basic Health Care Services and director of health services at Aajeevika Bureau, writes in The Wire that India’s “public health systems are in disarray: about 15,000 doctor positions at primary health centers are lying vacant, and 4,000 out of 5,000 community health centers do not have even a single obstetrician.”
India’s poorer states have health indicators that are worse than many nations in sub-Saharan Africa while the country’s healthcare spending is the lowest among BRICS (Brazil, Russia, India, China, South Africa) nations, as are its health indicators.
Experts blame many of the country’s current health problems on its abysmal spending of 1.4 percent of GDP on public health, one of the lowest rates in the world. China spends three percent while the figure for the U.K. is eight percent Even the world’s poorest countries, like Burundi in Africa, for instance, invest around nine percent in public health. As per world health statistics published by WHO, the per capita government expenditure on health in India was $18 in 2012, as compared to countries like Germany ($3,618), France ($3,592), Japan ($3,932), the U.K. ($3,019) and the United States ($4,153).
Specialists recommend that at least 2.5 percent of GDP be marked for public expenditure on health because of the huge burden of diseases in India. In addition to the current chikungunya outbreak, India is also highly vulnerable to yellow fever in view of its highly susceptible population and the abundance of the mosquito vector species, Aedes aegypti.
Higher spending on health is all the more critical for India as a UN report predicts that non-communicable diseases like cardiovascular disease, diabetes, and cancer could cost the Indian economy a whopping $6.2 trillion during the 2012-2030 period due to its rapid urbanization.
“Non-communicable Diseases (NCDs) present not only a threat to human health in cities, but also have significant economic implications,” said the Global Report on Urban Health jointly released by the WHO and the UN Human Settlements Program earlier this year.
The WHO states that more than 5.2 million lives are lost annually in India and the death rate in urban India is expected to rise by 42 percent by 2021. While one person dies of a stroke every minute in India, every sixth patient below 40 years is a victim of cancer and cardio vascular disease.
Another crucial measure, which determines the impact of a health emergency on a family’s welfare, is what proportion of health expenditure is paid out of a citizen’s pocket, as opposed to state provided healthcare. In India, that figure is a staggering 62.4 percent, as against a world average of 18.2 percent.
Experts predict that India cannot become a knowledge economy or a global superpower with its current quality of healthcare. “Governments must spend more on preventive public health measures, such as providing clean drinking water and being proactive in controlling epidemics such as the current one. At the same time, it also needs to raise its number of healthcare professionals and adopt a decentralized approach to medical governance,” advises Dr. Arvind Purohit, head of internal medicine at Max Hospital, NOIDA in Uttar Pradesh.
It’s not as if India is incapable of getting its act together. It has some of the finest doctors in the world and its prowess in medical technology is world class. The country also boasts of some remarkable achievements in public health such as significant declines in infant and maternal deaths. In 2014, India averted 126,000 deaths among children under five years of age, according to data released by the Registrar General of India. The survey indicates an 8.16 percent decline in under-five mortality during 2013-14, more than the decline of 5.76 percent during 2012-13.
A change in governmental attitude is also visible. As per the 12th Five Year Plan document, total public funding on core health is envisaged to increase to 1.87 percent of GDP by the end of the plan. The Draft National Health Policy 2015 also plans to progressively raise the public health expenditure to 2.5 percent of the GDP.
However, if India fails to adopt these measures, or register a quantum increase in health allocations, the outcome can be dire. As Dr. Pavitra Mohan writes, the country “will remain ailing, and large numbers of its citizens, who cannot afford expensive private healthcare, will remain diseased and undernourished.”
Neeta Lal is a New Delhi-based Editor & senior journalist.