WHO report exposes Modi government’s bluff on healthcare, with even poorer nations performing much better
On Global Health Security Index, India scores only 46.5 per cent, a score that is in itself an indication of dismal performance, what to talk about competitive performance vis-à-vis other countries
The sixth annual report on Monitoring Progress towards Universal Health Coverage (UHC) and the health-related Sustainable Development Goals (SDGs) in the South-East Asia Region has exposed Modi government’s performance on this front. It shows that healthy life expectancy for women in the country is worst in the entire region, while for men it is only slightly better than Timor-Leste and Myanmar.
To know how much the people of the country are left behind, one will have to go through the special section of this report that examines the health equity and who is being left behind.
Women are being left behind to such an extent that on an average they are not able to live a healthy life beyond 60.4 years, which is the worst among 11 countries – Thailand, Indonesia, India, Myanmar, Bhutan, Nepal, Bangladesh, Sri Lanka, Maldives, Timor-Leste, and DPR Korea - of the region, which is one of the six WHO regions.
For Indian men, healthy life expectancy is even less, 60.3 years. In the entire region the healthy life expectancy of females is 61.9 years and for males 61.1 years. The higher mortality rate of children under five may be one of the reasons for this anomaly.
This section says that the population in the region continues to live a longer and healthier life. Females have a higher life expectancy than males but also have 2.8 years more lost healthy life expectancy, indicating that females have a higher proportion of years lived with disabilities. This pattern indicates rapid transitions and associated inequalities in the evolution of mortality and morbidity.
On Global Health Security Index, which assesses the countries’ health security and capabilities across six categories – prevent, detect, respond, health, norms, and risk – even Thailand with 73.2 and Indonesia 56.6 with per cent score are far ahead than India. India scores only 46.5 per cent, a score that is in itself an indication of dismal performance, what to talk about competitive performance vis-à-vis other countries.
Although the region has made substantial effort in reducing child and maternal mortality, inequity still persists in the coverage of various sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services. Service coverage is generally higher among the advantaged group compared to the disadvantaged and vulnerable subgroup.
For example, the proportion of institutional deliveries is nearly 39 per cent more among the richest quintile compared to the poorer quintile. A similar trend is noticed for coverage by geography and mother’s education.
The report emphasized the importance of going beyond national averages as it could tend to overlook subgroup populations. Availability and use of disaggregated data can help identify those left behind from essential service coverage, so that accurate and effective policy and programme strategies can be implemented.
In 2018, one in three women of reproductive age (15-49) in the region had experienced intimate partner violence (IPV), which is rooted in gender inequality. Against 27 per cent the global lifetime average of IPV, India’s fared worse at 35 per cent. Even in the past 12 months average, India fared worse at 18 per cent against the global average of 13. India is better than only Bangladesh and Timor-Leste in lifetime average IPV which had scored 50 and 38 per cent respectively.
Even in 12 months average India fared worse than all other countries except these two. However, Bangladesh fared far better to reduce the violence in the last 12 months to 23 percent. Timor-Leste could reduced it to only 28 per cent.
In case of institutional deliveries in the region, the data shows that people living in rural areas have – on average – lower access than those in urban areas. The report warns that examining only the average may lead to biased conclusion and can cause some subpopulation to be overlooked.
For example, conditions of poor in urban areas are similar to, or worse than, those living in rural areas in all but one State i.es Maldives. It means lower access to essential health care today is a problem not limited to the people in rural areas only. Similar situation is also prevailing in India, where urban poor has less access than the rural population.
There is also Non-Communicable Diseases (NCD) risk factors, such as tobacco use, alcohol use, hypertension and raised blood sugar that are directly linked to NCD-related mortality and morbidity. Prevalence of tobacco use and alcohol consumption is higher among males than females across the region.
In Bangladesh, Myanmar, and Sri Lanka, the prevalence of hypertension is more among females than males while in Bhutan, India, Myanmar and Sri Lanka, males have a higher prevalence of raised blood sugar than females. India and Nepal have slightly higher consumption of alcohol, and tobacco use is higher in rural areas in Bangladesh, India, and Nepal.
As for availability of essential medicines, data is available only for four countries – Bangladesh, Sri Lanka, Nepal, and Myanmar. Availability is higher in private health facilities than the public health facilities, and the difference ranges between 4 per cent in Sri Lanka to 20 per cent in Myanmar.
Maldives is the best performer in the region in terms of current health expenditure as a share of total government expenditure by spending 9.4 per cent, followed by Nepal 5.4, Myanmar 4.8, Timor-Leste 4.3, Sri Lank and Thailand 3.8 per cent each. India comes next which spends a mere 3.5 per cent of its GDP on it. Only Bhutan, Indonesia, and Bangladesh spend less than India.
Consequently, out-of-pocket expenditure for the people in India is very high. In case of India, it is 62.7 per cent. It is an alarming figure since it is over 10 per cent of the income by definition. Over 17.3 per cent in India are estimated to face such a situation due to healthcare.
It pushes the people into extreme poverty, and impoverishment rate for India is 4.2 per cent or 57,966,000 people because of out-of-pocket health spending. The incidence of ‘catastrophic spending’ is higher in rural areas than in the urban areas.
Views are personal