Editorial Notes

[Editorial Notes] Is India’s Public Health System on Trial?

The Prime Minister’s announcement of a ₹15,000 crore package for emergency healthcare expenditure followed by an economic package of ₹1.7 lakh crore gives the impression of a two-pronged fight against COVID-19. But by having two separate allocations for health and economy, is the government trying to create an imaginary binary?
By IASToppers
April 07, 2020


  • Introduction
  • India’s polices towards public health expenditure
  • Urban and Rural healthcare personal gap
  • NITI Aayog’s health care index
  • Conclusion

Is India’s Public Health System on Trial?

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  • The people in India contributed to the growth of the economy that resulted in a nine fold increase in gross domestic product (GDP) in dollar terms between 1990 and 2019.
  • However, the share of public expenditure in national income, though it increased from 0.9% to 1.28%, continues to be one of the lowest in the world. In fact, this is less than the average of the poorest countries in the world at 1.6%.

India’s polices towards public health expenditure

  • A significant share of this expenditure is taken up by family welfare activities ignoring public expenditure on health.
  • In fact, the social sector is often the first to be targeted for reduction in the name of fiscal austerity.
  • In United States (US), the public expenditure on healthcare has been a solid 8% to 9% of the GDP for quite sometime now, though dominated by an aggressive insurance system.
  • The European version of neo-liberalism, despite valiant attempts by conservative political interests, also witnesses an expenditure ratio varying from 6% to 7% of the GDP. 
  • Despite being a member of the G-20, Primary healthcare is one of the most neglected segments in India.
  • Hospital beds per 10,000 people in India are in the vicinity of 7 compared to its equally big neighbour China with 42, Vietnam with 26 and Bangladesh with 8 beds. An equally dismal picture emerges when one looks at the availability of physicians.

Urban and Rural healthcare personal gap

  • The Employment and Unemployment Survey of 2017–18 brings out that the total personnel in all human health activities working in institutions with some inpatient facility is around 26.3 lakh, of which 72% works in urban areas. However, the public sector’s share in this is only 44% or 11.6 lakh workers.
  • Even in the public sector the share of personnel in rural areas is a mere 31%. However, the neo-liberal policies opened up the healthcare sector to the corporates, which now accounts for a little more than 15% of all health workers or about four lakh personnel, but 86% of them are concentrated in urban areas.
  • In fact, just eight states—five southern states along with Delhi, Maharashtra and Gujarat—account for 74% of the health personnel belonging to the corporate sector. It is not difficult to imagine that within these states most of them are in large cities.

NITI Aayog’s health care index

  • The NITI Aayog released a report on the health index in June 2019 highlighting the extreme disparity across states and lamented that while the health situation in Kerala is comparable to Brazil, the situation in Odisha is similar to that in Sierra Leone.
  • The top five states are Kerala, Andhra Pradesh (undivided), Maharashtra, Gujarat, and Punjab, and the bottom five states are Uttarakhand, Madhya Pradesh, Odisha, Bihar, and Uttar Pradesh in that order.
  • Average personnel available per 10,000 people is a mere 19.6 for all India; it however varies from 49 for Kerala among the top states and 6.8 for Bihar among the bottom states. 
  • But the regional inequality often hides the social inequality in healthcare, especially in policy formulation and planning.
  • The worst sufferers in access to healthcare are those belonging to the Scheduled Caste (SC) and Scheduled Tribe (ST) social categories. 


  • The neo-liberal solution of lopsided and unregulated growth of private healthcare is not a panacea for India’s massive health needs.
  • It calls for a people-centred, decentralised public health system that socialises the cost of healthcare.
  • A perfect healthcare model state will evolved over a period of time through effective public demand, responsive government policies, and the institutionalisation of a relatively strong panchayati raj with functions including health, finance and functionaries. 

Mains 2020 Editorial Notes

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