India is an open hospital. Don’t google for info; walk her streets, instead. They are the jam-packed corridors and ICUs of the world. See malnutrition and open, frothing wounds at the bazaars. Stroll around the railway platforms and admire elephantiasis and tuberculosis at work. Jump down to the tracks, scamper through to the adjoining platform, and watch how rats nibble at shit and scum and wait patiently for their turn to bring in a 100 new diseases, a million new Guinea pigs.

India accounts for 17% of the world’s population and 21% of its disease burden. Not alarming enough? Perhaps you’re waiting for when India accounts for 21% of the world’s population. Give us a decade, then.

Our burden comes from deaths of all kinds, but the cruelest are the maternal deaths, newborn deaths, child deaths, the deaths of the unborn – for the cause was noble: to bring life into this wretched world so the new may inherit the earth now that the old were turning to compost. But countless millions will have to die in the time it takes us to jump from 17 to 21%. After all, we want to be a world-first at everything and 21% will give us bragging rights over China.

There are very few success stories. Polio eradication is one. For the past two years, claims the government, there has been no new polio case. But this is 2013. How long ago was it before polio got eradicated from America? Couldn’t have been that long – world’s flat, didn’t you know!

The flatness has done something else. It has changed India’s epidemiological profile. Non-communicable diseases are responsible for 53% of total deaths now, up from 40.4% in 1990 and expected to increase to 59% by 2015. This is caused primarily by the emergence of cardiovascular and cerebrovascular diseases, metabolic diseases, cancer and mental illnesses. India is losing more than 6% of its GDP annually owing to premature deaths and preventable illnesses. That’s 6% of GDP lost…but how much does India spend on health? Must be at least double that – 12% – to tide over the losses? Er, no.

India’s expenditure on public health as a percentage of GDP is just 1.2%, lowest amongst the BRICS countries. That’s 12%, but with a painful red bindi in-between. Perhaps there is pleasure to be had in being a world-last in this category. “Lower…lower…careful now…lower…and…yes!”

India is also among the five countries with the lowest public health spending levels in the world even though per capita spending on health has risen from USD 21 in 2000 to USD 45 in 2009. Total expenditure on health increased from USD 30 billion in the 10^th plan to USD 70 billion in the 11^th plan. Not enough when you think we are a nation of 1.2 billion people. Nowhere near enough.

Indians have rightfully spotted this unsinkable India lumbering towards its gruesome hull-smashing end. The private sector has come in, before OPD goes the PDS way. Socialism couldn’t cure all our ills, after all. But the private sector’s predominance in healthcare has led to inequities in access to it. The switch has been swift – over 70% of human resources and advanced medical technology is now in the private sector’s hands, so are 68% of an estimated 15,097 hospitals and 37% of 623,819 total beds (MoH Annual report). Of these, most are located in urban areas. Worse, our health-worker density is laughable – 8 per 10,000 population, when the international norm is 25. Doctors and nurses are 3.8 and 2.4 per 10,000 population, with the nurse-doctor ratio tilted heavily in favour of doctors. And the Ministry of Health? Yes, you guessed it: playing fiddle as those who can’t swim turn the deck into an unreserved train compartment.

The greatest human resource needs are in UP and Bihar. Most nurses hail from Kerala, a state thousand miles adrift. The nation that discovered 0 can’t do this math.

What of the patient? Over 70% expenditure is out-of-pocket. This is against the global standard of less than 15% to protect people from financial ruin. Out-of-pocket payments have shot up, resulting in penury for nearly 2.2% of those who’ve undergone medical treatment. Hospitalisation remains a major cause of indebtedness, especially for those living below the poverty line. Cheer up, can’t be many – things have improved since the economy opened up.

Well, 830 million of us live on 20 rupees a day.

Amid all this, who else but WHO to the rescue! Those CFLs at the United Nation’s World Health Organisation have chalked up a “country cooperation strategy” for India for the next five years. Hopefully it will yield better results than the world cooperation strategy the UN had adopted for the eradication of poverty by 2015. The importance of the UN cannot be overestimated. In any case, here is their prescription:

1. Supporting an improved role of the Government of India in global health and ensuring the implementation of International Health Regulations and similar commitments.

2. Strengthening the pharmaceutical sector including drug regulatory capacity and trade and health.

3. Improving the stewardship of the entire Indian health system.

4. Promoting access to and utilisation of affordable, efficiently networked and sustainable quality services by the entire population.

5. Promoting universal health service coverage so that every individual would achieve health gain from a health intervention when needed.

6. Properly accrediting service delivery institutions (primary health care facilities and hospitals) to deliver the agreed service package.

7. Helping India to confront its new epidemiological reality.

8. Scaling up reproductive, maternal, newborn, child and adolescent health services.

9. Addressing increased combinations of communicable and non-communicable diseases.

10. Gradual, phased “transfer strategy” of WHO services to the national, state and local authorities with the sine qua non condition that no erosion of effectiveness occurs during the transition period.

If you managed to live through reading those Ten Commandments, congratulations! You have great potential to become a country cooperation strategist who can advise third-world and third-rate governments to – what was it again? – yes, Promote access to and utilisation of affordable, efficiently networked and sustainable quality services by the entire population.

There is a reason why we pay taxes, and the reason is this: Hey, you – Head of State! Listen up! Forget all that gobbledygook you just heard from strategists who sit around round tables and dream up commandments. You listen to me now. Spend my money on the following, you hear?

1. Give medical insurance to every Indian.

2. Set up 2 AIIMS and 2 Safdarjungs in every state. And don’t just lay the foundation stone and scoot. Make them functional.

3. Set up private-public medical centres. Do not discount the contribution of the private sector – it has a critical role to play. You keep on sanctioning tens of government hospitals and only nine out of them will ever emerge as navratnas, the rest landfill sites.

4. Prohibit politicians to go for treatment abroad.

5. Make generic drugs available at all hospitals at minimum cost.

6. Set up hundreds of train-hospitals, specialising in, among other things, ophthalmology and dentistry.

7. Set up medical clinics with access to modern ambulances near every village cluster.

8. Encourage R&D at medical centres, ask doctors to teach and train.

9. Don’t make it compulsory for medical undergraduates to spend a year in a village. Make it beneficial for them to do so, instead.

10. Carry out the above and you won’t need the tenth.

To hell with cricket, time to fix the nation.

This article first appeared in newslaundry on June. 07, 2013.