The Parlous State of Health Care in India

03/19/2014 11:22 am ET | Updated May 19, 2014

"India today is a sought after destination for high-end medical care by patients the world over," says Dr. Anupam Sibal, Group Medical Director of India's Apollo Hospitals. "Health care here is cheaper than almost anywhere else in the world."

That may well be so, but as the political season becomes more clangorous in preparation for April's parliamentary election, what seems to be missing in the campaign is any debate on health care.

"We need to have more and more medical colleges, nursing schools and paramedical educational courses to be able to meet our growing need of health care manpower to heal the global citizen," Dr. Sibal says. With nearly 60 hospitals, Apollo is Asia's largest medical system, and one of the biggest in the world.

When he was planning Apollo in 1981, Dr. Prathap Chandra Reddy and his colleagues devised what reputed institutions the world over now call the "Iron Triangle." Its components: "Quality, Affordability, Accessibility."

Casting a gimlet eye at the political dialogue in India today, Dr. Reddy says:

We need to provide a much larger vision. No time is more right than the present to take a giant leap and bring India to the forefront of global health care services. What would I describe as a 'disappointment' in this bittersweet journey? We are not going as fast as we could, and to add to our woes we have an increasing disease burden, like the lifestyle diseases, coupled with the aging population. The government, hospitals and health care providers need to work together, push ourselves and together prosper. We need to be relentless about this; health is in our hands and so is health care.

What Dr. Reddy expresses so succinctly contains the very essence of the future of global health care, and certainly health care in India. Long-term sustainability is the key to that future.

That thought has engendered in Dr. Reddy a relentless focus on how health care is delivered in a country of more than a billion people, most of them poor. He transformed health care by generating widespread awareness of a simple, sensible method -- that prevention is better than cure. He did it by building a system in urban and rural areas; more hospitals and clinics are in the pipeline. He did it by building training colleges for nurses, and schools for children in rural areas in the belief that education about health care should be part of the curriculum from an early stage -- and that perhaps more students would want to go on to choose medicine as a career in a developing country such as India.

Dr. Reddy recognized that India seemed well on its way to becoming the world's fourth largest economy, after the United States, China and the European Union. Business constituencies in America and elsewhere perceived exponential growth opportunities in a place that Winston Churchill had once dismissed as a land of fakirs.

"While issues such as poverty elimination have long been bandied about by the nation's leaders, health care hasn't been a significant part of the political conversation. Health affects a society's productivity. Health care must be a priority for India," the industrialist and shipping magnate Shashi Ruia told me.

The not-so-good news -- and it has nothing to do with Dr. Reddy -- is that in order to keep up with the growing demand for better health care, India will need to add at least 100,000 new hospital beds annually for the next 10 years. Right now, India has around 400,000 doctors, 800,000 nurses and some 2.5 million other personnel in the medical industry.

The country needs at least to double the number of doctors, have three times the number of nurses and four times the number of paramedics to take care of the present population alone. According to estimates by the Task Force on Medical Education for the National Rural Health Mission, as of 2009-10, India had approximately 300 medical colleges admitting 34,595 students annually. India needs to open 600 medical colleges (at a average of 100 seats per college) to meet the global average of doctors.

Moreover, India produces 30,558 medical graduates every year while there are only 12,346 postgraduate seats available in various courses of all medical colleges, according to the Central Bureau of Health Intelligence. According to the Economic Times, there are only 620,000 physicians in the country, against a requirement for 1,300,000 -- a staggering shortage of just over 50 percent, according to the 2010 World Health Statistics report. India has less than one doctor for a thousand people (0.6) as compared to China (1.4 doctors per thousand). In absolute numbers, the U.S. -- whose population is a fourth of India's -- has more doctors than India.

If the health care industry -- especially in the private sector -- is strengthened, it has the potential to be among India's biggest employers. Part of Apollo's strategy has been to expand its structural capacity -- what's known as "greenfield projects" -- to better meet the country's growing health care needs.

Every successive Indian government has promised the much-needed sizeable increase in spends on health care. But unfortunately when it comes to actual allocations, health care seems to lose its priority. Now that Dr. Reddy's efforts have dramatically opened up private sector participation, the nation as such is bound to benefit substantially if a responsive government steps up its efforts in addressing the primary health care needs and simultaneously provides encouragement to the private sector to focus on tertiary care. Measures such as according infrastructure status to health care can have a far-reaching favorable influence on the country's health system. So will streamlining the bureaucratic processes involved in managing and regulating health care.

Yusuf Hamied, founder of the pharmaceutical giant Cipla, says:

The government has to give us infrastructure -- not for a day, not for six months, there has to be long-term infrastructure, policies that are sustainable so that we can then also plan accordingly. In health care there are five ministries involved -- chemicals and fertilizers, finance ministry, law ministry, health ministry, commerce ministry -- there is no nodal body. Who do you go to for infrastructure or for advice or anything?

Keshav Desiraju, a member of the Indian Administrative Service and former secretary of the Department of Health and Family Welfare, told me in New Delhi: "The government recognizes that substantial spending is needed to make a dent in the country's disease burden." Desiraju, a grandson of the late President Sarvepalli Radhakrishnan of India, said: "Clearly, we don't have public resources to meet that disease burden. But there's also the question of the capacity to spend what's already allocated to health care."

Does that faze Dr. Reddy?

"It can be done if we have the collective will, the resources, and the guts," he says simply.