Is India's healthcare policy failing its people?

NEW DELHI —  It is past 10pm and Abdul Rehman, a labourer from the eastern Indian state of Bihar, sits on a thin blanket while his ailing son sleeps next to him on the subway floor outside the All India Institute of Medical Sciences (AIIMS), one of India's largest government-run hospitals.  

His 15-year-old son Sadiq is suffering from a disease that has caused his teeth to fall out. He has only four left now.

The teenager went through three back-to-back surgeries over  six months in AIIMS last year.

“My son is not keeping well for several months now and complain of severe pain in his jaws, so I thought we should come for a checkup. Doctors at AIIMS recommend some kind of therapy,” says Rehman.

Sadiq also has a tumour around his ribs which needs another surgery. 

“We have met the doctors several times but so far they have not given us any date for the surgery,” Rehman says.

The father and son have been staying outside the AIIMS for almost two months now, at a time when air pollution levels in the world's most polluted city are high and night temperatures have fallen below five degrees celsius. 

“Sometimes when the subway is overcrowded, we sleep outside on the pavement. On few occasions, we stayed in a Dharamshala [religious sanctuary] as well,” Rehman tells TRT World.

Long waits to access healthcare, that could last from weeks to months, is a norm in India. A government-funded healthcare scheme launched last September was aimed at helping at least half a billion poor and middle class Indians pay for their medical expenses, but suffered from a lack of funds. 

India's government spending on public healthcare is alarmingly low. While the wealthiest 10 percent of Indians own three-quarters of India's total wealth, thanks to low interest rates, the government spends just 1 percent of its GDP on the health sector, an extreme contrast compared to the global average of 6 percent. 

According to Oxfam's latest report, 63 million Indians are pushed into poverty every year, and they are either forced to pay for healthcare services or if they simply cannot pay they can eventually suffer fatal consequences.

Since state and district-level healthcare services owned by the government lack basic facilities and are largely understaffed, tens of thousands of ailing people throng AIIMS with the hope of receiving advanced medical treatment for subsidised prices.

The patients and their relatives, who can’t afford to stay in hotels or rent a room, camp inside or outside the hospital premises, sleep and eat on pavements or inside nearby subway stations, until they get a doctor's appointment. 

Rehman’s elder son works as a labourer in New Delhi’s Anand Vihar, which is about 15 miles from AIIMS. But they can’t stay with him.

“Last year we stayed with him for a few weeks but his landlord told us to leave or pay the monthly rent. We had no choice but to leave, so we ended up here on the street," said Rehman.

Among the others who are camping outside the hospital are the people suffering from cancer and severe lung and chest diseases.

Sarvesh Devi from Ghaziabad – a city in the north Indian state of Uttar Pradesh, less than 30 miles from AIIMS - suffers from throat cancer. Devi along with her husband Amarpal Goswami, who works as a rickshaw driver, has been staying outside the hospital for four days.

“My wife cannot travel much. She feels dizzy after walking a few steps,” said Goswami. “I requested the doctors to admit her, but they refused and instead prescribed some medicines. So we are left with no choice but to stay outside the hospital.”

Ashok Kumar, 36, from the neighbouring Haryana state, has accompanied his brother Maam Chand to New Delhi. Chand’s five-year-old son has a cancerous tumour in his leg.

“He can’t walk at ease" said Ashok. "He can't even go to school.”

The young boy received his first surgery in another north Indian city, Chandigarh. But he didn’t recover well.

Waiting to see a doctor at AIIMS, Chand, his brother and son have already spent their first night inside a subway.

“We don’t know for how many days we will have to spend here but we know AIIMS is a big hospital. I hope my son will be treated here,” Chand told TRT World.

Though India has seen improvements in healthcare access and quality since 1990, the country is still behind its neighbours China, Bangladesh, Sri Lanka and Bhutan, and ranks 145th among 195 countries.

According to a recent study by The Lancet, compiled by 30 public health experts from across the world and supported by the Gates Foundation and the Harvard T H Chan School of Public Health, 1.6 million Indians died due to poor quality of care in 2016.

Founded in 1956, AIIMS is known to treat 1.5 million outpatients and 80,000 inpatients annually.

“It is very unfortunate that some patients have to stay outside the AIIMS,” said Biplab Mishra, Professor Of Surgery at AIIMS. “The AIIMS is catering patients more than 15 times of its capacity,” 

Last month, the Delhi Urban Shelter Improvement Board (DUSIB) erected several tents around AIIMS to accommodate poor patients.

“The tents can accommodate 600 people,” said DUSIB board member Bipin Rai.

The tents couldn't accommodate everyone, though. Several hundred people still slept on nearby streets. Some patients and their companions even set up their own tents made of polythene sheets.

“Patients don’t visit the AIIMS just in winters. We need to find a permanent solution to this problem. We have time and again asked the authorities to provide us land for permanent shelters that have a capacity of accommodating over a thousand people. Unfortunately, they are not interested in it,” Rai added.

Dr Sailesh Mohan, a professor at the Public Health Foundation of India, is critical of Rai's proposed solution. 

“Measures should be taken to strengthen the healthcare at lower levels," Mohan told TRT World. "That would reduce overcrowding at tertiary care facilities like the AIIMS.”