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Governance deficit makes access to healthcare elusive

Access to healthcare is important in developing countries like India. This is because apart from treatment of ailments and diseases and the well-being of citizens, a productive population is the basis of economic growth.

Part IV of the Indian Constitution talks about the directive principles of state policy. Article 47 lists the “Duty of the state to raise the level of nutrition and the standard of living and to improve public health”. Despite this, successive governments have not been able to cater to the nutrition and standards of living of a large section of citizens. There are four principal reasons for this.

First, the overall system seems inadequate to cater to India’s vast population. For example, the total number of hospitals, public health centres (PHCs) and the private healthcare sector together seems inadequate to cater to the demand in spite of being big in absolute numbers. This is also true about healthcare professionals — be they doctors or nurses or other professionals in the sector.

Together, the system is simply inadequate to cater to demand. The private healthcare sector has developed as the public healthcare system was overburdened and thus inefficient. Also, experts and policymakers have been contemplating solutions to look at healthcare from the “reduction in demand” perspective. This includes improving hygiene as well as the environment to prevent ailments and diseases. But despite efforts, the present system is inadequate for the demand that India has for healthcare services.

Second, the shortfall in healthcare infrastructure and healthcare demand arose due to funding constraints. Funding in the healthcare system is another issue, which results in low healthcare access. The healthcare expenditure as a percentage of GDP by the government is one of the lowest in the world. Here, another issue is the way funds are disbursed to the states and spent. Often the funds are delayed and this results in non-utilisation in critical schemes and programmes of the union and state governments. As a result, a majority of the people bear healthcare costs with high out-of-pocket spending, as insurance penetration is low.

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