Is the government Primary Health Centre still a place "where poor people go to die"?

Between January and June 2014, 243 people out of 1,000 sought medical treatment within the public healthcare system of India, whereas 756 people out of 1,000 opted to visit a private doctor or private hospital.

This counter-intuitive finding, unusual for the preponderance of poorer patients flocking to paid private services when free public alternatives exist, was part of the 71st survey round of the National Sample Survey Office (NSSO).

It is well known that the entire public healthcare system, from tertiary care hospitals in large cities to Primary Health Centres (PHCs) in rural areas, is riddled with manpower shortages and inadequate supply of critical drugs and blood, so much so that one healthcare expert with senior government experience described PHCs as the place “where poor people go to die”.



Note to readers: The health budget figures shown in the video are expressed as percentage of GDP while allocating the budget, taken from World Bank data and not as percentage of expenditure.

Yet step into the bustling corridors of a major government hospital such as Chennai’s General Hospital (GH) and it would be hard to imagine how public healthcare could be doing more.

One option would be to pump in more money. Between 1995 and 2014 India’s public expenditure on healthcare rose only from 1.1 per cent of GDP to 1.4 per cent.

While acknowledging the need for a fiscal remedy to boost public healthcare capacity, Nachiket Mor, India Director for the Bill and Melinda Gates Foundation, believes that the quandary is essentially a “design problem,” because in some cases nearly 70-80 per cent of the people in tertiary care do not have to be there.

OOP stands for 'Out of Pocket' in above image

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India’s public healthcare policy has performed remarkably well in specific areas that it has chosen to focus upon, principally in bringing down maternal and infant mortality, and ensuring that an overwhelming proportion of births are from institutional deliveries.

The broader issue facing policymakers, however, is how to get patients to use PHCs and other primary treatment options optimally, and avoid rushing to tertiary care units which are overwhelmed and struggle to treat priority cases

Systemic reforms could help. Medical graduates spend vast sums acquiring degrees and opt to recoup costs in the private sector through specialisation, even if it is the public system and general practice areas that need them more.

Legislation akin to the Affordable Care Act of the U.S. could curb runaway costs in the private sector, which seems geared towards providing expensive diagnostics and treatment.

India could learn from the experience of Thailand, where health outcomes such as life expectancy have far outperformed India’s based on a universal healthcare coverage scheme that, since 2002, was built on a successful social insurance model.

The experience of many patients leave little doubt that Tamil Nadu’s public healthcare system is a lifeline to vast numbers among the poorer sections of its population.



This is the first of a six-part series on India's multi-dimensional healthcare crisis.