A World Bank report on health policies in South Asia has accused India of maintaining an abysmally low per capita health expenditure and allowing a pro-rich bias to creep in to subsidy allocations.
The Voluminous report Health Policy Research in South East Asia, edited by Abdo S Yazbeck and David Peters, has pointed out that the poorest 20 per cent of India's population get only 10 per cent of the subsidies, while the richest 20 per cent capture 33 percent.
A recent example of this conclusion arrived by the World Bank is visible in a decision taken by Union Helath Ministry that six major projects will be taken up for establishing hospital cum research centres, modelled on the All India Institute of Medical Sciences, around the country will be mainly in state capitals.
The Planning Commission has given its in principle clearance for the projects.
There is complete silence on tackling specialised medical care in the rural areas of the states.
The World Bank report says the only exception in the pro-rich pattern of health expenditure is Kerala, which has a more equitable health system than North India.
The country's per capita spending on health was one of the lowest in the world-comparable only with that of Rowanda, the African country being ravaged by a civil war.
Among the startling findings of the report is the failure of the consumer redress mechanisms to the disadvantage of the poor in India.
The governments throughout region lack the regulatory capacity needed for monitoring.
Dealing with the problems plaguing India the report said : public health subsidies are disproportionately distributed in favour of the richer groups.
The report flayed the country's management of consumer complaints in the majority of hospitals.
In 90 per cent of the cases, the time taken to resolve the conflict went well beyond the stipulated period of 90 days, it has said.
Mr Yazbeck said that calling for privatising the health sector in the country was meaningless because percent of all health spending was private.
A majority of state governments have displayed a pro-rich orientation in formulating their health policy.
The report suggested a strong consumer movement to reverse the trend and make the health programme directed towards the masses.
The proposed AIIMS-type projects will cost the exchequer Rs 4,158 crores.
The Health Ministry has received a communication from Planning Commission saying that the scheme for which allocations have been in this year's Budget, can now take off.
During the 10th Plan period the requirement of funds will be Rs 2,541 crores.
Work on the project, part of the Prime Minister's Swasthya Suraksha Yojana, will begin with the floating of a global tender in January 04 for architectural designs.
The formality of laying the foundation stone has been completed in for the institutes at Bhubaneshwar, Patna and Raipur, for the ones in Jaipur, Bhopal and Dehradun it is likely to be done by next month February 04.
The projects were announced by Prime Minister Vajpayee in his 03 Independence Day speech, according to officials of the Health Ministry aims at bridging the growing rural-urban divide in the health care sector.
Since the establishment of All India Institute of Medical Sciences in 1956, the health infrastructure in the country has deteriorated with the access of the rural population to better medical facilities becoming increasingly inadequate.
Health Ministry sources however point out that though the institutes are intended to carry out research along with providing specialised facilities to people in the rural hinterland, it may not help to blindly emulate AIIMS.
In fact, there could be more pressure on providing curative facilities for chronic, seasonal ailments rather than giving emphasis in too much research.
In a country where out of every ten doctors three are quacks and at least another three chose to migrate abroad, the state of health infrastructure, is pitiable.
In the case of nurses and other para-medical staff too the demand abroad is too lucrative to ignore.
In effect, then health facilities in rural India, like other essential services, remains unattended and uncared for.
The political promises come before election time and are usually forgotten till it is election time again.
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