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Resource centre on India's rural distress
 
 

India's public health


India’s public health system has become dysfunctional. There is no reason at all why vector-borne and other infectious diseases should recur with predictable regularity after every monsoon season. Government, especially state and local governments, must take primary responsibility for this malaise. Equally, civil society. A combination of governmental negligence and public apathy contributes to the unacceptably high incidence of diseases like dengue, chikungunya, Japanese encephalitis, swine flu, conjunctivitis (eye flu) and malaria. The media has understandably focused on the problem at hand in India’s national Capital on the eve of an international sports event. If New Delhi appears so helpless in dealing with the problem, one can only imagine the plight of lesser habitations. Over 1,600 cases of dengue fever alone have officially been confirmed to have occurred in Delhi, though the actual number of victims is believed to be several times higher. Many other states, notably Uttar Pradesh, Rajasthan, Gujarat, Karnataka and Kerala, have also reported several thousand cases of different seasonal maladies, and over 200 deaths as well. Given the regularity with which these diseases strike, the timing of the onset of these epidemics seems easy to predict well beforehand. Yet, preventive measures are seldom taken. It would, indeed, be a national disgrace if after spending, or even overspending, such large resources on preparations for the Commonwealth Games (CWG), participation of athletes and sports lovers is jeopardised due to health concerns. Over a score of countries are already reported to have issued advisories to their people and athletes against the dengue threat in Delhi.

While India tries to market itself as a destination for “medical tourism” on the one hand, and fancy corporate hospitals are coming up in every city, often with government subsidies in the name of the poor, a vast majority of Indians continues to suffer from ailments caused by inadequate attention to public health, including access to drinking water, proper sanitation and municipal maintenance. The steady erosion of government spending on public health may largely be to blame for that. It has dropped from about 1.6 per cent of the gross domestic product (GDP) in the 1980s to merely 0.9 per cent of the GDP now. Little wonder then that India was placed by the World Health Organisation at lowly 171, out of 175, in the public health spending ranking released last year.

The successful control of malaria in the 1970s, regardless of its subsequent comeback, is an unassailable evidence that management and even eradication of vector-borne maladies like dengue, chikungunya and Japanese encephalitis are not beyond reach if well-conceived strategies are put into action. For several other communicable diseases, vaccines or prophylactic medicines of allopathic, homeopathic or Ayurvedic origin are available now. Their use needs to be promoted. At the same time, doctors and hospitals should be discouraged from prescribing costly allopathic drugs and medical treatment when the real solution lies in improved public health.