Video I: A case study on the reality of healthcare in developing countries (www.oxfam.org/foall)
Public spending on health care in India is one the lowest in the world. Less 20% of healthcare
expenditure is in the public sector….
Transcription of the Story
The lack of investment in public healthcare actually means that we have few hospitals, few doctors, and
because of few hospitals and few doctors it means reduced access to healthcare. Now in practical come
to mean that the public hospital with a doctor is not very closed to you so you would have to travel long
distant to this place.
Interviewer: “Where are you from?”
Villager: “Bihar” (900 km away)
When you reach the public hospital, you have extremely long waiting times. You don’t know what have
patients per the doctor very high, so you meet your doctor for a very short period of times.
Interviewer: “What happened here?”
Villager: “He has a boil.” “We had to come twice but nobody’s seen to us.”
Interviewer: “Now what?”
Villager: “They said come back tomorrow at 7.” “We couldn’t even get our registration card sorted.”
Interviewer: “Can you get it dealt with privately?”
Villager: “We don’t have enough money to get it done privately.”
We have a situation with the very very weak public sector and very large unregulated and active private
sector. You will find places especially where the poor live where doctor without any kind of formal
training have public clinics so that’s one part of the story. The second part of the story even you are
trained doctor; Do you need any kind of permission? Do you need any kind of registration?, Do you need
to find any kind of paper to set up a clinic? Actually no.
Interviewer: “Are you the doctor here?”
Doctor: “Yes.”
Interviewer: “Is it mainly general ailments you see?”
Doctor: “That’s right.”
Interviewer: “So you are a general physician?”
Doctor: “Yes, I am physician and surgeon, both.” “I do small things, putting on bandages etc. ”
Interviewer: “So mainly wounds? ”
Doctor: “Sure, what else?”
Interviewer: “How do you diagnose?”
Doctor: “I diagnose according to the patient.”
Interviewer: “How else?” “Do people from the government ever come to check on you?”
Doctor: “I said I’m registered, right” “So what is there to check?”
…. : “Well you say on your board, you are a child specialist and surgeon.”
Doctor: “I only wrote surgeon.”
…. : “No it says ‘child specialist’ on the board.”
Doctor: “Well, I can diagnose children too.”
The kind of care you can access depends on the amount of money you have available. You wouldn’t go
sometimes to the best of the highest quality of health care because you don’t simply have that much of
money. No regulation... No standardization... No accountability… That’s what you have for private sector
so in the mean of efficiency what we have been promoting over the last few years is actually a kind of
market analogy. The poor should be able to receive the service they need at the cost they can effort.
Now if it’s very poor, service should be free.