Correction:

A previous version of this story incorrectly said that national spending for New Delhi’s health budget is about $3 billion annually. The actual amount is $20 billion. This story has been corrected.

India plans big increase in health-care spending to catch up to rivals

NEW DELHI — With its health-care system increasingly eclipsed by rivals, India has a plan to nearly double public spending on health over the next five years, with the goal of eventually making medical care free for all Indians.

It is an ambitious goal, and the kind of investment many experts have been advocating for decades. But already critics are wondering if the government will live up to its promise, or if throwing money at the problem without reforming the health-care delivery system from top to bottom will make much of a difference.

In recent years, India has watched with alarm as countries such as China, Egypt, Mexico and Brazil raced ahead, and as its performance on child health and infant mortality was overtaken even by much of sub-Saharan Africa.

The planned budget increase would lift annual spending on health to 2.5 percent of the country’s economic output, from 1.4 percent. The increase is aimed at giving free medicine to all Indians at government facilities, setting up free ambulances in rural areas, doubling the number of trained health workers, and lifting millions of young children and women out of chronic malnutrition and preventable deaths.

“In the past five years, other emerging economies like Brazil, Mexico, Malaysia have marched ahead on basic public health indicators,” said Amarjeet Sinha, a senior health official in the northern state of Bihar who helped design India’s rural health program. “Just two decades ago, we were all in the same place. It’s a shame that we got left behind in our health performance despite our economic progress.”

With a rapidly growing young population, India urgently needs to harness the energy of its youth by creating jobs and improving their health care, or it will squander the gains of its recent economic boom, analysts say.

A newborn baby dies every 20 seconds in India and four out of 10 children are malnourished. Last month, Prime Minister Manmohan Singh called the state of the health-care system a “national shame.”

“In the years to come, these children will join our workforce as scientists, farmers, teachers, data operators, artisans and service providers,” Singh said, releasing a report by an anti-hunger and anti-malnutrition advocacy group Hungama. “We cannot hope for a healthy future for our country with a large number of malnourished children.”

The proposed hike in New Delhi’s health budget, from a current national allocation of a little more than $20 billion annually, was first discussed almost a decade ago, but bureaucratic delays and a lack of political will delayed the decision to go ahead.

Misspent money

Critics say Singh’s government has a habit of throwing money at problems without reforming basic delivery systems to ensure that the money reaches those it is meant for. India spends $7.8 billion every year on one of the largest rural job guarantee programs in the world. It is also planning a $20 billion program to make food accessible to millions of poor. Much of the money ends up in the pockets of local officials or is lost in poor implementation.

“If spending public money could alleviate poverty, improve health care, provide education, then by now India should have been a garden of Eden,” said Barun Mitra, who heads the free-market economic group Liberty Institute. “Allocation is not equal to outcome.”

With India’s economic growth slowing down to 6.1 percent in the last quarter of 2011 against mounting fiscal deficit, some say that spending at the levels Singh is proposing may either be unsustainable or may create new avenues for corruption.

But other analysts who have blamed decades of poor investment in health care for the crippling shortages welcome the hike.

“India failed to anticipate the need for more medical education institutions to meet the pressure of the growing population,” said Arvind Singhal, chairman of Technopak, a consultancy firm that prepared a report on health-care worker shortage. “Now, India is sitting on a public health time bomb. There is a shortage of about 1 million doctors and 2.5 million nurses to meet the needs of the current Indian population. And India has to open 600 new medical and 1,500 nursing colleges right away.”

India has committed to the United Nations Millennium Development Goals of bringing down its infant mortality rate by two-thirds of the current level by 2015. To achieve this, India needs an additional 2.6 million trained health workers, says the child-care advocacy group Save the Children UK.

The shortage is most apparent in rural areas. A government-run rural health center in a district sub-center called Bihiya in Bihar has only three doctors but needs eight. Instead of nine nurses, it has only two. There is no anesthetist or obstetrician. A filing clerk doubles as a pharmacist, and an office boy stitches and dresses wounds.

Pregnant women are often forced to deliver babies on the cold floor of the center because there are too few beds. Village nurses are overworked and are not able to meet immunization targets.

But the government says it will embark on a massive project to train villagers and create an army of front-line community health workers.

“Our goal is to have universal free health care,” Sinha, the health official in Bihar, said. “For that we need to have health-care providers and services in place. We have started late. But we now have successful models from other countries that we can learn from.”

 
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