As the most populous country on the planet, India鈥檚 healthcare policy shapes the well-being of more than 1.4 billion people. During Narendra Modi鈥檚 decade-long tenure as prime minister, the nation has started various public health initiatives, and yet its healthcare system still falls short of meeting needs.
Preventable illnesses like tuberculosis and diarrhoeal diseases remain leading causes of death there, and chronic conditions such as heart disease and cancer are rapidly rising. Can this be turned around?
Low healthcare spending is partly to blame for poor outcomes. In 2020, this was equivalent to less than of the country鈥檚 gross domestic product (GDP). By comparison, other emerging economies like China and Mexico spent roughly the equivalent to 6 per cent of GDP on healthcare whereas the US and UK were at almost 19 per cent and 12 per cent, respectively. Healthcare also accounts for of the Indian government鈥檚 expenditure.
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鈥淧art of it is health has never been a political topic in India,鈥� says at Duke University in North Carolina. For example, less than of voters cited healthcare as their top concern in the 2019 election.
Instead, they have pushed for development and anti-corruption initiatives, leading Modi鈥檚 government to focus on reforms like reducing poverty, improving education and expanding infrastructure. All of these indirectly affect health, but aren鈥檛 captured by healthcare spending statistics.
鈥淚f you think of health broadly, it has a lot to do with social determinants of health, which, by some estimates, are actually more important than pumping money into the [health] system,鈥� says at Harvard University.
One infrastructure project is Modi鈥檚 sanitation initiative, called the Swachh Bharat Mission. Between 2014 and 2019, the number of rural households with access to a toilet increased from . This effort has reduced India鈥檚 rates of open defecation, which is associated with the spread of diarrhoeal disease, though research suggests it issue.
The government has also added of highway over the past nine years, which has improved healthcare accessibility. 鈥淚f you look at the drop in maternal mortality, India has done phenomenally well over the last few years, and a lot of it [probably] has to do with just having the road infrastructure so that a woman can get to a hospital when she鈥檚 in labour,鈥� says Kalita.
That isn鈥檛 to say Modi has had no specific healthcare policies. The most significant initiative is (PM-JAY), dubbed Modicare.
Launched in 2018, it provides low-income households with roughly $7100 to pay for hospitalisations for specific conditions or procedures 鈥� almost double the average household income of . About 40 per cent of India鈥檚 population 鈥� roughly 500 million people 鈥� qualify for PM-JAY, making it the largest public health insurance scheme worldwide.
Yet not everyone eligible for PM-JAY uses it, partly because of low awareness of the programme. Only of respondents knew of it in a survey conducted between 2019 and 2020. Of them, less than 80 per cent understood their eligibility for the scheme.
Uptake is also complicated by the fact that healthcare is a state-level responsibility in India. As a result, adoption and implementation of PM-JAY varies widely, with some states opting out of it entirely. 鈥淭he joke is we have 6000 governments in India, so I guess we also have 6000 different health systems,鈥� says at the Indian Institute of Management Bangalore.
PM-JAY鈥檚 most significant limitation is it only applies to hospital care. This deters people from seeking care earlier, when a condition may still be prevented or easily treated with low-cost interventions, says Kalita. Instead, they wait until they deteriorate to the point of hospitalisation, driving up costs for both households and the system, she says.
鈥淎 big missing piece of the pie, as far as the health sector in India goes, is primary health care,鈥� says Mukherji, noting that local health centres are frequently understaffed and undersupplied.
Modi鈥檚 government also hasn鈥檛 addressed problems about quality of care. 鈥淒uring covid, the vast majority of healthcare providers in the country were writing prescriptions that made no sense at all,鈥� says Mohanan, such as for , but risk contributing to antibiotic resistance.
In fact, in some ways, the government has exacerbated the issue by promoting unsubstantiated traditional medicines, which Modi sees as a way of furthering India鈥檚 global influence. 鈥淥ur traditional medicine is a repository of hundreds of years of accumulated knowledge,鈥� he said in 2022, during a ceremony to mark the construction of the World Health Organization鈥檚 Global Centre for Traditional Medicine in Jamnagar, which is due to be finished this year.
As India grows on the international stage, such views have global ramifications. 鈥淸India] is a sixth of humanity, and if the vast majority of them are getting really poor care, it鈥檚 something for us all to think about,鈥� says Mohanan.
