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CfB Bureau

The number of people reporting sick is more in urban India compared to rural areas, whereas the un-treated spell is more in rural India, a national survey reveals. Worryingly, about 86 per cent of rural population and 82 per cent of urban population are still not covered under any health expenditure support scheme

Photo for representation purpose only

A national health survey conducted by the National Sample Survey Organisation (NSSO) shows more people fall ill in urban areas compared to rural India. "A Health Survey conducted by the National Sample Survey Office (NSSO) has indicated that during a 15 day reference period 89 per 1,000 persons reported illness in rural India against 118 persons per 1,000 in urban areas," an official statement.

However, the un-treated spell was higher in rural (both for male and female) than urban areas. Private doctors were the most important single source of treatment in both the areas, it added. "More than 70 per cent (72 per cent in rural areas and 79 per cent in the urban areas) spells of ailment were treated in the private sector," the statement said.

And, despite a separate ministry to promote alternative medicine, allopathy still rules the roost in the country as more than 90 per cent people prefer that treatment over AYUSH (ayurveda, yoga, unani, siddha and homoeopathy) in both urban and rural areas.

NSSO under the Ministry of Statistics and Programme Implementation has released key indicators of the 'Social Consumption in India: Health', generated from data collected in its 71st round, conducted during the period January to June 2014 and aimed at generating basic quantitative information on the health sector.

The key indicators are based on Central sample consisting of 4,577 villages in rural areas and 3,720 urban blocks spread over all States and Union Territories of India. The total number of households covered was 36,480 in rural India and 29,452 in urban India.

Medical treatment of an ailing person as an in-patient in any medical institution having provision for treating the sick as in-patients, was considered as hospitalised treatment.

In the urban population, 4.4 per cent of the persons were hospitalised at some time during a reference period of 365 days. The proportion of persons hospitalised in rural areas was lower (3.5 per cent).

It is observed that in rural India, 42 per cent hospitalised treatment was carried out in public hospital and rest 58 per cent in private hospital. For the urban India, the corresponding figures were 32 per cent and 68 per cent respectively.

Since both rural and urban sets depended on private hospitals for treatment, their spending for hospitalisation was also higher. The average cost of treatment in a private hospital was Rs.25,850 as compared to Rs.6,120 charged in a public hospital.

The highest expenditure was recorded for treatment of cancer (Rs.56,712), followed by that for cardiovascular diseases (Rs.31,647). Average medical expenditure per non-hospitalisation case was Rs.509 in rural India and Rs.639 in urban India.

Incidentally, 86% of rural and 82% of urban population are not covered under any scheme of health expenditure support. To pay for treatment, rural households primarily depended on their ‘household income/savings’ (68%) and on borrowings (25%) whereas urban households relied much more on their ‘income/saving’ (75%) for financing expenditure on hospitalisation, than on borrowings (only 18%).

Only 12% of urban and 13% of the rural population is under health protection coverage through Rastriya Swasthya Bima Yojana (RSBY) or similar government schemes.

The statistics, chanted like mantra by academics and the media, are of no consequence to the majority Indians trying to meet the basic requirements of living and slide into poverty when faced with a health crisis.

Spending on public health care according to the WHO is 1.1% of GDP, placing India below Pakistan, China and Nigeria in the spending table. Cash (or out of pocket) payments are increasing (up to 80%) amongst those who have the money, but for the majority health care is an unaffordable luxury. In a country with more people living in poverty than all Sub-Saharan African countries combined, an additional 40 million a year are estimated to be forced into destitution by medical costs.

The inequities in health care provision represent the extreme levels of inequality and social injustice pervading the country, as The Lancet makes clear, “mainly because of insufficient government funding for health.”

Although the urban population continues to grow (currently thought to be about 400 million), by most estimates 75% of the population – (a staggering 900 million people) still live in rural areas, where health-care is universally appalling. Although India is said to have a universal health care system administered by the various states, whose “primary duty” as stated in the Constitution is “raising the level of nutrition and the standard of living of its people and the improvement of public health,” there is a clear urban-rural divide here.

Urban hospitals have four times more doctors and three times more nurses than the hospitals rural India; this means that of the latter almost 10% have no medical staff at all, 40% are without lab technicians and almost 20% lack a resident qualified pharmacist. The results of this dearth of medical support is that 50% of all villagers have no access at all to allopathic healthcare providers, 10% of all babies die before their first birthday and 50% of all rural babies are likely to be permanently stunted for want of proper nutrition.

The divide between the tiny percentage that have benefitted from economic development and market liberalization, and the vast majority that have been condemned to a life of extreme poverty and illness, is approaching cosmic proportions. Most people live in rural areas, but the beneficiaries of growth have primarily been city residents.

Mahatma Gandhi believed the soul and spirit of India rested in its village communities. He said: “The true India is to be found not in its few cities but in its seven hundred thousand villages. If the villages perish, India will perish too.” One imagines the ‘Father of the Nation’ would be ashamed, as the Indian government should be.

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