In India, some of the best healthcare in the world is delivered through the private sector. Nine out of ten doctors in India work in the private sector. But the fact remains that for nearly 600 million rural and urban poor, quality, affordable healthcare is beyond their reach. Despite being the fourth largest economy in the world, India is near the bottom of the U.N. Human Development Index and healthcare inequities contribute greatly to India’s low standing. A recent report by the WHO highlighted the fact that nearly 70 percent of India’s population spends most of their available income on healthcare. Each year nearly 40 million Indians are thrown into poverty because of out of pocket health spending. A report by Save the Children estimates that there is a shortage of 2.6 million health workers. In short, although much progress has been made in India in tackling disease, particularly communicable disease, much more needs to be done.

Now as prosperity grows in India, so too does the economic and social burden of chronic non- communicable disease. Despite an abundance of quality, domestically produced generic medicines, few drugs are available to the poor -- largely because of a lack of primary healthcare delivery. A recent study published in The Lancet highlighted the fact that less than 10 percent of cardiovascular patients in India had access to some of the cheapest medicines for the management and prevention of cardiovascular disease.

At the heart of India’s growing healthcare crisis is the issue of health system capacity and adequate funding. Without health system reform, India’s healthcare inequities will grow, as will disparities between the growing affluent middle class and the rural and urban poor. As for public funding of healthcare India spends about 1 percent of GDP. Although medicines make up the lion’s share of health spending, India commits less public funding for pharmaceuticals than almost every other country in the world. According to the WHO World Medicines Report, public spending makes up only 4 % of pharmaceutical spending in India. By contrast in China, which has experienced many of the same issue of health inequities as India, over 40 percent of spending for medicines is publicly funded.  In developed countries like France, U.K. and Germany the public sector contributes over 70 percent of spending in medicines and in the U.S and Canada public sector spending on medicines is between 40 and 50 percent of the total.

India recognizes that it has problem in health equity and has once again committed to provide more resources for healthcare. It has also announced a commitment to develop a system of universal healthcare. But the question is: will it adequately fulfill this commitment? Also in question is whether or not the approaches India takes to health reform will improve health equity. The recent National Pharmaceutical Pricing proposals focus of containing the costs of the top three brands in each therapeutic category thereby reducing the costs for affluent consumers and doing nothing for the poor who are most likely to rely on lower cost generic brands. It can only be assumed that such an approach is driven by an industrial and trade strategy to benefit domestic manufactures rather than by a social policy that helps the poor masses. The fact remains that for most of India’s poor, medicines are not affordable at any price, and price controls will not improve access for the poor. In terms of primary care reform, the problems of rural India will not be addressed through more qualified doctors and nurses because overwhelmingly fully qualified health professionals will practice where they can make the most money.

For India, in the short term,  the prudent way forward is to aggressively increase health system capacity through adequate funding. This should start by focusing on training informal caregivers in the communities in which they live. To address the urgent need for better access to medicines India should embark on the necessary regulatory and other mechanisms for pharmacy reform that will ensure the procurement prescribing and dispensing of low cost generics and eliminate the abuses of prescriber mark-ups. Most importantly, India needs to make the commitment to provide the level of public funding for medicines that is expected of a country that is becoming a growing economic power.