By Nita Bhalla
NEW DELHI (AlertNet) - "No, thanks," is the response most middle-class Indians give as they scoff at the idea of visiting a public hospital for medical treatment. And rightly so.
Run-down, poorly staffed and under-equipped, dilapidated state-run hospitals are full of patients waiting for a doctor or a bed in squalid corridors – in a scene that is played out across the country.
Reports abound of neglect and mismanagement. Of expectant women refused admission and giving birth outside hospital gates, of reckless fires which see patients burnt alive in their beds and of babies dying within hours of being born.
And so, while India's middle-classes make a beeline for the swanky, state-of-the-art private hospitals offering everything from heart to plastic surgery, high mortality rates continue to plague the poorest, who have no choice to turn to health system which is woefully under-funded.
According to media reports, India's public spending on health as a percentage of its gross national product (GDP) is amongst the lowest in the world.
India's public health expenditure - averaging about 1.2 percent of GDP annually - lags behind its rival, China, which spends 2.3 percent of GDP. It is also much lower than more developed countries in Europe and the United States, which spend between 6 and 8 percent on healthcare.
And the country's shameful public health figures reflect this.
MOTHERS, BABIES DYING
India's infant mortality rates show that 48 babies per 1,000 die within the first year of birth, compared to 17 in similar emerging economies like Brazil, or 16 in China, according to the World Health Organisation.
The number of children dying before their fifth birthday - mainly from preventable diseases such as malaria, pneumonia, diarrhoea - stands at 66 per 1,000, compared with 19 in China and 21 in Brazil.
Maternal mortality rates are not much better. According to the health ministry, one in five women die while giving birth or during pregnancy in India. This works out at 63,000 women dying every year, the U.N. World Population Fund (UNFPA) says.
Child malnutrition remains a serious concern. The latest figures from a government-backed report found that 42 percent of children under five are underweight - almost double that of sub-Saharan Africa.
In fact, around 48 percent of Indian children under five are stunted, 20 percent wasted and 70 percent anaemic. This is an economic worry as well as a health one, with the World Bank suggesting that malnutrition slashes around 3 percent from annual economic growth.
UNDERFUNDED HEALTH SCHEMES
Often living in remote areas, India's rural poor suffer the most from a lack of access to medical services. Patients are often marginalised and discriminated against purely because they may belong to a low caste or a minority tribal community.
Basic health problems persist mainly due to poor nutrition, a lack of clean water and sanitation facilities such as toilets, poor healthcare for expectant mothers and child immunisation coverage. A lack of knowledge about HIV/AIDS or basic practices such as how to protect yourself from malaria and other mosquito-borne diseases are also a problem.
However, some efforts are being made to improve things.
The National Rural Health Mission (NRHM) launched in 2005 has helped to improve health service delivery, partly due to the training of tens of thousands of village women as health workers who promote child immunisation, maternal care and advise on basic health issues and good hygiene practices.
Another scheme, the Integrated Child Development Services (ICDS), has been running for almost 40 years and aims to tackle health issues in early child development from setting up supplementary feeding centres for malnourished children, immunisation rounds and education on nutrition.
But despite these programmes being some of the largest social welfare schemes in the world, they are vastly underfunded, health and child nutrition workers say.
Many rural health centres are poorly maintained and run-down, with only the most basic equipment. There are not enough health workers, and there is a high level of absentseeism due to a lack of incentives and low salaries.
Plans to more than double health expenditure to account for 2.5 percent of GDP by 2017, and at least 3 percent by 2022, are welcome.
Let's hope it's not too little, too late.