The focus of Healthcare in India is increasingly shifting towards have – not’s Society.

Meena was a student of Government High School in Aara, Bihar. We could easily recognize her by her weak profile. “If you see any student studying the whole day while coughing, it would be Meena,” says her teacher. She used to top her class. But nobody paid attention to the cough she had. She died 1 year later, probably because of tuberculosis as her parents couldn’t afford treatment.

There are thousands like Meena who have become victims of the lax healthcare system of India. Who knows we might have lost a teacher, a pilot, or a Nobel laureate in her. But then who is to blame? Is it because of poverty of parents, poor primary healthcare infrastructure of India, or something else.

This essay will try to answer such questions. We will look into the evolution and present state of healthcare infrastructure. We will look into current measures taken to help ‘have nots’ like Meena and analyze as to whether they are enough. This essay will conclude by looking into some international best practices and how ‘India healthcare’ can be better universalized.

WHO ARE HAVE-NOTS?
Have-Nots as a phrase is used for people who lack socio-political and economic resources at their disposal. They are the neglected sections of the society who may have been socially discriminated like SES/STS (Caste-based), Women, Transgender (Gender-based). It also includes people who are economically marginalized poor who cannot afford healthcare. They have been discriminated due to various reasons for healthcare facilities.

Take the case of highly neglected ‘have nots’ i.e. tribals. Their isolation from mainstream society has reduced access to healthcare for them. Moreover, 47% STs live below the poverty line and are thus unable to afford the highly privatized healthcare facilities which translates into high MMR and IMR (Infant Mortality Rate).

Similar is the case with women. It is an unwritten practice that women eat last in Indian households which has translated into malnutrition, evident in 53% being Anemic (NFHS-IV). Lacking financial independence, they are not taken to hospitals by highly patriarchal Indian society, as can be seen in high non-institutional deliveries and MMR (Maternal Mortality: 122/1 lakh).

But is the deplorable condition only because of society or there are fractures in the Indian healthcare system itself? The neglect of ‘have nots’ has not been due to choice but probably a systemic issue.

INDIAN HEALTHCARE SYSTEM: PINNACLE OF ASYMMETRY
Indian healthcare has made long strides since Independence. When India started its ‘Tryst With Destiny’, the average age of an Indian was only 32 years which has more than doubled to 69 years today (census 2011). But the growth has not been commensurate with population rise and has been highly asymmetrical.

India lacks basic healthcare infrastructure which is the bedrock system for providing healthcare to ‘have nots’ of society. The number of beds per 1 lakh people is 70 in India compared to 420 in China. Doctor to people ratio is 1:1456 compared to WHO’S recommendation of 1:1000 which speaks volumes of scarcity of resources.

The healthcare system has discriminated against the ‘have nots’ due to structural issues too. Health being a ‘state subject’ has led to incoherence in policy making at state and national levels, the latest example being chaos amidst the initial phase of COVID-19 spread. The latest National Medical Commission bill also lacks adequate state representation adding to the chaos.

Medical Education in itself has become so expensive that it is seen as an ‘end in itself’ rather than as a ‘means’ for the ‘end’ of public welfare. This gets reflected in urban: Rural doctor ratio divide of 38:1 as only the ‘rich’ can afford it, leaving the ‘have nots’ in dark who reside primarily in rural areas or in shuns.

Let us look at why India hence needs to make a transformative shift towards have-nots at the first place then.

HEALTH IS WEALTH
India is entering into the phase of ‘Demographic Dividend’ where India’s strength will be its youth to transform it into a knowledge-based economy. As Winston Churchill once said, “Healthy citizens are a country’s greatest asset”. A citizen-centric & accessible healthcare makes liabilities (demographic burden) turn into ‘assets for the future’.

Healthcare has multifold impacts on other fields of living too. India’s out-of-pocket expenditure is 68% compared to UK’S 17%, thus pushing the already marginalized into deeper darkness. It churns the vicious cycle of poverty where the unhealthy are not able to learn & equip themselves with education & skills, thus only going downwards.

In fact, the need for ground-based healthcare has not been felt strongly ever than amidst the COVID-19 pandemic. This has been on the minds of policymakers now for a long time and India has taken notable steps towards it.

INDIAN HEALTHCARE: SHIFTING GEARS
The ‘have nots’ and vulnerable have become a center point of Indian Healthy policy now. India has launched Ayushman Bharat – the world’s largest insurance scheme of such kind. Rs. 5 lakh insurance per family is provided for treatment in secondary and tertiary facilities. This has transformed healthcare where beneficiaries are now directly assisted by ‘Arogya Mitras’.

Along with it, PM Jan Aushadhi Yojna is providing generic medicines at affordable costs- a boon for the economically marginalized ‘have nots’. Integrated Child Development Services (ICDS) have taken healthcare to the doorstep thus bridging the Divide and filling the gulf between administration and citizens.

Women who are at the forefront of today’s policy making have PM Matru Vandana Yojna for institutionalizing deliveries and reducing MMR rates. Mid Day Meal is further fighting the ‘devil’ of malnutrition.

India’s latest announcement of National Digital Health Mission will help institutionalizing entire healthcare networks, thus opening doors of transparency and accountability for have-nots. Thus, Indian Healthcare truly seems to be shifting towards the have-nots.

But All that Glitters is not Gold.
The number of empaneled hospitals under Ayushman Bharat are still less than 2%. There have been various cases where the poor are threatened to pay in cash instead of it being a cashless scheme.

The latest case of private hospitals denying ICV beds in Bihar to the poor despite government regulations against doing so, becomes a case in point of the current state of healthcare infrastructure.

Thus, armed with disabilities of low insurance penetration, unaffordable healthcare, and low awareness, have-nots of India are struggling for a living, more so amidst COVID-19.

UNIVERSAL HEALTHCARE: A RAY OF HOPE
Universal healthcare might be the solution to the above problems. It amounts to universalizing access to healthcare infrastructure. The concept is not new and in fact has been in practice in Thailand and Cuba.

Cuba has successfully employed UHC. It has not only helped decrease poverty but also has improved cohesion in society. Amidst the COVID-19 shock, Cuba dealt with it with its highly decentralized system and emerged out stronger. It is now even helping other Central American countries to cope with the pandemic.