New Delhi: Despite India on the path to becoming the third-largest economy in the world, healthcare under Prime Minister Narendra Modi’s leadership has faced significant challenges.
Government spending on healthcare remains low at around 1.2% of GDP, while out-of-pocket expenses for healthcare remain high. Flagship initiatives on primary healthcare and universal health coverage have so far failed to deliver services to people most in need, The Lancet says in its new report.
In fact, India’s spending on healthcare is the lowest among G20 countries. Moreover, despite being the fourth largest economy in the G20, it has the lowest per capita income in the group.
Titled ‘India’s elections: why data and transparency matter’, the journal says, “Persistent inequity in both access to and quality of health care are well recognised. But a major obstacle that India also faces, which many Indians might be unaware of, relates to health data and a lack of data transparency.”
The lack of recent and reliable data impedes democratic decision-making and hampers progress toward the government’s vision of a developed India by 2047. A more transparent and robust data system is essential for informed policy-making and national progress, it says.
“The 2021 census was delayed due to the COVID-19 pandemic, and for the first time in 150 years, a whole decade has gone by with no official comprehensive data on India or its people. A promise that the next census will be an electronic survey carried out in 2024 is yet to be fulfilled. The census is also the basis for all national and state-level health surveys. For example, the periodic measurement of morbidity and out-of-pocket expenditure by the National Sample Survey Organization is overdue, and there are no plans to conduct it,” it says.
“No reasons have been given for why the Sample Registration System survey report for 2021, which is India’s most reliable source of data on births and deaths, is delayed, or for why completed poverty surveys are not in the public domain,” it adds.
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‘Government unhappy with certain datasets’
The Lancet report also refers to the resignation of the Director of the Institution for Population Sciences, K.S. James, who led the National Family Health Survey – one of India’s most robust data sources. The Health Ministry has said that the reason was irregularities in recruitment; however, media reports have linked his dismissal to the survey finding results that were unfavourable to the Government.
The Union government suspended him citing an irregularity in recruitment, The Wire reported.
Sources told The Wire that James had been asked by the government to resign earlier as the government was not happy with certain data sets that came up in the surveys conducted by the International Institute for Population Sciences (IIPS). IIPS prepares the National Family Health Surveys. It comes under the Union health ministry.
The NFHS-5 had thrown up several data sets inconvenient for the government.
For example, it showed that India was nowhere close to being open defecation free – a claim that this government, including the Prime Minister Modi often makes. Nineteen percent of households do not use any toilet facility, meaning that they practice open defecation, the NFHS-5 pointed out. There is not a single state or Union Territory, except for Lakshadweep, where 100% of the population has access to a toilet, it said.
The NFHS-5 also showed that more than 40% households did not have access to clean cooking fuel – thus questioning the claims of success of the Ujjwala Yojana. It said in rural areas, more than half the population, 57%, does not have access to LPG or natural gas.
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Need for reliable data
The credibility of India’s COVID-19 death toll is in question, with official figures significantly lower than international estimates. Key reports, such as the 2021 Civil Registration report and the Sample Registration System survey, are yet to be published, raising concerns about data transparency.
“Without access to recent and reliable data, democratic choices are impoverished. The Government’s key policy is Viksit Bharat 2047 – a plan to make India a developed nation by 2047, 100 years after independence. Success in achieving this vision—should the Government gain a third term – will be driven by people and services, not manufacturing. India must therefore focus attention and investment on health and education,” says the report.
And this can be done, per The Lancet, with far more robust and open data.
“It would be appropriate for India to aspire to lead with data and be unafraid of its uses. The systematic attempt to obscure through the lack of data, means that the Indian people are not being fully informed,” it says.
