India urged to double health spending to aid its impoverished sick

ALIGARH // When Nasir Khan cried out at night from the searing pain of kidney stones, the entire slum could hear him.

A magic healer promised an inexpensive cure through chanting while pinching his side where the kidney stones were lodged, but it only made it worse. His condition became life-threatening, and doctors said he would need surgery for a fourth time.

The operation cost him - and his extended family - their home.

Without insurance and unable to get a loan, they sold the broken brick shack in the industrial north Indian city of Aligarh for 250,000 rupees (Dh20,500). It had been home to the Mr Khan, 35, his four brothers, three wives and 11 children.

"There is no choice. It is my life," Mr Khan said in gasps, writhing atop a crude wooden cot as his relatives hovered helplessly nearby. He screamed for his mother. He screamed for Allah. He screamed for anyone to deliver him from the pain.

His story is repeated so often across India it evokes little sympathy, yet it represents one of the biggest threats to India's battle to lift its poor up from squalor.

Each year, the cost of health care pushes 39 million people back into poverty, according to a study published in The Lancet medical journal. Patients shoulder up to 80 per cent of India's medical costs. Their share averages about 3,000 rupees (Dh246.4) annually per person - a crippling sum for the 800 million or so Indians living on less than US$2 (89 rupees) a day.

A diagnosis of asthma, a broken leg or a complicated childbirth can mean having to choose between medicine or food, spending on treatment or relying on prayer.

While India boasts an economic growth rate near 9 per cent, the wealth has done little to help millions burdened by poverty and disease. The poor, aside from struggling to afford care, also face extreme shortages of doctors and medicines.

The situation is particularly dire in rural areas, where more than 70 per cent of the country's 1.2 billion people live. Some desperate patients resort to seeing quacks. Others pay bribes. Many simply don't seek help until it is too late.

The World Bank and other experts have warned that failure to address the country's healthcare woes could take a toll on long-term growth.

Yet India's government spends comparatively little on health care: just 1.1 per cent of the country's GDP, a figure that has not changed much since 2006 when China was spending 1.9 per cent; Russia, 3.3 per cent and Brazil, 3.5 per cent, according to World Health Organisation figures.

Dr K Srinath Reddy, the president of the Public Health Foundation of India and a member of a government-commissioned committee recommending reforms, said: "The political will is simply not there yet. We have to help realign the country's priorities."

Statistics that might highlight areas of need are scarce, thanks to erratic case reporting, few autopsies and a tradition of quick cremation that destroys evidence of disease. WHO reports often leave India out for lack of data. A recent study in The Lancet suggests malaria deaths could be 10 times higher than estimated.

India, which says hospital costs impoverish a quarter of all patients, has vowed to raise spending on health to 3 per cent of GDP by 2015 and provide universal primary health care - but it is an unfulfilled promise that has been made before.

The Lancet, in a series on India in January, urged the government to double its pledge to 6 per cent by 2020 or jeopardise its ability to shake off poverty.

"What is the point of economic success if there is nothing in it for the population?" editor Richard Horton said.

Meanwhile, India boasts a thriving medical tourism industry with shiny private clinics luring tens of thousands of foreigners for everything from bargain tummy tucks to experimental stem-cell treatments in an industry estimated to be worth nearly 100 billion rupees. The pharmaceutical industry is making lifesaving drugs at cut-rate costs, private hospitals are pioneering advances in open-heart surgery and medical schools are churning out physicians eager to work in the West.