Dengue challenges India’s health system

The Lancet-EDITORIAL SEPT 2015.

India’s health system is under the spotlight as Dehli endures its worst dengue outbreak in 5 years. The country’s national media abounds with stories and images of state hospitals overrun with patients, patients sharing beds, and private hospitals refusing to provide care.
The government’s response has been to order more beds in state-run hospitals, limiting charges to patients for care, cancelling doctors’ leave, and penalising private hospitals that turn away patients.

India’s health ministry has reported nearly 21?000 dengue cases for the country up to the second week of September, 2015, which is more than twice that reported for the same period in 2014.
Cases of the mosquito-borne disease generally peak in October after the monsoon season but this year’s surge in cases is possibly because of substantial increases in rainfall, creating favourable breeding conditions for the Aedes aegypti mosquito, the primary vector of the disease.
However, as discussed in World Report this week, India’s poor surveillance network possibly leads to huge under-reporting of cases—one study estimates that dengue could be 282 times higher than officially reported.

India’s response to this acute public health emergency points to a health-care system that is chronically underfunded, unregulated, and has inadequate infrastructure. In the past 12 months, media have reported on a sterilisation scandal that left 16 women dead, budget cuts threatening AIDS and tuberculosis control, and botched cataract operations. In August, The Lancet drew attention to the abysmal state of the country’s rural health services.

Successive governments have promised health reform but at the same time have curtailed funding for many health ministry programmes.
Despite some gains in health care, India only spends 1·2% of its gross domestic product on health, which is among the lowest in the world. In 2011, a Lancet Series called for the implementation of a universal Indian health service.
The recent debate arguing for greater dependence on the private sector for health care is deeply troubling and reflects an ideological split within the government. In December, 2015, we will assess progress since our last series—publicly financed universal health care must remain the goal.

G Mohan.