Inside India's Sagging Health System, One State Shines

All is not right with India's health care system. Across the country, infant mortality and communicable disease rates are alarmingly high, and malnutrition stunts the growth of almost 40% of children under age three.

For all of India's booming technology and growing pharmaceutical industry, on average, the health of the general population remains quite poor. Why the persistent health deficit? According to former chief economic adviser to the Indian government Shankar Acharya, who analyzes two newly published papers, the reasons come down to 1). the withering of India's public health sector and 2). the overspecialization of its medical profession.

In 1947 at the time of India's Partition, two separate mandates and funding structures for the medical and public health sectors existed. But subsequent legislation merged them, and throughout the 20th century, a series of measures slashed funding and cut resources for an autonomous public health sector. As the years went on, appealing career options for young people in public health faded, and money ended up funneled to programs targeting specific diseases instead of broad-based sanitation and disease-prevention measures. At one point, for example, most sanitation inspectors were co-opted to work on smallpox and malaria eradication.

But a ray of hope comes from within India's own borders: from the southeastern state of Tamil Nadu. The state spends less per person and has private health expenditures that are lower than India's national averages. And yet Tamil Nadu still has better infant mortality rates, a very high percentage of women receiving pre-and post-natal case and excellent child immunization coverage. The state even was able to offer excellent disaster relief during the tsunami.

How does Tamil Nadu do it?

Unlike most other Indian states, Tamil Nadu kept their public health and medical sectors separate, including their budgets. The state implemented legislation -- the Public Health Act -- that ensured the former would be staffed and well-funded for years to come. Officials also continued to incentivize career paths in both fields -- not simply in the medical profession, often perceived as the more lucrative and glamorous of the two -- and required a separate public health degree for all practitioners.

With health care at the forefront of many national consciences these days, it'd be smart for the United States and other developed countries to note the effectiveness of a distinct public health entity, particularly in countries like the U.S., home to such glaring regional health disparities. As countries look to build or rebuild health care systems, the case of Tamil Nadu offers one comprehensive, relatively low-cost model.

Photo Credit: jpereira_net