New Delhi: The year 2017 saw both private and public hospitals facing heat over poor standards and high prices of healthcare. An example of the public sector’s failure was when twenty-three children died overnight allegedly due to lack of oxygen at BRD Medical College, Gorakhpur. Another case, at Fortis Hospital, where a family was billed Rs 15 lakh for the treatment of their seven-year-old child, saw the private sector being scrutinised for prohibitive prices.
Between the failures of the private sector and the public sector are Indian patients, strapped for choice. However, data from the fourth National Health and Family Survey (NHFS) confirms one choice that Indian patients are definitely making: less than half of urban (42%) and rural (46%) India opt for government health services.
The demand for private sector healthcare is by and large comparable in both urban and rural settings: 56% of urban India chooses private healthcare and 49% of rural India makes the same choice.
The percentage of households using the public sector for healthcare increased over the ten years between the last survey held in held in 2005-2006 and the recent one. In the 2005-2006 round, the percentage of those households using public sector healthcare was 34% and in this round, it is 45%.
Both rural and urban settings largely access government healthcare at government and municipal hospitals.
Below this level, urban India rejects government healthcare while rural India still depends on community health centres and primary health centres, with 14% and 12% choosing these points of care. There is very little uptake of the sub-centre in rural India with only 1.5% choosing care here. In the last budget, the government announced that it would be converting sub-centres into “wellness centres”, a renovation-move to increase their uptake.
More people go to ‘shop’ than they go to AYUSH practitioners
A substantial number of people in rural India – 4.5% – chose to go to “shop” to seek healthcare. Examining this further by wealth-index, it is in fact the poorest of the poor who go to “shop”. 6.1% of people in the lowest quintile and 5% of the second lowest quintile of the wealth index seek care here.
The NHFS captures data separately for those who go to a “pharmacy/drugstore” for healthcare. Nearly 2% of India seeks healthcare at these informal sources.
Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) medicine fares dismally – in both private and public healthcare in urban and rural settings, only about 1% of people choose traditional Indian medicine.
Totalling the percentages, in urban India, only 0.5% choose vaidyas, hakims, homeopaths or traditional healers. In rural India, the number stands at 1.2%.
In India, pharmacists, nurses and practitioners of Indian systems of medicine are among the categories of people in the chain of healthcare who are explicitly prohibited from prescribing allopathic medicine or giving diagnosis. Yet due to the scarcity of facilities, this in in fact a reality.
The government recently proposed in the National Medical Commission Bill, 2017, to have a “bridge-course” to enable those trained in Indian medicine, to begin prescribing perhaps a limited number of allopathic medicines.
The Wire has reported on how this clause is being fiercely contested – the allopathic and homeopathic lobbies have both rejected it and the Central Council for Indian Medicine supports it, but with reservations.
Why does India reject government healthcare?
The NHFS captures data for households who don’t use government health facilities when they are sick. The survey collected this information on the following grounds: no nearby facility, inconvenient timings of the facility, absent health personnel, a long waiting time and poor quality of care.
Over all, 55.1% of households don’t use government health facilities.
The leading reason for this is the poor quality of care – 48.1% households responded with this reason. The close second reason, at 44.6%, is that there is no nearby facility at all. And a close third, at 40.9%, is that even if they come to a facility, the waiting time is too long.
India’s most populous state, Uttar Pradesh, is in fact the one who rejects government facilities the most – a whopping 80% of households in the state reject it.
In the band of 70% to 80% of households who reject government care is Bihar (77.6%), Punjab (72.9%), Jharkhand (71.7%) and Telangana (70.7%).