In 1947, India’s health expectancy was a mere 32 years. But today it is 70 years. We are nearing the 81-year target, which is the average for G7 countries.
The nation is celebrating 75 years of Independence—Azadi ka Amrit Mahotsav—and the world is watching India’s achievements in different sectors. India managed the Covid-19 pandemic fairly well, barring the unprecedented tough time of April to June 2021 orchestrated by Delta wave. Finally, we can safely declare Covid-19 an endemic in India. The pandemic made us reflect upon our healthcare preparedness and plug the holes. It has been also instrumental in teaching a new lesson to the globe. Our erstwhile understanding that the best of health is the monopoly of those who have wealth proved to be fallacious. The powerful nations could not keep their people healthy during the pandemic, despite unlimited resources at their disposal. Often wealth nurtures arrogance and self-centreedness to build euphoria that they can buy everything including “health”. But we have seen how the large economies collapsed like a pack of cards due to the Covid-19 pandemic that brought the rich and mighty to their knees. The changed narrative being, maintain good health, wealth will follow, and in that sense, only a healthy nation can be wealthy nation. Achieving good health isn’t an easy job though.
There are diverse opinions, like a half glass full or half glass empty. I am of the opinion that India has done remarkably well and has come a long way in health, nutrition and hygiene, looking at different yardsticks of its progress, hence it is half full and a filling glass.
The most important health parameter is “life expectancy at birth” and when India got Independence in 1947, it was a mere 32 years. But today it is 70 years, to be precise 69 years for men and 71 years for women. Looking at where we were and where we need to be, we are nearing the 81-year target; which is average for G7 countries (2020).
Now look at parameters of birth rate, death rate and growth rate over the 40-year timeline. I remember in 1981, when I was in Geneva for the 34th World Health Assembly (WHA), where Prime Minister Indira Gandhi in her address expressed deep concerns about India’s growth rate being 2.2% or 22 per thousand. India’s birth rate was 40 and death rate was 18 per thousand then. We have indeed come a long way as our current growth rate is just 1.1% with birth rate being 1.82% and death rate being 0.73%, respectively.
I remember 1985, when I started talking about the poor health-spending in India, it was 0.3% of GDP. However, currently it is 2.1%, with a seven-time jump in 17 years. When compared to the West we are still far from 5% of GDP for healthcare, but the antagonists ignore crucial facts—the cost of medicines, testing and consultations are proportionately far lower in India.
When India began its G-20 presidency on 1 December 2022, Prime Minister Narendra Modi said this will work to further promote oneness, inspired by the theme of “One Earth, One Family, One Future” and included healthcare as one of the prominent agendas for the same, apart from food, energy security and digital transformation. This in itself is a great achievement for a continued importance to health. India is making efforts to join G7 and this goal may be achieved soon.
Now let us look at the healthcare infrastructure then and now. There were only 50,000 doctors for a population of 35 crore in 1947, but currently we have 12.5 lakh MBBS doctors and another 4.5 lakh postgraduate doctors—a total of 17 lakh from the modern medicine stream. Additionally, we have non-allopaths or vaidyas from the AYUSH (Ayurveda, Unani, Siddha, Homeopathy) stream. In 1981, our doctor-population ratio was 1:10,000 and our goal was 1:5,000. Today we have one doctor for 1,000 people. Yes, there are discrepancies between urban, rural and tribal populations. The health-infra is better for the urban people, with a disproportionately high tertiary-care. We need to look at how we can bridge the divide and achieve better primary and secondary healthcare in rural and tribal areas. Primary health centres (PHCs), sub-centres, community care centres and Anganwadis comprise the backbone of primary healthcare, needing constant push with higher allocations. Ayushman Bharat-PMJAY is the world’s largest health assurance scheme and aims to provide an annual health cover of Rs 5 lakh per family and covers 50 crore people or 35% of the population for tertiary care in the same facilities that cater to the paying class people. Additionally, several states have launched their own health schemes like Janani Aarogya Yojana in Rajasthan, Mahatma Phule Jan Aarogya Yojana in Maharashtra and Biju Swasthya Kalyan Yojana in Odisha, to name a few.
ACHIEVING THE IMPOSSIBLE
Let us take a cursory glance at maternal and child health indicators to see how we achieved impossible goals. The foremost was elimination of fatal diseases that were vaccine preventable. We eliminated polio, smallpox and tetanus because of excellent immunization coverage. Institutional deliveries are now higher than home deliveries, with better care for the newborn that reduced our Infant Mortality Rate (IMR), Child Mortality Rate (CMR) and Maternal Mortality Rate (MMR). Eventually, this strengthened people’s faith in family welfare programmes. Apart from lack of knowledge and access to birth-control tools, people produced more children because of insecurity, following high IMR and CMR. The uninterrupted implementation of family welfare programmes, irrespective of changes of guard at the Centre or the states, brought down the total fertility rate to 2.18 births per woman (2020) and made us achieve population control.
In the 1960s, when I was a young child, “roti-kapada-makaan” (food, clothes, shelter) used to be the main discussion everywhere. When people die of starvation, food security takes centre-stage and other priorities take a back seat. Today, we have surplus food, with hunger-related deaths being a rarity.
In 1980s, the rhetoric changed to “bijlee-sadak-paani” (electricity, road, water). Electrification, connectivity to villages, potable water, hygiene and toilets became a priority. Lately, the focus has shifted to education, health and other developments. As a result, today Indian doctors, engineers, IT professionals, MBAs are omnipresent and in great demand globally. A recent revelation that Indians in the United States paid six times more taxes than average Americans, surprised the world.
Undoubtedly, the pandemic taught us that health and healthcare preparedness are crucial criteria for life. Infrastructure laden with adequate human and material resource can take care of any exigencies that include pandemics or catastrophes of gigantic proportions.
Our current challenges include 40 million malnourished children including 25 million stunted. Other important issues are immunization derailment, HIV, tuberculosis and malaria. There has been a lot of collateral damage caused to these national programmes. We also have other infectious and lifestyle diseases to be taken care of.
PHARMACY CAPITAL OF THE WORLD
India not only looks after itself but the entire world, with the philosophy of “Vasudhaiva Kutumbakam” (the world is one family). Today India is the pharmacy and vaccine capital of the world. Nearly 92% of the global requirements of anti-retroviral therapy (ART) for HIV patients, 80% of the global requirement of antibiotics including anti-TB drugs are made in India. Similarly, 80% of global childhood immunization is taken care of by low-cost but high quality India-made vaccines. Can one imagine global health issues minus India? How many more million people would have died, especially in Africa, Asia and Latin America but for India? Indian medicines are available at a pittance of the innovator’s cost. To give some examples, ART is at 0.7% of the global cost (US$69 versus US$10,452 per patient annually) and Hepatitis-C cure medicines are at 0.3% of the global cost (US$250 versus US$84,000 per patient, for a course of 12 weeks).
I believe, India’s upward stride in economy can be attributed to its achievement in healthcare. Achieving good health is not a simple job but not an impossible one too. We will be numero uno globally in population, with a 17.5% share, but that is not a negative point, so long as we maintain excellent health parameters. Here the population should be considered as an asset, not a burden.
We should thrive to achieve “one planet, one health and one future”, with India playing a pivotal role there. During the Covid-19 pandemic, India showcased once again how it is an example of turning an adversity to an opportunity.
Dr Ishwar Gilada is Consultant in HIV in Infectious Diseases, President of AIDS Society of India, Secretary General of Organised Medicine Academic Guild (OMAG) and Governing Council Member of International AIDS Society, [email protected], www.unisonmedicare.com