Insights into Editorial: Poverty and Health
Poverty and poor health worldwide are inextricably linked. The causes of poor health for millions globally are rooted in political, social and economic injustices. That’s why it is so crucial to tackle the root causes of poor health as well as the symptoms.
Poverty increases your chance of getting ill because of:
- Poor nutrition
- Lack of clean water
- Harsh realities that may make putting your health at risk the only way to survive or keep your family safe.
Poor health increases poverty by:
- Reducing a family’s work productivity
- Leading families to sell assets to cover the costs of treatment. This increases poverty and their vulnerability to shocks in the future.
Healthcare system for the poor and under-privileged:
The state of India’s healthcare system is somewhat dichotomous — the country is a global supplier of life-saving, affordable and good quality generic medicines, yet lakhs of families are driven into poverty because they are forced to spend much of their earnings and savings on medications to treat chronic and life-threatening diseases.
The poor, particularly, spend disproportionately large amount of their income as out-of-pocket expenditure on healthcare, mostly to buy medicines and this has been known to India’s policy-makers for decades. Spending patterns of households on various items, including medicines and doctors, are routinely collected during the course of the Consumption Expenditure Surveys by the National Sample Survey Organisation.
The Health and Morbidity Surveys of the same organisation too have been a rich source of information on expenses incurred by the population on treating various ailments and diseases that include cancers, cardiovascular diseases and diabetes.
Now, a research paper published in the medical weekly BMJ has once again highlighted the sad condition of healthcare in India. It has estimated that about 5.5 crore people were pushed below the poverty line between 1993-94 and 2011-12 by out-of-pocket expenditure on healthcare.
Of further concern is that medicine purchase was the single largest component of OOP at 63 per cent and the rise in the proportion of population reporting any OOP payments to 80 per cent in 2011-12 from 60 per cent in 1993-94.
This has also meant that the share of healthcare expenditure in the Indian households’ consumption expenditure has risen from 4.8 per cent in 1993-94 to seven per cent in 2011-12.
The Centre’s intervention to control prices through Drug Price Control Orders has provided some relief in the past but with treatment protocols and drugs changing, that has not proved enough.
- India’s rank on Universal health care among 100 countries – 56
- People pushed to extreme poverty every year in India due to healthcare expense- 49 million
- Physicians per 1000 persons in India – 7
- Psychiatrists per 1,00,000 persons in India – 3
- Surgeons per 1,00,000 persons in India – 6
- Hospital beds per 10,000 persons in India – 6
- Percentage of people who spend at least 10 percent of their household budgets to pay for healthcare – 33
- India’s expenditure on health care – 15 per cent of GDP
Although India has a public healthcare network ranging from primary health-care centres all the way to super-speciality hospitals, the basic network is poorly equipped, under-staffed and overcrowded, forcing people to look to private providers.
Also, the infrastructure is grossly inadequate — India has less than one bed per 1,000 population and less than one doctor per 1,000 persons.
Ayushmaan Bharat – An attempt to transform India’s Healthcare Map:
Innovative and path-breaking scheme in the history of public health in India. It may have a transformative impact if implemented in an effective and coordinated manner.
Aim: To make path-breaking interventions to address health holistically, in primary, secondary and tertiary care systems
Objective: Prevention + Promotion (Health & Wellness)
Full proof mechanism while allowing States to accommodate the existing schemes, keeping the flavour of Digital India intact.
AB-NHPM will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban. The scheme is designed to be dynamic and aspirational and it would take into account any future changes in the exclusion/ inclusion/ deprivation/ occupational criteria in the SECC data.
Two major initiatives:
Health and Wellness Centre: Foundation of India’s health system
- 1.5 lakh centres will provide – comprehensive health care, including for non-communicable diseases and maternal and child health services, provide free essential drugs and diagnostic services
- The budget has allocated Rs.1200 crore for this flagship programme
- Contribution of the private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.
National Health Protection Scheme:
- Will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries)
- Coverage of up to ₹5 lakh a family a year will be provided for secondary- and tertiary-care hospitalization (50 crore beneficiaries)
It is hoped that the Ayushman Bharat Health Protection Mission, announced in the current year’s Budget and scheduled for rollout on August 15, will reverse the trend of rising OOP and increase access to quality healthcare and medication for the poor.
Only a universal health insurance programme, or provision of healthcare at subsidised rates, can ensure that large numbers of people are not driven to poverty by catastrophic medical expenses. For this to happen, besides the cost of medicines, both the Centre and States have to address the yawning gaps in India’s healthcare infrastructure.
The state and central agency will keep an eye that system is not distorted. For a system of this magnitude in any country, strong monitoring and governance system is required. Help of IT and artificial intelligence will also be taken.
Moreover, there should be a link between institutions or hospitals, with health centres and the community as community engagement helps in planning and implementation of programme. The success of this mission depends on its design and execution, as well as top-down leadership to ensure that the stated goals are met.
This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to. This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to improvement in quality of life.