There are large deviations in the ability of third world nations to deliver health care. If the care is privately funded then the standard of care is on a par with the best available treatment in the Western world.
However, a significant number of people living in the third world live on or below the poverty line. It is the ability of a nation to afford basic health care to these people that needs to be improved, even while a transition occurs in the economic state of the country.For example, India has an estimated population of over 1.18 billion people. This is approximately 18 percent of the world’s population living on 2.4 percent of the earth’s land area. Couple this with the fact that roughly 41 percent of its population lives below the poverty line of $1.25 per day and it becomes easy to see why there are such gross variations in the health care systems in place. Indeed, health care in India varies as greatly as its landscape, climates and cultures. One can use India as a working example to study its utilization of resources and policies to try and maintain the health of its nation.
A universal health care system is run by the constituent territories under the auspices of the central government. The Constitution urges every state to improve the level of nutrition, standard of living and health facilities within its domain. The central government has “five-year plans” in parternship with regional administrations and coordinates major health care program sponsorships.
State hospitals provide treatment at taxpayers’ expense, however, many medicinal products are given at no cost at all and most treatments are significantly subsidized, particularly if the patients are living below the poverty line. Still, these hospitals are often understaffed and underfunded. Further, they tend to be within the confines of a major city and are inaccessible to the poor who are often based in rural areas. Additionally, even if patients are within close range of a treatment center, they don’t reach the hospital in time because ambulances are often stuck in heavy traffic jams.
There are other major weaknesses in the public health sector in India. Clinics and hospitals are overcrowded and services are crumbling against the backdrop of poor infrastructure and financing. Corruption is also rife within the organizations, with service providers taking money in exchange for services that should be provided for free. In global comparisons of health care spending, India comes out poorly. It allocates less than 5 percent of its gross domestic product for the sector, while rural Indians spend almost 27 percent of their income on medical costs. Per capita expenditure on public health is seven times lower in rural areas, compared to state health spending for urban areas. The ratio of hospital beds to the rural population is 15 times lower than in urban centers. The ratio of doctors to the rural population, meanwhile, is almost six times lower than in urban areas.
In some ways, India is experiencing a paradigm shift. The Bhore committee in 1946, tasked to investigate problems in the public health care system, outlined its vision for comprehensive universal health care. Today, efforts are focused on mass immunization, family planning and disease surveillance.
Since the early 1990s, the private health care sector has grown at an exponential rate to the detriment of its public counterpart. While the private sector is fully capable of providing top-notch elective care for benign disease, emergency provisions still fall short of the gold standard.
In stark contrast to the Indian experience, Britain’s National Health Service provides free care to most British residents, whose taxes comprise the bulk of NHS funds. The NHS entitles individuals to treatment for all conditions, from minor ailments such as the flu to major surgeries for cancer or heart disease. The health service is under constant review to ensure that aid is dispensed as smoothly and efficiently as possible.
Strategic health authorities, created by the government in 2002 to manage the local NHS units, as well as local trusts monitor the performances of hospitals within their areas of responsibility. A major benefit to this system is that quality health care is ensured. However, since the local trusts are allocated money from a central organization, there are variances in the performances of some local groups compared with others. For example, one trust may be able to sanction a certain chemotherapy drug, while another trust may not. This inequality has been labeled a “post code” lottery and much has been made of it in the Western media. Nevertheless, the health care system in Britain is far more advanced than in India, its former colony.
The important question now is how governments can improve the health inequalities in developing countries. First, the government has to provide basic social services to its citizens, acknowledging the fact that gross health inequalities exist. Every government should realize that access to health care is a basic human right. They have to assume a “duty of care” to the poor and realize that those who need health care the most are the majority who live below the poverty line. If the state recognizes glaring inadequacies in its health care system and infrastructure, it can take steps to provide better facilities and services, especially for poor rural populations. Perhaps greater financial rewards will be needed as incentives for health care workers to attend to people in rural areas, where their skills are needed most. In addition, the standards of health care provision need to be standardized in urban and rural areas. This is a separate issue but is inextricably linked to the proper training of medical professionals and health care workers.Additionally, it is not enough to tackle the issue of the health care system by itself, since it is related to problems in social awareness, adequate sanitation and patient education — issues that also need to be urgently addressed. Further, citizens have to acknowledge that they have a social responsibility toward one another. In essence, this is the notion that allows the NHS to survive despite its many inadequacies: The highest earners pay the highest tax and thus assist in the provision of basic needs for all.
Developing countries could adopt progressive taxation, wherein the rich share their largesse to help the poor indirectly, such as through health care. Increased social responsibility has been the mantra of many nongovernmental organizations and charitable institutions. That mentality must seep into the psyche of officials and citizens in developing nations as well.
There needs to be an increase in public-private partnerships, such as a government privatizing certain sectors so that services can be improved. In the hands of the private sector, but with regulation from the government, health services can be officially dispensed. As an example, local governments in third world nations could allocate some funding to a pharmaceutical company, which would then be responsible for providing vaccinations in an area, with the help of state hospitals.
India is diverse, multicultural, overpopulated and undergoing rapid unequal economic growth. The socioeconomic differences in its population are bound to present challenges to its health care system. As its population and economic prowess grow, it is imperative to ensure that those most in need of basic fundamental rights receive them.
Dr. Samir Pathak is a specialist registrar in general surgery and an associate of Strategic Asia’s European office.