How does the Indian health care system work and how many people can access it?

Abdul Haneefa tolls us that most of India’s health care system is private and all cancer treatment facilities are located in cities leading to a great disparity among people on the possibility of being treated. But how does it really work?
According to an interesting article written by Kasthuri in 2018, the challenges to healthcare in India may be grouped in the “5 A’s” and the lack of them: Awareness about health issues, Access to healthcare facilities both in physical and quality terms, Absence of health care personnel and of its equitable deployment on the territories, Affordability of the cost of healthcare, Accountability for all what lacks.
India’s healthcare delivery system is divided between publicly and privately founded facilities. According to IBEF (India Brand Equity Foundation), the government focuses on providing basic healthcare facilities in rural areas in the form of “Primary Healthcare Centres”, and it funds limited secondary and tertiary care institutions in key cities. Only around 1.5% of its GDP is spent in the healthcare sector, one of the lowest of the world. On the contrary, the private sector funds most of the specialized health care facilities, characterized by more services of a better quality. Around 75% of the healthcare infrastructure is concentrated in urban areas, where only 27% of the population live.
Therefore, the healthcare system is highly context-specific with a lot of differences among and within states and the effect is intuitive. The well-heeled have access to some of the best healthcare facilities, having also a choice between public or private providers, while those with limited or no resources at all have limited or no options. Moreover, quality healthcare treatments often cannot be reached by people from rural areas because they cannot afford the costs of the travel. Another intuitive consequence is obvious: a larger share of unhealthy population resides in rural areas where the risk of health issues is increased even by urgent problematics. To name just a few these are the unsafe drinking water, the lack of sanitation and the use of biomass fuels.
The lack of health equity has been a constant in India’s recent history and this is also shaped by the socioeconomic status, class, religion, caste and gender of people. This is now acerbated by the continuous underfunding of the healthcare system determining the worsening of the infrastructures. According to the National Health Profile, there is one government-run hospital every around 90.000 people and there is a meagre number of beds, doctors and nurses per people. According to the Indian Journal of Public Health, to bridge the doctor-patient gap, by 2030 India needs around 2 million doctors.
If the covid-19 pandemic exacerbated the situation making clear the absence of both hospitals and beds on one side, it also increased people awareness on their healthcare needs and rights. In a nation like India with 1.3 billion people, it is estimated that 30% of the population is devoid of any kind of financial protection for health issues and according to Brookings, it is common for people to be drained of all what they saved because of medical emergencies and often, without even the certainty of hospitalization. Moreover, the absence or unaffordability for health facilities, determines late diagnosis, delayed treatments and consequently longer recovery especially in cases of cancer treatments, transplants and critical ails.
Change will be a long process that needs to start from investments in more disadvantaged areas, but it is being seen that community engagement is an effective alternative. Empower people and the prioritization of their health through health education and the spreading of preventive and promotive healthcare practices is a must at local, regional, and national level. In this way, access to healthcare is improved together with a sense of ownership and accountability among communities. This is already happening with the Accredited Social Health Activists (ASHAs) that bridge the gap between formal healthcare systems and communities left aside. Another alternative is “medical crowdfunding” , a still emerging form of financing that together with awareness campaigns could bring substantial change to rural areas.
Lastly, while most Indians do not have the possibility to be cured, India remains the world’s pharma capital, exporting products throughout the world. Its competitive advantage is based on a good number of well-trained professionals as doctors, nurses and researchers and because of the low cost of clinical research, international players invest in Research and Development. The cost of surgery in India is ridiculously minor compared to Asian or Western countries and this is determining the rise of a new phenomenon: medical tourism.