According to the Global Burden of Disease study, India performed poorly in tackling cases of tuberculosis, rheumatic heart diseases, Ischaemic heart diseases, stroke, testicular cancer, colon cancer and chronic kidney disease among others.
India was ranked a poor 145th among 195 countries in terms of quality and accessibility of healthcare by Lancet, behind its neighbours like China, Bangladesh, Sri Lanka and Bhutan. The study, however, mentioned that India has seen improvements in healthcare access and quality since 1990. The authors say that their findings may be a warning sign that some countries’ health systems are not evolving at the same rate as population health needs, especially as many non-communicable diseases and cancers become more common.
In 2016, India’s healthcare access and quality scored at 41.2 (up from 24.7 in 1990). “Although India’s improvements on the healthcare access and quality (HAQ ) index hastened from 2000 to 2016, the gap between the country’s highest and lowest scores widened (23.4- point difference in 1990, and 30.8-point difference in 2016),” the study stated.
India behind Sri Lanka, Bangladesh
It said that Goa and Kerala had the highest scores in 2016, each exceeding 60 points, whereas Assam and Uttar Pradesh had the lowest, each below 40. India lags behind China (48), Sri Lanka (71), Bangladesh (133) and Bhutan (134), while its health index was better than those of Nepal (149), Pakistan (154) and Afghanistan (191).
The five countries with the highest levels of healthcare access and quality in 2016 were Iceland (97.1 points), Norway (96.6), the Netherlands (96.1), Luxembourg (96.0) and Finland and Australia (each with 95.9).
The countries with the lowest scores were the Central African Republic (18.6), Somalia (19.0), Guinea-Bissau (23.4), Chad (25.4) and Afghanistan (25.9). “These results emphasise the urgent need to improve both access to and quality of healthcare, otherwise health systems could face widening gaps between the health services they provide and the disease burden in their population,” says senior author of the study Dr Rafael Lozano from the Institute of Health Metrics and Evaluation at the University of Washington, US.
It’s time to invest in healthcare delivery
“Now is the time to invest to help deliver health systems for the next generation, and accelerate progress in the sustainable development goal era.” According to the study, India performed poorly in tackling cases of tuberculosis, rheumatic heart diseases, Ischaemic heart diseases, stroke, testicular cancer, colon cancer and chronic kidney disease among others.
Sub-national inequalities were particularly pronounced in China and India, although high-income countries, including England and the US, also saw considerable local gaps in performance, it said.
“The study stated large disparities in subnational levels of personal healthcare access and quality emerged for several countries, especially China and India. “These results emphasise the urgent need to improve both access to and quality of healthcare across service areas and for all populations; otherwise, health systems could face widening gaps between the health services they provide and the disease burden experienced by local communities,” it said.
The study used an index to measure the quality and accessibility of healthcare, based on 32 causes of death which should be preventable with effective medical care. Each of the 195 countries and territories assessed were given a score between zero to 100. For the first time, the study also analysed healthcare access and quality between regions within seven countries: Brazil, China, England, India, Japan, Mexico and the US.
The study found that China and India had the widest disparities in healthcare access and quality with 43.5 and 30.8 point differences, respectively. Japan had the narrowest differences with 4.8 points. In 2016, the global average healthcare access and quality score was 54.4, increasing from 42.4 points in 2000.
Disparities between countries remained similar in 2016 and 2000, with a 78.5 point gap between the best and worst performing countries in 2016 (18.6 in the Central African Republic and 97.1 in Iceland), compared with 79.3 points in 2000 (13.5 in Somalia and 92.8 in Iceland).
The authors note some limitations, including that their estimates rely on accurate recording of deaths in each of the 195 countries analysed. The study does not take into account the differences between primary and secondary healthcare, and so cannot distinguish if changes in the healthcare access and quality index over time are due to improved primary, secondary or overall care. The study was funded by the Bill and Melinda Gates Foundation and conducted by researchers from the GBD 2016 Healthcare Access and Quality Collaborators.
Ensuring quality health services
According to Lancet, the global ambition towards universal health coverage by 2030 necessitates ensuring that all populations have good access to quality health services. Progress is possible, as shown by accelerated gains on the HAQ Index for many low-SDI countries during the MDG era.
However, such advances are not inevitable, as underscored by slowed improvements in several countries and for non-communicable diseases that are best targeted by quality services coordinated across continuums of care, it said. “Large geographical inequalities persist across and within countries, highlighting an urgent need for policy attention toward places at risk of being left behind.
Current performance represents action from the past, and thus the pace of progress could accelerate for many middle-to-low SDI countries if recent investments can be translated into healthcare gains. To strengthen and deliver health systems for the next generation, national and international health agencies alike must focus on improving health-care access and quality across health service areas and reaffirm their commitment to accelerating progress for the world’s poorest populations.”
Elaborating on the findings in India, the Lancet said, “Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91.5 (89.1– 93.6) in Beijing to 48.0 (43.4–53.2) in Tibet (a 43.5- point difference), while India saw a 30.8-point disparity, from 64.8 (59.6–68.8) in Goa to 34.0 (30.3–38.1) in Assam.”