Yawning gaps

As the pandemic rightly demonstrated, the global medical response left much to be desired. Healthcare systems in most cases had no capacity and/or capability of adapting to the rapid onset of the virus. While other reasons do exist, a significant portion of this incapability is as a result of healthcare systems that are underfunded and stretched too thin. In the 21st century, even as our average life spans have continued to slowly increase, healthcare spending has largely been caught up in cycles of decline or stagnation worldwide. A WHO report on the global trends of public health spending found that in 2016, healthcare spending from all relevant sources totalled USD 7.5 trillion, a figure representing roughly 10 per cent of global GDP at the time. This pattern, as per the report, has been consistent since the year 2000. The report noted a great disparity in spending across high-income, middle-income and low-income countries with a variation of 1.5-6 per cent of the GDP. Before COVID-19, the potential downsides of spending less than recommended amounts on healthcare were little more than distant warnings in most cases, forming an on and off political issue in some countries while being untouched in others.

But the pandemic exposed gaps in such underfunded healthcare systems on many levels, from access to innovation and infrastructure. India too has found itself in similar predicaments owing to extremely limited healthcare spending. While the overall expenditure has increased year to year, as a percentage of the GDP, it has continued the pattern of stagnation and decline. Over the years, estimates over healthcare spending in India have tended to vary. In 2017, the World Bank estimated India's healthcare expenditure at 3.4 per cent. For comparison, it may be noted that the average for middle-income countries like India sits at 5 per cent. In 2018, National Health Profile data put the estimate at 1.28 per cent, also noting that the price of health treatments is also increasing in the nation. Now in the COVID times, a new report by Oxfam titled 'Commitment to Reducing Inequality (CRI) Index 2020' has placed India's healthcare spending as the fourth-worst in the world at 4 per cent of its budget. This means that as a percentage of total GDP, India spent one-third of what Burundi, one of the poorest nations in the world spent. It must be noted that there is no real magic number in regards to what must be spent on healthcare by a nation. The 'World Health Report 2010' pegged the number at a minimum of 5 per cent. The recommended spending has largely been stated to be 15 per cent in recent times. Regardless, India's healthcare spending has been described as insufficient by every standard of assessment.

The Oxfam report has also noted that out of pocket spending on healthcare in India is among the highest in the world with 70 per cent of healthcare spending being borne by the citizens themselves. Additionally, only 55 per cent of the population has access to even the most basic healthcare services. A combination of these factors has meant that India's healthcare response was pushed to its limit early on. India is not alone in such straits. As the 158 country report shows, South-East Asia is uniformly at the bottom of the list with India, Nepal and Sri Lanka all being part of the bottom ten group. All this, of course, does not go on to assert that healthcare spending guarantees a fluent COVID response. Japan, with 23.6 per cent of its budget being spent on healthcare is struggling to contain outbreaks. However, health care spending provides, among other things, flexibility in the systems themselves, allowing it to manage sudden strains like a pandemic. As a Lancet study showed, healthcare spending on the COVID-19 response has suddenly spiked in every country with expectations for it to grow even further. While some of the spendings is unavoidable, much of it is still going to address shortfalls and gaps that should not have existed in the first place. With only 26 countries achieving the 15 per cent mark, the pandemic should be a costly and abrupt lesson for the other nations to do better. This is not the last healthcare crisis and worse awaits if such clear signs of trouble are ignored further.