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The elephant in the room: tackling corruption and maladministration in Indian health

By R S Rajan
on June 3, 2015

Healthcare across the globe is facing a crisis of sorts. Though each country has got its own problems,  it may not be incorrect to say that all of them share the problem of affordability. Whether it is the United States, which is spending a whopping 17% of its not inconsiderable GDP on healthcare or any one of the sub-Saharan countries struggling to provide basic care, the global problem is how to make healthcare affordable, regardless of who is paying for it.

India’s new draft health policy released earlier this year by the Modi  government makes interesting reading for all the wrong reasons. It is somewhat disappointing after all the expectations it raised in the public mind.

Although there are several health problems to be tackled in a country like India, I expected a focus on cost effectiveness. India spends precious little on its healthcare and hence I imagined that our policymakers are asking if we are we getting the best out of every rupee spent on healthcare by the government? Unfortunately, such a critical approach is missing in the policy document.

Moreover, the two most important issues staring at us in the Indian public healthcare system are corruption and maladministration. The two often go together.

If corruption in the healthcare system is not addressed effectively, it will be throwing good money after bad money, like filling a leaky bucket. The extent of corruption in healthcare is well-known but finds no direct mention in the document (see for example BMJ’s compilation here). Perhaps it is difficult to see the elephant in our drawing room. Unfortunately, in this instance, there are many elephants-at least one in every state and maybe, several in the centre. It boggles one’s mind to think of a health policy which does not take serious note of this. It may be difficult to achieve but unless attempted, all our policies and plans will remain ineffective. There are volumes of reports available on the subject and a determination to tackle this menace should be the backbone of the Policy. Why is it that the government healthcare system with 70% of resources with them is not able to care for more than 40% of the healthcare needs of the people? Why are people losing faith in them? Should this not be addressed in the policy?

Maladministration is another evil responsible for poor quality healthcare in public sector. Why are many government hospitals filthy, crowded, chaotic, ill-maintained, ill-equipped and outdated? More money into public hospitals cannot by itself cure this malady unless the administration is effective. From the Aanganwadi (pre-school supplementary nutrition centres in India) to centres of excellence at the national level, corruption and maladministration pervade everywhere and every activity. Urgent attention to this should be the best way to get more from the existing set-up before we go in for more.

There are many other critical issues crying for attention in the healthcare system but unless the twin problems of corruption and maladministration are faced squarely and tackled effectively,  going after more things and new things will turn out to be a wild goose chase

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