In 1947, India’s entire healthcare infrastructure consisted of some 700 primary care centres and 7,000-odd hospitals/ dispensaries. Today, we count over 30,000 PHCs, 69,000 hospitals and nearly 2 million hospital beds—with the transformative touch of technology visible across the spectrum, including in the eSanjeevani telemedicine outreach that caters to nearly 35,000 patients daily in remote areas (3 million consultations till date, across 31 states).
India also has the world’s largest health insurance scheme—since it began in 2018, Ayushman Bharat has provided Rs 7,000 crore and free treatment 10 million times to patients from the 100 million poor families eligible for a Rs 1 lakh cover. Some 40,000-odd new wellness centres too are operational, of the scheme’s sanctioned 62,000. And yet, the gaps are massive and the skew decidedly favours urban areas (see graphics).
A doctor attends to Ramu, ‘The Wolf Boy’, in Balrampur, UP, in 1954; The ‘Mitra’ robot assistant on call for a patient at a Noida Covid hospital, 2020 (Getty Images)
Even there, Covid-19 gave us a stark picture of limitations and awakened everyone to the importance of investment in health infrastructure. At a mere 1.2 per cent of the GDP, our health budget ranks among the world’s lowest, even after public investment increased by 50.5 per cent between 2017-18 and 2021-22—from Rs 47,353 crore to Rs 71,269 crore. The budget estimate for 2022-23 is Rs 83,000 crore. Attaining 2.5-3 per cent of the GDP is a crucial first step to closing in on the world average of 6 per cent (China is at 5 per cent)—that would already ease out-of-pocket expenditure by 30 per cent. In recent years, the growing burden of cancer, TB and lifestyle diseases has distended that figure to an unhealthy 65 per cent (global average: 18.5 per cent). The curative needle must aim at both: sickness and the cost of health. For everyone.
To accomplish that, we must turn to the human component at the heart of the infrastructure—running the hardware. February 1835 saw India’s first initiates into modern medicine: a batch of 50 young men at Calcutta Medical College, set to study on a stipend of Rs 7-12 each. By 1947, with 19 medical schools, India had a mere 47,000 doctors for its hundreds of millions—1 for every 6,300 people. It took 75 years for us to inch close to the WHO-mandated ratio of 1:1,000, with over 1.3 million doctors. This is not counting the world’s second highest number of dentists—270,000 as of June 2022. But overall numbers don’t ensure accessibility and quality.
Rural India, home to 60 per cent of our population, had a 78 per cent shortfall of physicians in 2019. Nursing is also in deficit: 3.4 million personnel means less than two nurses for every 1,000 Indians, well short of WHO’s golden ratio of 3:1,000. This situation of want is what leads to concerns over the mental health of healthcare workers, as evidenced by the ‘I am Overworked’ campaign by Indian doctors in 2019—one year before the pandemic. The resilience we saw thereafter calls for a million salutes.
