This election season, the country has been promised plenty by each of the major political parties. Including, of course, a return to the soaring economic growth India knew a decade ago. If the GDP is, in fact, such a concern, here’s something to keep in mind: in 2009, the World Bank pointed out, India was losing 6 percent of its GDP due to “premature deaths and preventable illnesses.”
On that note, here’s what the latest manifestos had to say on how they would improve India’s dismal public health system. The BJP wants to “radically” reform the National Rural Health Mission (NRHM). They want to introduce the National Assurance Health Mission, which, like the NRHM, promises to provide access to “universal and affordable” healthcare. AAP will introduce a bill guaranteeing every Indian the “Right to Healthcare.” The Congress says it will expand on its existing schemes and introduce many more.
The Congress, BJP and AAP all devoted a single page to healthcare in their manifestos. In that page, they told the country what they would do, if elected, but not how they intend to do it. None of them mention numbers. They all promise a universal, affordable healthcare system without acknowledging India’s private healthcare sector, which will soon account for over 80 percent of services.
None explain how they will pay for this “right to health”? Will they expand the budget for health? The Congress reminds us that the UPA is spending five times more than what was spent 10 years ago.
Well, the Congress must know that India is among the five countries that spends the least on public health. Overall, we spend a meager four percent of our GDP on health. Out of pocket (uninsured) expenses, meanwhile, account for 70 percent of healthcare expenditure. As a result, families are often choked with medical debt and sink into poverty. And this is affecting India’s growth.
It’s hard to miss the fact that women, especially poor women, are disproportionately affected by India’s public health crisis. Poor women eat less; they are weaker; they marry young; and they give birth quickly and often. And they find it harder to access medical care. But women receive a token nod from the Congress and BJP. AAP, which has committed to the Womanifesto, talks gender justice but healthcare finds no mention.
The Congress manifesto alone has the words maternal, infant, mortality: three words that sum up India’s biggest public health failure. The BJP doesn’t include them but it does refer to a “program” in the “domains of nutrition and pregnancy.”
Here are five major healthcare challenges for the next government, including the grim statistics that nearly every election manifesto has conveniently ignored:
Facts: Over half the women in India are anaemic. They have unusually low levels of haemoglobin, which makes it difficult for the blood to clot and increases the risk of postpartum hemorrhage (excessive bleeding) during childbirth. Studies show that anaemia is responsible for 40 percent of maternal deaths in India. And that’s only the women; the World Bank estimates that nearly 70 percent of the children in the country are also anaemic.
Why: Although some kinds of anaemia can result from infection, most cases of the disease in the developing world are the result of poor nutrition, especially deficiency in iron. Tablets and injections that supplement iron are cheap and accessible, but diagnosis remains a challenge because most poor women and children never get tested for anaemia.
Facts: Each year, 56,000 women in India die due to complications arising from pregnancy or childbirth. According to data released by the Registrar General last year, India’s Maternal Mortality Ratio (MMR) — the number of women who die during pregnancy and childbirth per 100,000 live births — has dropped from 212 to 178 between 2007 and 2012. However, the regional disparities are huge. States such as Tamil Nadu and Kerala, with an MMR of 105, have fared better than poorer states such as Bihar, Uttar Pradesh, Madhya Pradesh, and Chhattisgarh, whose MMR is still over 250. The country as a whole is far behind the Millenium Development Goal of 103. The number of women dying in childbirth is fewer than before, but it still kills more than 150 women everyday.
Why: Too many women in India, who are poor and often anaemic, give birth at home. Many of them are stunted or too thin, which puts them at a higher risk for complications. With no access to sufficient nutrition, antenatal care or even decent hospitals, they succumb to the complications.
Facts: According to a 2012 report by the UNICEF, 1.7 million children under the age of 5 die in India every year. Diarrhea — yes, loose bowel movements — alone kills 98,000 children under the age of 5 years. In 2011, India, along with four other countries (Democratic Republic of Congo, China, Pakistan and Nigeria) accounted for half the global deaths of children under five. Alone, it accounted for nearly a quarter of the deaths. The causes include pneumonia, malaria, HIV and measles, but a majority of them died within a month of being born because of complications arising from their birth.
Why: The biggest reason, according to the UNICEF study, is poor nutrition. Poor education, lack of breastfeeding and maternal mortality drive up child deaths, especially in the immediate weeks following the birth – when they are most vulnerable to weakness and infection.
Facts: Research organizations such as The Brien Holden Institute in Australia estimate that 456 million people in India need vision correction to help them see clearly. Of those, 133 million, including 11 million children, are blind or visually impaired only because they don’t have access to an eye examination and a pair of glasses.
Why: For the latter group, the biggest reason is lack of access to an eye test — a room where a trained optometrist can measure their refractive error and write them a prescription for glasses.
Facts: A report in 2013 by the US-based Cervical Cancer Free Coalition said that 72,000 women in India die from cervical cancer every year. That’s more than a quarter of the global toll. It’s also the most common cancer among women in India.
Why: The disease, which is sexually contracted, carries a fierce taboo. In addition to that, access to a pap smear test (a reliable cervical cancer screening), and subsequent treatment, is hard to come by in rural India where access to gynaecologists is limited.
A 2009 study says that most of India’s 27 regional cancer centers don’t have gynecological oncologists on staff, and that they don’t reach enough women anyway. Another study from 2013 depicts the sorry state of community health centers, with 70 percent of spots for specialists such as surgeons, paediatricians, gynaecologists lying vacant.
Aparna Alluri is a freelance reporter, finishing up a graduate degree at Columbia University. For now, she is tinkering with words and sound, and she is always plotting where to travel next. Follow her @aparnalluri
Anand Katakam dreams of working in Minnesota or Manipur after his time at the Columbia Journalism School. When he isn’t attending class, he is roaming the streets with his camera. Find out more about his wanderings @anandkatakam