India below Sudan on healthcare access

New Delhi: A study has ranked India 145 among 195 countries and lower than China, Bangladesh and Sudan on health care access and quality, measured through their capacities to prevent premature deaths from 32 diseases.

The study by an international consortium of researchers has revealed India's gains over time but widening gap between best and worst scores within the country, a finding that public health experts say possibly reflects inequities in access to quality health care.

India's overall score on the health care access and quality (HAQ) index increased to 41.2 in 2016 from 24.7 in 1990, but the gap between the highest and lowest scores increased from 23.4 in 1990 to 30.8 in 2016, the study has found.

Goa and Kerala had the highest scores, both above 60, implying populations in these states have the best access to quality health care in the country, while Assam and Uttar Pradesh had the least scores, both below 40, meaning people there had the poorest access.

The study, published on Wednesday in The Lancet, generated a novel measure called the HAQ index to track gains and gaps in personal health care access and quality in 195 countries between 1990 and 2016. It has assessed countries and states on their capacity to prevent premature deaths from a set of 32 illnesses, including infectious diseases, select cancers, cardiovascular diseases and chronic kidney diseases, among others.

"The widened gap between best and worst means states doing relatively well about 15 years ago have improved far more than states that were not," said Panniyamakkal Jeemon, assistant professor at the Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, and co-author of the study.

The study has ranked Bengal at position 12 among India's 31 states in 2016, with the state's HAQ score calculated at 47.1, higher than India's overall 41.2, but lower than Delhi, Tamil Nadu, Sikkim, Maharasthra and Punjab, among other states.

For comparison, Iceland had the highest score (97.1) for health care access and quality, followed by Norway (96.6) and the Netherlands (96.1), while the countries with the lowest scores were Central African Republic (18.6), Somalia (19) and Guinea-Bissau (23.4).

"These findings emphasise the urgent need to improve access and quality of health care, otherwise health systems could face widening gaps between health services they provide and the burden of disease in their populations," said Rafael Lozano, the study's lead author at the University of Washington in the US.

India's health ministry has announced plans to improve access to primary health services through 150,000 health-and-wellness centres and a national health protection scheme that will provide poor and vulnerable families hospitalisation cover of up to Rs 5 lakh.

The centres are expected to help free diagnosis and basic services for a range of primary health conditions, while the protection scheme will address conditions requiring tertiary-level care such as surgical procedures.

But health experts have cautioned that both these schemes will require far more financial investments than have been earmarked thus far.

"The budgetary allocations to the (health-and-wellness) centres and the national health protection scheme this year are very low and need to be increased at least five-fold next year," said K. Srinath Reddy, president of the New Delhi-based Public Health Foundation of India.

Without significant increase in financial resources, Reddy wrote in a commentary earlier this week in the Journal of the American Medical Association, out-of-pocket expenditure on outpatient care and catastrophic expenditure on hospital care will continue and progress to universal health care will be "sluggish".


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