As India hurtles down the deathly path, its breathless people bang on the doors of hospitals, and hospitals send SOS messages to political executive, shrieking about falling Oxygen supply levels, the entire debate has come to be focussed on fixing the Oxygen supply line, augmenting ventilator numbers and adding a few beds here and there. Daleel with SP Singh explores the Indian health sector in conversation with Dr Manmeet Kaur, from PGI School of Public Health and Dr Pyare Lal Garg, Ex-Registrar, Baba Farid University of Health Sciences.

IN THIS INFORMED CONVERSATION WITH Dr Manmeet Kaur, from PGI School of Public Health, & Dr Pyare Lal Garg, Ex-Registrar, Baba Farid University of Health Sciences, we discuss if we are still missing out on a huge opportunity to revisit, redesign and reimagine our entire approach towards healthcare. It is much beyond Oxygen, and while breath supply needs to be fixed, things wouldn’t work if we do not pay attention to the structural and systemic loopholes the size of the Indian Ocean in our healthcare system.

No wonder, we haven’t even seen the beginning of any talk to make health a fundamental right, something we thought should have been the core of the debate when the pandemic struck. Much like we missed the debate on the clever move by the Centre to shift the entire focus from sickness to preventive healthcare in the National Health Policy (NHP) 2017. Many of our do-good Samaritans seemed to advocate the ‘preventive’ part more than the ‘sickness/treatment’ part, and the government cleverly couched its policy to align itself with activists’ rhetoric.

The debate brings out an interesting aspect about money pumped into healthcare. The NHP 2017 promised to increase the expenditure on health from 1.4% to 2.5% of GDP by 2025, even as currently it is pegged at 1.4%. States account for 0.9% of this 1.4% and the Centre an abysmal 0.6% of the GDP. The total health expenditure in India is 4.7%, so the rest goes out from people’s pockets. As a result, some 63 million people in India, roughly equal to the entire population of Great Britain, are pushed into poverty as a result of this high out-of-pocket health expenditure.

The debate also focuses on the number of doctors per million, a key statistic that determines if you will find a doctor when you are sick. India has slightly more than a million doctors to treat its 1.3 billion people, of which only around 10% (1.1 lakh) work in the public health sector! Clearly, you don’t need an epidemic, however predictable, for the public health system to collapse. Even when there wasn’t any Covid around, patients shared beds, doctors were overworked, and we had made peace with that routine.  Public hospitals, in particular, just end up being places where the sick go to die.

A report by Shailaja Chandra, former chief secretary of Delhi, said there were no large-scale surveys on quackery. She had authored the report on Unqualified Medical Practitioners that said 58% of doctors in urban areas had a medical degree while only 19% of doctors in rural areas had one.

The panellists refer to the WHO report that says only one in five doctors in rural India were actually qualified to practice medicine, while 31.4% of the “allopathic doctors” were educated only up to Class 12 and 57.3% of doctors did not even have a medical qualification.

A report by Shailaja Chandra, former chief secretary of Delhi, said there were no large-scale surveys on quackery. She had authored the report on Unqualified Medical Practitioners that said 58% of doctors in urban areas had a medical degree while only 19% of doctors in rural areas had one.

Stick to the episode till the very end for a poignant tale about a man called Dana Majhi, someone we should never forget if we want things to fall in place.