Healthcare in India

It is a daunting task to erect an efficient and well-functioning publicly-funded health system in low-resource settings such as India. Although India has a vast system of publicly-funded health facilities, most of them are under-resourced. Even basic amenities, such as electricity and running water, are non-existent in a number of health facilities. Health system strengthening in India was never really based on "Health for All" principle. WHO and the likes always focused on result oriented primary care interventions. Consequently, the health system that we have today is fragmented and unable to respond to crises appropriately in time. However, in 2005, the central government of India took another step towards strengthening publicly-funded health system by introducing a nationwide program. The program has been extended to 2017. The most important thing to remember while analyzing Indian context is that Health is basically a state subject. Some states like Tamil Nadu and Kerala have well-functioning publicly-funded health systems. It is up to the state government how it responds and acts when the Center offers financial and technical assistance. For most of the northern Indian states, health has never been a political priority. Health systems in these states are dysfunctional and corruption is rife everywhere. A lot of states are now slowly trying to develop capacities so that they can have good health system in place but they still have a long way to go. As far as Modi is concerned, his main thrust is on getting country's economy back on track as early as possible. A happy economy means having enough money for the implementation of health system reforms. I don't see substantial changes taking place in the health systems of North Indian states, especially Bihar and Uttar Pradesh, for next 5 years or so. 

BTW, I was born and bred in rural Uttar Pradesh. I lost a 3-month old sister in the year 1985 just because there were no health facilities around my village. The nearest private/public doctor was 15 kilometers away from my home. My father and grandfather both were out of station. For a young Indian mother whose social behavior and freedom of movement was constrained by several cultural and economic factors, the thought of traveling 15 kilometers on her own, roaming around in an unknown city, looking for a child specialist in the district hospital was unimaginable and scary. My mother did not go and waited for my father to come back. By the time, my father came home, my sister had already taken her last breath. Very little has changed over last 3 decades in my state. There was one midwife per 5000 people in 1990. Today, it is less than 1 midwife per 8000 people. Most of them are in their 50s and will soon retire from the job. The state centers for midwife training have not produced a single midwife since 1990. The whole system is in shambles, but who cares? Not even people!!! :(