Increase public expenditure in primary care – the way forward

India’s public expenditure for healthcare and lack of focus on primary care are two areas that will need urgent attention to prepare for future, industry leaders and doctors speaking at the ‘Gratitude Week – A Tribute to Health Guardians’ by Integrated Health and Wellbeing (IHW) Council have concurred.

Prof. K Srinath Reddy, President, Public Health Foundation of India (PHFI) says, “Doctors need to be readied with care, concern, compassion, courtesy, and communication – communication is important to build trust. We also need universal health coverage and increased public spending in healthcare to improve primary care. We need to become advocates for system change, better healthcare and I would request the finance commission to look into increased spending for better coverage.”

Dr M.R. Rajagopal, Chairman, Pallium India & Director, Trivandrum Institute of Palliative Sciences says, “A lot of healthcare institutions succumbed to the panic of the pandemic. Our disease-focused care, catastrophic expense, and inappropriate end-of-life care are major problem areas.”

India’s total healthcare spending (out-of-pocket and public) is at 3.6% of GDP, which, as per Organisation for Economic Co-operation and Development (OECD), lower than other OECD countries where the average in 2018 was 8.8% of GDP.

“We must realise that India’s health security is as important as its defence security. Our healthcare budget is 1/5th of the defence budget – healthcare budget in countries like the US or China is more than their defence budget. I believe science should prevail, so we have not asked for emergency approvals,” says Sanjiv Navangul, Managing Director & CEO, Bharat Serums and Vaccines Limited (BSVL). Last month, the company received approval from the Drug Controller General of India (DCGI) to conduct phase III clinical trials on existing drug ulinastatin for mild-to-moderate acute respiratory distress syndrome (ARDS) patients which is also likely to help COVID-19 patients.

“There are great social inequalities in India that affect healthcare access too – only 5% of the population can access any kind of healthcare. Healthcare infrastructure is slowly improving in north-eastern states like Assam, as well as in Bihar and Odisha but we need to strengthen our public healthcare system and focus more on primary and secondary care. We can learn many lessons from Kerala which tackled COVID so well, and handled NIPAH in the past,” says Dr. Sudeep Gupta, Director, Advanced Centre for Treatment, Research and Education in Cancer & Professor of Medical Oncology, Tata Memorial Hospital, Mumbai.

“This is not the last pandemic – there will be an outbreak at 30% in 30 years and 100% in 100 years. The right tribute for healthcare workers will be to prepare for the next war. We need to increase our expenditure from 1% to 5% to ensure medical services reach every nook and corner,” says Prof. Ravi Kant, Director, All India Institute of Medical Sciences (AIIMS), Rishikesh.