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India needs to improve its public hospitals so that the Universal Healthcare insurance scheme becomes effective, says Shiban Ganju, Founder Save A Mother Foundation

Any universal health care (UHC) scheme will not succeed in India unless the public health facilities – primary health centers, community health centers and district hospitals have better infrastructure and operations. People covered by UHC prefer private hospitals because of perceived better care. Public health system in India needs considerable improvement to gain the trust of people. Even a casual visit to rural public clinics or district hospitals will convince anyone that their dismal infrastructure needs an overhaul.

As a first step, India needs massive investment to upgrade its public health system.  Government spends about 1.1 percent of GDP on healthcare, which is one of the lowest in the world. Neighboring counties like Thailand and China spends two to three times more. Government expenditure on healthcare in western countries is 6 to 9% of their GDP.

Among all contentious issues in the current 2019 election season, almost all parties agree that the public health spend should increase to 2.5% to 3% of GDP. While the political parties may differ in their approach to expenditure of this public money, all parties should concede that, in the beginning, the increased investment should be dedicated to two areas: capital expenditure and training of personnel. 

Improved public health facilities will increase their revenue from UHC by attracting more patients, as Tamil Nadu has shown. The increased revenue, supplemented by annual government expenditure, will allow public hospitals to upgrade their facilities continuously and give fair competition to private providers. In its absence, UHC becomes the source of revenue for private hospitals. Only the public health system has a nation-wide reach to the masses. The private health delivery system at present is mostly an urban venture for profitable tertiary care. Any universal health care (UHC) scheme will fail to improve the health of the masses unless public health facilities improve. The need for massive investment in public health system is urgent.