Health care is paradox in India

Editor—The National Rural Health Mission is an ambitious yet sincere effort of India's health ministry.¹ It is reassuring to note the commitment to raise the annual spending on health care to more than 2% of gross domestic product, which had fallen to 0.9% in the past few years.

India is a land of striking inequalities. More than 70% of its population lives in rural areas, where only 20% of the total hospital beds are located. Yet India is proudly announcing that it is ready to cater to “health tourists” from the developed world. The advances in health care are accessible to only a very small percentage of Indians. With the influx of medical tourists the healthcare inequality is bound to widen.

Corporate hospitals are well known for “poaching” doctors from government and teaching institutions, luring them with huge sums of money, which often paralyses the government's healthcare infrastructure.

How can a country allow its doctors, who were educated at the people's expense, to cater for affluent patients from developed countries when more than 1300 people die every single day from a completely curable disease such as tuberculosis?

Most medical education in India is government sponsored, but no mechanisms are in place to ensure that the beneficiaries of this subsidised education pay back the people who have contributed to their education.

India is probably the world's leading exporter of trained medical professionals (doctors, nurses, paramedical workers). Some of the world's poorest people living in rural India actually subsidise the medical care provided to people from developed countries, either in the form of health tourism or “export” of medical skills.

Only when these issues are dealt with can the rural health mission become successful—quality healthcare delivery requires that trained professionals are made available where they are most needed.