“THE PAPER  IN MY WALLET”:THE PROBLEM STATEMENT

Nobody knows the value of those crumbled tokens of labour more than me. Physically dry, they may be, but apparently soaked in drams of my metabolic excreta called sweat. Each of them represents a canvas of exorbitantly painful events of exploitation. Each of them to be extracted for a plate of rice and a piece of cloth. These crumbled tokens are my world, my means of surviving. Yet the black hooded carnivores snatch them from me , with a knife on my stomach: literally. Shall I call them healers?  - a Farmer

Disease is omnipresent in this mortal world. It is something like an integral part of human life. It has been an unavoidable phenomenon of life ever since that mortal bite by Adam. Therefore healthcare becomes a basic need along with “roti, kapra, makan” (food, clothing, shelter). It has been recently regarded as one, at a time when man was compelled to look beyond the extraordinary greediness of commodity accumulation. Interestingly, none of these basic needs have been included in our fundamental rights. Were the makers of the constitution, ignorant of it or avoided it purposefully or thought it is not feasible for the government to provide these basic needs to the people. The point to be noted is that these basic needs of life have been included in the directive principles of state. So the needs which are fundamental for living are not included in the fundamental rights but in the list of objectives which the state do not guarantee a citizen but should strive to achieve.

The state is presently in a tug of war. On one hand there are the international markets, organizations, MNCs, hungry bureaucrats pressurising the government to let healthcare be treated as commodity that has to be bought from the market, and on the other hand , the media and social scientists demanding for free healthcare. However, the former group has won because of their stronger "holding" on the government. Theresult:“the paper in my wallet has been stolen". Indeed there are thieves in the health system of the country(the huge NRHM scam is a small example).

Off late, we have had a battery of scams, rather a battery of identified scams. This might just be the tip of the ice berg. Take for example, the much hyped 2G scam, which has said to have resulted in a loss of crores of rupees. Many intellectuals have been crying how much good could have been done with that money. But even if the money had been present, there would be multiple mini-scams, each may be on an individual basis to absorb the money and the picture perhaps wouldn’t have been a rosy one. The trickle down theory doesn’t work anyway, whereas it needs to work on a grand scale to ensure these "papers in the wallets" (fruits of economic growth), trickledown to the poorest of the poor.The social and health programs of the government have failed to trickle down and raise the living standards of the poor. According to Rahul Gandhi, only 5 per cent of development funds reached their intended recipients due to hierarchical corruption in the country! However this failure of the trickle down theory has received little attention as compared to the 2G scam.

Let us now look at some “unhealthy” Indian statistics:

Ä      World bank says, 40% of the hospitalised Indians has to borrow or sell their assets to meet the healthcare costs and of these 35% fall below the poverty line and the world bank thinks that public interventions are a barrier to removal of poverty. [NSSO]

Ä      Coming to public spending on health, it has changed drastically over the years. With the beginning of post colonial era, it gradually increased till 1980s and 1990s after which the SAPs prescribed a decreased public spending on health. According to United Nations calculations, India’s spending on public health as a share of GDP is the 18th lowest in the world.

Ä      The low public spending continues till NRHM when the public spending increased and now we are looking at further increase with the 12th 5yr plan. However, with 1.2% of GDP dedicated to health, there has been 1 NRHM scam;                                                Now, with 2.4% of GDP, there might be 2 NRHM scams.                                            More focus on efficient mobilization of existing resourcesrather than injecting more funds into the system was/is painfully absent.

Ä      Heart disease, strokes and diabetes cost India an estimated $9 billion in lost productivity in 2005. The losses could grow to a staggering $200 billion over the next 10 years if corrective action is not taken quickly, says a study by the New Delhi-based Indian Council for Research on International Economic Relations.

Ä      India is the TB capital of the world:India accounts for one-fifth of the global TB incident cases. Each year about 1.8 million people in India develop TB, of which 0.8 million are infectious cases. It is estimated that annually around 330,000 Indians die due to TB. [WHO India]

Ä      India is the diabetes capital of the world [India Today]. India has very high mortality rate from malaria & HIV/AIDS.

Ä      Women to men ratio were feared to reach 20:80 by the year 2020 as female fetus killing is rampant. Ten million girls have been killed by their parents in India in the past 20 years, either before they were born or immediately after. [India Fact Book]

Ä      Nearly 9 out of 10 pregnant women aged between 15 and 49 years suffer from malnutrition and about half of all children (47%) under-five suffer from underweight and 21 % of the populations are undernourished. [UNICEF]

Ä      India alone has more undernourished people (204 million) than all of sub-Saharan Africa combined.[WFP]

Ä      Nearly 20 % of women dying in childbirth around the globe are Indians. [WHO]

Ä      Six out of every 10 births take place at home and untrained people attend more than half of them. [WHO]

Ä      44 % of the Indian girls were married before they reached the age of 18. 16 % of girls in the age group 15-19 years were already mothers or expecting their first child and that pregnancy is the leading cause of mortality in this age group.[UN]

Ä      According to WFP, India accounts around 50% of the world’s hungry.  (more than in the whole of Africa) and its fiscal deficit is one of the highest in the world.  India’s Global Hunger Index (GHI) score is 23.7,  a rank of 66th out of 88 countries. 

Ä      India accounts for about 10 percent of road accident fatalities worldwide and the figures are the highest in the world. [World Bank]

Ä      We are not done with the ravages of the communicable diseases and the non-communicable diseases(NCDs) have already started to plague us in a big way. the role of NCDs in the health system has become so much significant of late, that for the first time a UN summit was held in September, 2011 on the issue; the only UN summit on health after HIV/AIDS 2001.

With health, the cockpit of socio economic growth of the nation, in such dire straits, no wonder the hard earned “papers in wallet” of the poor men has been melting into thin air.

WHO IS LISTENING!! (pun intended)

Dr. Sugata Pyne

MHA-Hospital Administration

2012-2014 Batch

TISS,Mumbai