It is no secret that healthcare in India is a disparate situation. Urban areas, despite catering to a minority of the population, continue to house the majority of healthcare infrastructure. Rural areas often have such poorly developed healthcare infrastructure in their area that access to such basic medicines as paracetamol or ibuprofen is sporadic at best.
TheWire.In has offered quotes from two authors that summarise the situation perfectly. Science fiction author William Gibson famously stated “The future is already here – it’s just not evenly distributed.”
Technology writer Richard Hartley, meanwhile, goes into specifics regarding the global healthcare situation/ “In the wealthiest countries, thousands of people in their 60s and 70s are kept alive with cardiac pacemakers that are remotely monitored over the internet, and adjusted by algorithms with no human intervention,” he says. “In poorer states, three-quarters of a million children under five are dying each year because of shit in their water,”
Dr Tedros Adhanom Ghebreyesus, Director General of World Health Organisation (WHO), notes that there is a 32 year difference in the life expectancy between the richest and the poorest nations. He refers to the situation as unconscionable.
The rural, urban divide
The situation is a complex one. Healthcare budgets are limited, particularly in developing nations where economies are not as strong. As such where any healthcare infrastructure is developed, it is often positioned in areas where the population density is highest. This greatly favours the more populous urban environments over sparsely populated rural locations.
A new clinic, for example, is beneficial to more people in a town of tens of thousands than in a village with only a few hundred people. However, this line of thinking does little to help those in rural communities.
India in particular suffers from this disparity. India hosts a population in excess of a billion people. There are urban metropolises such as New Delhi where the population is over twenty million, yet there are also tribal communities numbering in the hundreds in geographically isolated communities.
Providing adequate healthcare in such differing circumstances is a financial and logistical challenge. This is not aided by the fact that India’s public health spending is yet to reach even two percent of its GDP, despite government pledges to increase funding. Current figures place India’s health spending at just over one percent of GDP, considerably lower than other countries with comparative economies.
The strained healthcare budget has created a situation where rollouts of healthcare infrastructure have prioritised quantity over quality. Many rural locations will have a primary health centre, though it is often a health centre in name only. Staff shortages and lack of even the most basic of equipment have made some health centres all but useless. According to a study published in The Lancet sub-par healthcare is responsible for around 1.6 million deaths a year in India. Many of these would have been prevented had the healthcare system been of a suitable quality.
The issue of low-quality healthcare is often most apparent when considering the abundance of open healthcare positions. Understaffing is a considerable issue across many specialist positions. India needs 88,000 cardiologists to adequately provide cardiac care for its population. It has just 4,000. This is despite the fact that heart disease is the leading cause of death in India.
Rural areas suffer the brunt of the staff shortages. Many doctors outright refuse to work in rural locations. This is not entirely due to often lower wages. The issue relates largely back to the lack of healthcare equipment.
Doctors often state they lack even the most basic of medical resources, resulting in them not being able to provide simple services. This often draws the ire of the community they are serving. In some cases this has even escalated into violence, with the doctor blamed for the death of a relative.
Healthcare tech: a further divide
The vast majority of healthcare tech developments such as new equipment or new medicines are typically developed by major pharmaceutical companies in Europe, the US, or other wealthy nations. This naturally allows these nations to access these developments first.
India relies largely on imported medical devices, as such it receives these new devices at a much later date, putting the healthcare system behind that of other nations. The private sector will typically access these new technologies first, meaning the more advanced technology is accessible typically by wealthier urban populations first.
The new technology may eventually reach public sector clinics, though by this point it may have taken many years. Most rural environments may never see the benefits of these new developments. Issues such as this may partly explain the considerable difference in life expectancy between wealthier nations and developing countries, as, much like rural India, these nations may be behind in terms of medical advancement by many decades.