A tale of haves, have nots in Indian medical practice

India is home to a burgeoning private medical industry offering high quality care, but public programmes aimed at improving health care for the poor are beset by problems.

By Sahana Ghosh for Khabar South Asia in Kolkata – 14/2/12

February 13, 2012
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The state of Indian healthcare is a dichotomous one.

  • Newborn Indian babies rest inside a ward at a Lucknow hospital. With a population of 1.2 billion, India faces the challenges of maintaining a health programme designed to improve the lives of poor and rural residents. Meanwhile, private hospitals use domestic and foreign investment to build clinics and facilities catering to foreign medical tourists. [Reuters]

    Newborn Indian babies rest inside a ward at a Lucknow hospital. With a population of 1.2 billion, India faces the challenges of maintaining a health programme designed to improve the lives of poor and rural residents. Meanwhile, private hospitals use domestic and foreign investment to build clinics and facilities catering to foreign medical tourists. [Reuters]

On one end: a flush of domestic and foreign private investment has resulted in a proliferation of hospital chains, medi-cities and specialised clinics. These cater to India's wealthier citizens, as well as to affluent foreign "medical tourists" -- who pay one-tenth the price of similar medical treatment in the United States.

At the other end, most of India's 1.2 billion people depend on the public health system, where standards of care are comparatively poor.

Abhijit Banerjee, an MIT Economics professor, conducts random control trials on poverty alleviation programmes in various countries. He found "low-hanging fruits" of preventive treatments like vaccinations are grossly under-utilised because of a lack of awareness concerning their benefits.

Basanti village resident Swapna Sarma lives in the Sunderbans, about 100km (62 miles) southeast of Kolkata. Sarma had a harrowing experience obtaining treatment for her eight-year-old daughter, Rakhi, after she developed a high fever. Rakhi had received no vaccinations since birth, because her landless family members, who eked out a living as agricultural labourers, simply did not know the worth of vaccines.

After taking her to traditional healers, and to a local unlicensed medical practitioner, Rakhi was brought to a health centre only after becoming delirious. The lone resident doctor diagnosed her with typhoid symptoms.

Since the centre did not have the proper drugs to treat her, the resident doctor referred Rakhi to BC Roy Memorial Hospital for Children in Kolkata--about a five-hour drive and a river-crossing from Basanti. They arrived the next day to find nearly 1,500 outpatients being treated daily. After Rakhi was finally admitted, mother and child stayed and slept on the floor for five days because a bed was unavailable.

"It's a miracle that my daughter recovered at a hospital that has in the recent past, experienced 25 child deaths in a day, many because of negligence," Swapna said.

Though the World Health Organisation celebrated 2011 as India's first polio-free year, health officials continue to face staggering challenges.

"Government expenditure in public health, at just 1% of GDP, is grossly inadequate to deal with communicable diseases like malaria and tuberculosis, as well as expanding the public healthcare system into the rural hinterland," said Dr. Arun Kumar Chakroborti, former Public Health and Hygiene director for Kolkata and a WHO consultant.

Launched in 2005, India's national healthcare mission aims to expand the public system, especially in rural areas where nearly 70% of Indians live. Although infant and maternal mortality have declined, the rates are still high compared to other developing countries.

According to the CIA World Factbook, India's 2011 infant mortality rate dropped to 47.57 deaths per 1,000 live births from 64.9 in 2000.

Still, it remains much higher than in neighbouring countries China (16.05), Nepal (44.53), Sri Lanka (9.7) and Thailand (16.06). Only Bangladesh (50.73) was higher. India's 2011-2012 maternal mortality rate dropped slightly to 212 deaths from 254 in 2004-2005.

The average for Asia is 30.

Because the provision of healthcare is a state responsibility, national funds are to be used by state health departments. Instead, reports of misused funds are frequent.

Prabir Guharay, joint secretary of the West Bengal health department, told Khabar South Asia that most state governments are still too cash-strapped to provide medical infrastructure in rural health centres.

"Besides, there is a shortage of doctors who are willing to work in the government hospitals, where salaries are far lower than in private hospitals," Guharay said. "Most government hospitals are under-staffed and have severe shortage of medicines and equipment." He also said inadequate government monitoring of healthcare delivery results in doctors and nurses absent from duty 40% of the time.

Medical tourism

Meanwhile, for those who can afford it, private facilities offer services that are on par with the best facilities worldwide, with highly trained professionals and state-of-the art technology.

Sumitra Ghosh, a 66-year-old Kolkata resident, knows firsthand that quality at that level can make a tangible difference.

While on holiday in Sikkim province, Ghosh blacked out for under a second. Previously, she had a pacemaker implanted after suffering two strokes. The doctor at a local public clinic diagnosed her as having spondylitis—a form of spinal arthritis. He suggested neck exercises as the electrocardiogram (EKG) showed no abnormalities.

Returning home, Ghosh went straight to Salt Lake's Anandalok Hospital, where doctors took another EKG and immediately found her pacemaker was malfunctioning. Within eight hours, she had successful surgery to replace its faulty battery.

The machine at the public clinic might have been malfunctioning, or its doctors did not understand how to read the chart. By contrast, their colleagues at Anandalok had the expertise needed – and the necessary equipment available -- to make an accurate diagnosis.

Deficiencies in the public healthcare system have thrown open opportunities for private business. Hospital chains like Apollo, Fortis and Wockhardt are expanding in major cities and establishing delivery centres abroad. Rising incomes and urban middle-class health insurance make private healthcare a burgeoning business even in poorer states like West Bengal and Uttar Pradesh, says NGO activist Suman Bhowmick. She strives to find employment for the rural youth as medical technicians.

A 2010 report from RNCOS, a Delhi-based business intelligence company, projects that India will be able to grab a 3% share of the international medical tourism industry, which produces an annual $3 billion in global revenues. A FICCI report ranks India among the top five medical tourism destinations. Elite Indian hospitals and clinics treat an estimated 60,000-85,000 foreign in-patients every year.

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