WHEN NARENDRA MODI, then the chief minister of Gujarat, addressed the eighth Global Healthcare Summit at the Ahmedabad Management Association on 3 January 2014, it was a rare opportunity for the healthcare professionals, policy experts and bureaucrats in the audience to hear directly from him about what a Modi government at the centre might mean for India’s health sector. But when the speech was over 54 minutes later, the audience was none the wiser: the hour had been rife with jargon about “innovation,” “technology,” “better branding” for the health sector, and the need for public–private partnerships in healthcare reforms, but bereft of nuance.
When Modi’s Bharatiya Janata Party finally released its manifesto on the eve of the general elections earlier this year, it was no surprise to see the same rhetoric repeated. The party promised to initiate a new “National Health Assurance Mission,” to expand insurance coverage and bring more people into India’s public health system. As it happens, almost all the major parties set out similar goals on health in their own election manifestos (the Congress, for example, unveiled the idea of a nationwide “right to health” agenda). But for people familiar with India’s complicated, crumbling public health sector, unregulated private sector and highly fragmented state-level insurance schemes, these suggestions seemed equivalent to prescribing a band-aid to cancer patients and wishing them a swift recovery.
India’s ability to move from being a regional power to a global one depends heavily upon how the country performs in sectors such as health, water, sanitation and education. As things currently stand, India accounts for 17 percent of the global population and 21 percent of the global disease burden. The economic progress of the last two decades has led to a significant shift in disease and mortality patterns: the new mass killers are not infectious or parasitic diseases, but degenerative and non-communicable diseases—or NCDs—such as diabetes, cardiovascular ailments and cancers. According to the Global Burden of Disease study from 2010, the country is sitting on an epidemic of NCDs, which account for 53 percent of deaths in India. In 2013, the World Health Organisation found that India has 0.9 beds and 0.6 doctors per 1,000 people. This is considerably low when compared to the global average of 2.9 beds per 1,000 people, and also in comparison to other low- and middle-income countries such as Sri Lanka (3.1 beds), China (3) or Brazil (2.4).