Coronavirus – Health and Governance Issues

South Asia’s healthcare burden


From UPSC perspective, the following things are important :

Prelims level : Not much

Mains level : Paper 2- Need for investment in public healthcare in South Asia

The article contrasts the public healthcare system in South Asian countries with that of their Southeast Asian peers and highlights the shortcomings.

Subpar public healthcare system

  • Super spreader events, a fragile health infrastructure neglected for decades, citizens not following health protocols, and logistical mismanagement were the factors responsible for the destruction in the second Covid-19 wave.
  • What has exacerbated the situation is a subpar public healthcare system running on a meagre contribution of a little over 1% of India’s Gross Domestic Product (GDP).
  • While the private medical sector is booming, the public healthcare sector has been operating at a pitiful 0.08 doctors per 1,000 people, World Health Organization’s (WHO) prescribed standard ois1:1000.
  • India has only half a bed available for every 1,000 people, which is a deficient figure even for normal days.
  • Bangladesh and Pakistan fare no better, with a bed to patient ratio of 0.8 and 0.6, respectively, and a doctor availability of less than one for every 1,000 people.
  • While ideally, out-of-pocket expenditure should not surpass 15% to 20% of the total health expenditure, for India, Bangladesh and Pakistan, this figure stands at an appalling 62.67%, 73.87% and 56.24%, respectively.

Lack of investment in healthcare

  • Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
  • While India has the world’s third-largest military expenditure, its health budget is the fourth-lowest.
  • Indian government in this year’s budget highlighted an increase of 137% in health and well-being expenditure, a closer look reveals a mismatch between facts and figures.
  • In Pakistan, even amidst the pandemic, the defence budget was increased while the spending on health remained around $151 million.
  • Not too far behind is Bangladesh, with decades of underfunding culminating in a crumbling public healthcare system.
  • Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
  • A quick look at pre-pandemic sectoral allocations explains the chronically low status of human development indicators in the three countries.

Learning from Southeast Asia

  • Southeast Asia has prioritised investments in healthcare systems while broadening equitable access through universal health coverage schemes.
  • Vietnam’s preventive measures focused on investments in disease surveillance and emergency response mechanisms.
  • Even countries like Laos and Cambodia are making a constant effort towards improving the healthcare ecosystem.
  • All have done much better than their South Asian peers.


Learning from the devastation unleashed by the pandemic, South Asian countries must step up investment in their public healthcare sectors to make them sustainable, up to date and pro-poor; most importantly, the system should not turn its back on citizens.

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