In 1947, India’s entire health care infrastructure consisted of about 700 primary care centers and 7,000 hospitals/dispensaries. Today, we count over 30,000 PHCs, 69,000 hospitals and nearly two million hospital beds – with a transformative touch of technology visible across the spectrum, including e-Sanjeevani telemedicine outreach, which caters to nearly 35,000 patients daily in remote areas. (3 million consultations so far). , in 31 states).
India also has the world’s largest health insurance scheme – since its launch in 2018, Ayushman Bharat has provided free treatment of Rs 7,000 crore and 10 million times to patients from 100 million poor families eligible for a Rs 1 lakh cover . About 40,000-odd new wellness centers are also operational out of the plan’s approved 62,000. And yet, the gaps are massive and the slant certainly favors urban areas (see graphics).
Ramu, a doctor in ‘The Wolf Boy’, visits Balrampur, Uttar Pradesh in 1954; ‘Friends’ robot assistant on call for a patient at Noida COVID Hospital, 2020 (Getty Images)
There too, COVID-19 gave us a clearer picture of the limits and made everyone aware of the importance of investing in health infrastructure. At only 1.2 per cent of GDP, our health budget has grown from Rs 47,353 crore to Rs 71,269 crore, even after a 50.5 per cent increase in public investment between 2017-18 and 2021-22. The budget estimate for 2022-23 is Rs 83,000 crore. Achieving 2.5-3 percent of GDP is an important first step to lock down the world average of 6 percent (China is at 5 percent) – which would already reduce out-of-pocket spending by 30 percent. In recent years, the rising burden of cancer, tuberculosis and lifestyle diseases has raised this figure to an unhealthy 65 percent (global average: 18.5 percent). The goal of the therapeutic needle should be both: the cost of disease and health. for all.
To accomplish this, we must turn to the human component at the heart of the infrastructure – driving the hardware. February 1835 saw India’s first foray into modern medicine: a batch of 50 young men, each drawn to study at the Calcutta Medical College, on a stipend of 7–12 rupees. By 1947, with 19 medical schools, India had only 47,000 doctors for millions of people—1 for every 6,300 people. It took us 75 years to get close to the WHO-mandated ratio of 1:1,000 with over 1.3 million doctors. That’s not counting the world’s second largest number of dentists—270,000 as of June 2022. But the total number does not ensure accessibility and quality.
Rural India, which accounts for 60 per cent of our population, had a 78 per cent shortage of doctors in 2019. Nursing is also at a deficit: 3.4 million personnel means less than two nurses for every 1,000 Indians, far below the WHO’s golden ratio of 3. :1,000. This state of deprivation causes concern over the mental health of healthcare workers, as evidenced by the ‘I’m Overwork’ campaign by Indian doctors in 2019, a year before the pandemic. The resilience we saw after that demands a million salutes.
