India has been ranked lower than China, Bangladesh, Sri Lanka and Bhutan in terms of quality and accessibility of healthcare, according to a Lancet study. The medical journal placed India at 145th position among 195 countries on May 24, 2018. However, its Global Burden of Diseases study mentioned that India has seen advancement in healthcare access and quality since 1990. The study used an index based on 32 causes of death that should be preventable with effective medical care. Each country was given a healthcare access and quality (HAQ) score between 0-100. India’s HAQ score is 41.2, up from 24.7 in 1990.

Notably, this time the study also analysed healthcare access and quality between the regions of the same country. India and its neighbor China had the widest disparities of 43.5 and 30.8 points while Japan had the narrowest of 4.8 points. In India, the 30.8-point difference marks an increase in disparity from 23.4 points in 1990. Goa and Kerala had the highest scores in 2016, both over 60, whereas Assam and Uttar Pradesh had the lowest, both below 40.

Though India has seen growth and developments since the 1990s, its HAQ score was lower than 50 for 23 of the 32 causes of death. Particularly, skin cancer got only 12, neonatal death and adverse medical settled for 24 and tuberculosis and chronic kidney ailments at 30. Speaking to the media, Dr. Madhukar Pai, Canada Research Chair in Epidemiology and Global Health said, “This is really disappointing – well behind BRICS countries.”

“This does not surprise me since TB deaths should be rare if quality care was available. We know India accounts for nearly 30% of global TB deaths… TB is often missed by practitioners, and MDR-TB is diagnosed very late. In the public system, patients are lost along the entire care cascade, and this means only 1 in 2 TB patients make it to the finish line. With MDR-TB, only 1 in 5 patients cross the finish line and successfully complete therapy. All this makes for a poor HAQ score. The bottom line, simply focusing on coverage of TB services is not enough. We need to also improve quality of TB care, in both private and public sectors”, D.r Pai added.

Citing reason D.r Srinath Reddy, president of Public Health Foundation of India said, the major reason for India’s poor rank is because it has a low density of health workers. “For instance,e the Janani Suraksha Yojana has registered a rise in the number of institutional deliveries. However there is no demonstrable correlation with lowering of maternal mortality in certain states,” D.r Reddy said.

On a closer look, these scores given by the Lancet clearly shows that the country’s health system is severally weak. The report also suggests that that the government funded schemes though have provided health access in certain areas but was failed to improve in certain states. The global average HAQ score was 54.4. Iceland and Norway top the list with a HAQ score of 97 each.