India needs universal health coverage, public health investment

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[NEW DELHI] India needs to set up a real-time infectious disease surveillance system, improve public health infrastructure and pursue universal health coverage, according to experts.
The absence of an effective public healthcare system has contributed to the resurgence of a range of infectious diseases such as malaria and tuberculosis (TB). Others, such as cholera and typhoid, are continuing to rise, Jacob John, a fellow at the Christian Medical College, Vellore, said this week (11 January) at the launch of a special issue of The Lancet on Indian health.
Scientists writing in The Lancet emphasised how India’s recent economic growth must now be matched by the implementation of a universal healthcare system by 2020.
The reports paint a dismal picture of India’s health system. The country has the world’s highest number of maternal and child deaths, with 1.8 million children under five and 68,000 mothers dying each year.
In 2009, India had two million new cases of TB, the highest of any country worldwide. Diseases such as visceral leishmaniasis, filariasis, cholera, and dengue are severely neglected, with little monitoring and surveillance, leading to repeated outbreaks.
The country is also facing a crisis of chronic diseases such as heart ailments, diabetes, and cancer that are set to worsen over the next few decades.
Much of the problem lies in India’s fragmented healthcare system, with states differing widely in their health policies. A severe shortage of health workers in remote areas and clogged supply chains of drugs and vaccines leave millions with no access to healthcare.
Much of India is too poor to pay for health — half of its population lives on less than a dollar a day. High out-of-pocket payments to private doctors are sending many families into crippling debt.
The Lancet noted that it is time India moved towards a universal health care system, with its national rural health mission, initiated in 2005, offering a good starting point. The mission is starting to decentralise health planning, increase funding and community involvement in rural areas, and integrate vertical health programmes.
Noting a huge challenge in financing a universal healthcare system for India’s one billion population, experts suggested a hike in public spending on health from one per cent to six per cent of the national wealth, through a variety of taxes.

Link to The Lancet papers: http://www.thelancet.com/series/india-towards-universal-health-coverage