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Q.4) The government's hopes of exploiting the country's demographic dividend will be "shattered" if it fails to
sufficiently focus on the public healthcare system. Discuss the issues that India's healthcare system is facing. (10
Marks 150 Words)

How to approach the question

Introduction
 Write a brief about demographic dividend.
Body
 Write about how public healthcare and demographic dividend are related.
 Write about issues in the public healthcare system.
Conclusion
 Write a suitable conclusion giving suggestions.

Answer: Introduction
According to United Nations Population Fund (UNFPA), demographic dividend means, "the economic growth
potential that can result from shifts in a population’s age structure, mainly when the share of the working-age
population (15 to 64) is larger than the non-working-age share of the population (14 and younger, and 65 and
older)".
 According to the Economic Survey 2018-19, India’s Demographic Dividend will peak around 2041, when the
share of working-age,i.e. 20-59 years, population is expected to hit 59%.

Body

With more people in the labour force and fewer children to support, a country has a window of opportunity for
economic growth if the right social and economic investments and policies are made in health, education,
governance, and the economy.

Relation between good public health and demographic dividend

 Good health and nutrition will enhance the

productivity of the labourforce .
 Focus on preventive healthcare and affordable
curative care will reduce the man days lost due to
illness.
 Preventive care will create increased fiscal space to
divert resources for physical and human
infrastructure.
 By investing in old age healthcare we can witness a
rise in women’s workforce by reducing their care-
giving work.
 Increase in savings rate with the availability of a good
public health care system and thus less out of pocket
expenditure.
 Focus on family planning measures will ensure a
smaller share of children in the population and thus

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higher investment per child. Therefore, the future entrants in the labour force can have better productivity
and thus boost income.

issues in India's healthcare system

 Insufficient Medical personnel:

o There is a massive shortage of medical staff, infrastructure and last mile connectivity in rural
areas.e. G. :Doctor: Population 1:1800 while WHO standards require 1:1000 and 78%
doctors cater to urban India (population of 30%).
 Health budget:
o India’s expenditure on the health sector has risen meagerly from 1.2 per cent of the GDP in
2013-14 to 1.4 per cent in 2017-18. The National Health Policy 2017 had aimed for this to be
2.5% of GDP.
 Infrastructure constraints:
o There are doubts on the capacity of India’s infrastructure to take on the additional load of
patients during pandemics like Covid-19 as seen recently.
o There is a shortage of PHCs (22%) and sub-health centres (20%), while only 7% sub-health
centres and 12% primary health centres meet Indian Public Health Standards (IPHS) norms.
 Strong role of Private players:
o Approximately 70 percent of the healthcare services in India are provided by private
players.
o However, Private hospitals don’t have adequate presence in Tier-2 and Tier-3 cities and
there is a trend towards super specialisation in Tier-1 cities.
o lack of transparency and unethical practices in the private sector.
 High Out of pocket expenditure:
o According to the latest National Health Accounts (NHA) estimates released in March 2021,
patients bear a big chunk of health expenses, as high as 61 per cent of the total health
expenditure, by themselves.
o Even the poor are forced to opt for private healthcare, and, hence, pay from their own
pockets. As a result, an estimated 63 million people fall into poverty due to health
expenditure, annually.
 Poor insurance penetration:
o India has one of the lowest per capita healthcare expenditures in the world. Government
contribution to insurance stands at roughly 32 percent, as opposed to 83.5 percent in the
UK.
o The high out-of-pocket expenses in India stem from the fact that 76 percent of Indians do
not have health insurance.
 Fake doctors:
o Rural medical practitioners (RMPs), who provide 80% of outpatient care, have no formal
qualifications for it.
o People fall prey for quacks, often leading to grave disabilities and loss of life.
 Healthcare without holistic approach:
o There are a lot of determinants for better health like improved drinking water supply and
sanitation; better nutritional outcomes, health and education for women and girls; improved
air quality and safer roads which are outside the purview of the Health Ministry.
Conclusion

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India needs a holistic approach to tackle problems in healthcare industry. This includes the active collaboration of all
stakeholders viz. public, private sectors, and individuals. There is an immediate need to increase the public spending
to 2.5% of GDP, despite that being lower than the global average of 5.4%. Generic drugs and Jan Aushadi Kendras
should be increased to make medicines affordable and reduce the major component of Out of Pocket Expenditure.
Leveraging the benefits of Information Technology like computer and mobile-phone based e-health and m-health
initiatives to improve quality of healthcare service delivery.

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