The first part of this two-part series on health care looks at the commitment that various governments have made to the health of their people through the analysis of financial commitment to health care as well as establishment of infrastructure.

In general, the financial commitment to health care in South Asia is low compared to other parts of the world – Maldives is an exception. Per capita health care access (in $US normalized to Purchasing Power Parity) in almost all of South Asia is less than half to what a citizen of China has access. Besides Maldives and perhaps Sri Lanka, there is little difference among the other countries.

Further analysis of the state’s commitment to health care leads to the separation of public and private funds available for health care. In general, private funds are available for services to primarily the middle and upper classes in a nation – communities that can afford to pay for their health care directly or through insurance plans or are corporate or government employees and hence have access to certain plans.

The public component of health care funding is focused on improving health care facilities and training individuals in the area of health care besides providing health care for most of the country’s population. It is this index that reflects the commitment that a nation has to the health of its people. As % of GDP, India has the smallest commitment to the health care of its people. For most part, it has privatized its health care and this is a result of pressure from various international financial institutions. Even Pakistan and Bangladesh – despite their dire economic state – have a larger government commitment to the health of its people. As financial institutions begin to apply greater pressure on governments to open their markets and renege on the responsibility that the state has for its people, we expect to see an even more skewed private to public expenditure.

The absence of commitment of the state to the health care of its peoples is reflected in (and somewhat correlated to) the number of physicians per 100000 people. While one could argue that large sections of these nations survive through traditional health practices and that may reflect on the low numbers of physicians, other health indices such as mortality rates and incidence of disease reinforces the claim the health of South Asia is dismal.

The extent of immunization is another index of the commitment that the state has made to the health of its people. 20 to 40% of one-year olds in South Asia were found to have not been immunized against common diseases such as TB and Malaria with Pakistan and India being at the bottom of that heap. While one could argue that the low immunization rates are a sign of a culture that has not taken to western medicine. That may be one interpretation; however, it is more likely that these numbers reflect the lack of infrastructural commitment.

Even these numbers do not account for numerous cases reported by various health care agencies where vaccines are delivered; however the absence of equipment to transfer and store them have often rendered them ineffective. Accounting for those would probably result in these numbers being even lower.

A common disease that affects many in South Asia and is not included in this survey is polio.

Perhaps the most conclusive evidence of the lack of the states’ commitment to health of the people is the lack of sustainable access to improved water (defined as regular access to potable water), to sanitation facilities and to drugs. It is sad that despite its claims to high economic growth, India has the worst access to sanitation facilities. For most part, access to sustained sanitation is between 30 to 80% in South Asia with Sri Lanka, Bhutan and Pakistan heading the pack.

For most part, between 40 to 70% of South Asians have access to common drugs except for Nepalese at about 30% and Sri Lankans at about 90%. Indians have among the worst access to drugs.

Based on these numbers, India’s commitment to the health of its people is abysmal despite is larger market size and high economic growth. Smaller nations, sometimes ones with severe economic crisis – such as Pakistan and Bangladesh – or ones with severe civil unrest – such as Sri Lanka or Nepal – have made a greater commitment to the health of their people. These numbers also dismiss ethnic or race based stereotypes that are sometimes made regarding hygiene or health of the people from different parts of South Asia.

As Jean Dreze points out in his article, despite claims by many in India and parts of the modern world, of regressive policies of Islamic peoples, both Pakistan and Bangladesh have a greater commitment to the health and education of their respective nations than India.