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The fault line of poor health infrastructure

Topics Covered: Issues related to health.

The fault line of poor health infrastructure:


The second wave of the COVID-19 pandemic has exposed the abysmally poor state of the country’s health infrastructure.

Current state of India’s health infrastructure- World Bank data:

  1. India had 85.7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 100 in Sri Lanka and 241 in Japan).
  2. 53 beds per 1,00,000 people (in contrast to 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan).
  3. 172.7 nurses and midwives per 1,00,000 people (in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan).
  4. India has among the highest out-of-pocket (OOP) expenditures of all countries in the world- 62% of the total health expenditure in India is OOP.

Reasons and causes for this:

  1. Low public health expenditure- 1% of GDP 2013-14 and 1.28% in 2017-18 (including expenditure by the Centre, all States and Union Territories).
  2. Centre is the key player in public health management because the main bodies with technical expertise are under central control. The States lack corresponding expert bodies such as the National Centre for Disease Control or the Indian Council of Medical Research.
  3. States also differ a great deal in terms of the fiscal space to deal with the novel coronavirus pandemic because of the wide variation in per capita health expenditure.

Inter-State variation in per capita health-care expenditure (between 2010-11 to 2019-20):

  • Kerala and Delhi have been close to the top in all the years.
  • Bihar, Jharkhand and Uttar Pradesh have been consistently towards the bottom of the ranking in all years.
  • Odisha is noteworthy as it had the same per capita health expenditure as Uttar Pradesh in 2010, but now has more than double that of Uttar Pradesh.

What needs to be done? How to manage the pandemic? 

  • A coordinated national plan at the central level to fight the pandemic.
  • The central government should handle the responsibilities including that of procuring vaccines from the international market.
  • Once the vaccines arrive in India, these could be distributed across States equitably in a needs-based and transparent manner.

Sources: the Hindu.