Confessions of the Republic of India
Forgive me, my people, for I have sinned. My biggest failure has been in the area of protecting you, my people, from ill health and malnutrition.
The policies and practices I have adopted have resulted in us having the highest number of underweight children in the world. Why are children malnourished? Because as they grow they fall ill and their parents cannot afford the treatment offered in the country.
Forgive me, my people, I have consistently and over the years allocated very little money for public health. So little is given that it is a miracle we have a public health system at all. At 200 rupees per capita per year, what miracle do we expect?
Forgive me for I have trained far less doctors and nurses than needed. The ones I have trained have moved on so that Europeans and Americans do not sneeze. The rest have concentrated themselves in the cities, so much so there are less than two doctors for a population of 10,000 people in our villages. In the cities there are 11 doctors for 10,000 people.
Forgive me, my people, for you spend more money from your pocket to meet your health needs than any other comparable country. I have not had the vision of a Ghana or the courage of a Thailand or the imagination of Brazil or Indonesia in putting together a health system that works for my people.
For each episode of ill health, you, my people, especially the poor among you, are pushed further into poverty.
My dear people, since you have to spend from your pocket, about 23 percent of you do not access care at all because you cannot afford it. About 40 percent of you slide below the poverty line after a single hospitalization.
Most of your health expenditure, I know, is made out of your savings, and a large part of the amount is borrowed.
Nearly 80 percent of outpatient and 60 percent of hospital care is through private providers. (NSS 60th Round). Because I have not given you a government health system that works for you.
I know that the cost of private health care especially for outpatient care is striking: It is nearly 22 times the amount of public health facilities in the rural areas and over 40 times in the urban areas. The personal and family expenditure in seeking health care is rising incredibly and I still do not know how to stop it.
In Rajasthan, for instance, an alarming average of 89.4 percent of household health expenditure is on drugs. At least 30 to 40 percent of people are unable to afford these drugs.
One reason why you, and especially the poor among you, spend more money is because I have allowed 92,000 drug formulations to be produced and marketed without a conscience, while only 350 are required. No other country in the world manufactures these many brands. This has led to irrational use of drugs and irrational manufacturing, prescription and dispensing.
I seek forgiveness from you for the Indian pharmaceutical industry, which makes high profits from ignorant and hapless consumers and for my failure to rationalize them.
I seek forgiveness for our doctors, who as prescribers willingly abet this by prescribing certain brands of medicine instead of giving the option of cheaper non-branded drugs.
I once again seek forgiveness from you, the poor who suffer the most, because you have neither the purchasing power to obtain the drugs nor are you aware of your choices. Very little I have done either to add to your knowledge or resources.
I specially seek the forgiveness of the 13 percent of India’s population who actually incurs 'catastrophic spending'.
When households have to spend 10 percent of their total income on healthcare it is considered catastrophic spending.
I have now gone ahead and closed down several of our vaccine manufacturing units in the public sector, another crime that will escalate our immunization costs. Let me seek your pardon for that, too.
I collect a lot of health data. I do not analyze them, I do not make them available where it is required because health and caste are related; health and poverty are related things which I do not want actually show to the public. I am guilty of not employing the collected data to correct the system; not employing the data to target specific vulnerable groups.
My guilt increases when I hear how other countries have tackled the issue. Ghana, a country in southern Africa, has a system of universal access to medicine, i.e. free or cashless medicine to everyone in Ghana. The country does not have a production capacity and imports most of its drugs from India. It still has such a scheme of free medicine accessibility. I am ashamed.
Forgive me, my people, for I have sinned.
C-8030, Vasant Kunj, Sector C
New Delhi 110070
HIFA2015 profile: Augustine Veliath is the founder director of Listeners’ Institute, New Delhi. He recently retired from UNICEF. The data presented here are from a national convention organized by Human Right Law Net Work and All India Drug Action Network. Veliath is available at augustinevj AT gmail.com