Why is healthcare neglected in developing countries?

In this year’s Interim Budget presented in the Lok Sabha in February 2009, there were significant allocations for the continuation of various Health Schemes (for example  rural drinking water projects, midday meal schemes, child development schemes, Rural sanitation programmes,the National Rural Health Mission, death and disability covers) but there is no indication as to whether budget allocations for Healthcare have increased over the previous year. In 2008, last year’s budget, there was a 15% increase over the previous year’s (2007) budget allocations for Health. When the new government presents its final budget with a brand new Health Minister, one can only hope that Healthcare gets priority. For human development to keep up with a country’s financial health, or in fact for financial growth to continue, Health as well as Education need top priority. 

Here is WHO data on the health situation in different countries. The figures (which can be customized and made into a table according to one’s  needs by choosing the criteria one wants) are a few years old as latest authentic data was not available. However one can get a good comparison with our neighbours as well as a few developed countries like the U.K, the U.S and Japan, and it’s sobering. (Click on it to get a clearer image which will open in a new window).

 

Only Bhutan (107), Pakistan (100), and Nepal (99) fare worse than India (82) when it comes to infant mortality per thousand live births. China (37) is next but they are still a whole lot better than the other three! Thailand and Sri Lanka are at 26.  It’s the same story when it comes to maternal mortality. Nepal is in the worst state here with 830 deaths per 100,000 live births. China scores better on all criteria as compared to India. 

That India needs to spend more money on Health is staring the Indian government in its face. But governments, particularly governments of developing countries don’t seem to care enough. However Thailand, despite it not being a First World country, seems to be doing alright. 

The table below tells us how much priority different governments give to Health.

If developed countries are spending so much on the health of their populace it’s probably because their population is more educated, more aware and therefore demand their rights. Considering that people in poor countries do not have their basic needs like clean drinking water met and do not have access to basic medical care, they should actually be more demanding. They are not. Public Health Systems in poor countries may be pathetic but the poor are not casting their votes for better Healthcare. And governments are getting away with not fulfilling its populace’s health needs.

Ignorance of their rights, a sense of helplessness and lack of access to organised groups who will fight for them for free is a major hurdle for the poor in developing countries. Also poor and illiterate populations are often swayed by religious and/or caste issues which governments use to mask their failings. Freebies are also flung at the poor for the same reason. A poor person will get taken in by fancy freebies and ignore larger health issues. In the just concluded 2009 Lok Sabha elections there was a mad scramble to attract the poor in Orissa by offering cheap rice:

At least four political parties have been competing with each other to provide cheap rice to the BPL families across the state, which comprises nearly 55 lakh families, and are considered as a major chunk of the vote banks in the state

This desperate attempt to woo voters went so far that the Election Commission had to intervene and stop the Chief Minister’s photograph being used while advertising the scheme. Anyway, the Rs 2/- per kg rice scheme worked. It’s said that this was one of the reasons why Naveen Patnaik won. 

There is another reason why the poor are less demanding when it comes to healthcare. In places like India the poor feel they have a choice  – traditional remedies. While some traditional medicine is good, one cannot depend on it entirely. Only education and awareness can change all this.  And in any case there is no substitute of good clean water and sanitation facilities. Half of India has no toilets!  

Interestingly China, which is developing at a much faster rate than India, is  spending very little on the health of its people (as a percentage of its total expenditure) despite it being a so-called communist country.  Even a country like Thailand spends more (10%) on health than China. True, China’s mortality statistics are better than that of most developing countries (not Thailand) and this is so because their expenditure in actual terms is higher. The table below gives the per capita expenditure on Health. China, like India, suffers from a bloated population, so there are more people to cover per Health Rupee, but then both India and China spend very little on health if one looks at percentage spend.  

The table gives the per capita expenditure on health.

India’s figures are shameful. As for China, that country can easily bring its Health Systems on par with that of developed countries like the UK and the US but it isn’t doing it. As of 2005, it was spending  just 1% on Health! I wonder why they say that Communist countries are meant to benefit the masses.

To improve the health scenario in India the money allocated also needs to reach the intended. There needs to be better control from the top to reduce corruption. There have been appeals from many quarters to not take tainted ministers in the cabinet and I hope the government listens. The rot should not exist at the top. For starters. 

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