“I took my mother to Kolkata in 2017 for an eye operation, every year since then we have been going to Kolkata for her treatment. My concern is that if she needs medical assistance now, it would be difficult to go. Also I get worried when I see the situation in India” says Tanbir Arman from Dhaka. He is among the several thousand who come to India in search for better medical facilities. Around 3.4% of Foreign Tourist Arrivals (FTA) in India were for medical purpose in the year 2013 as per the Bureau of Immigration. 10.4% of the FTA from South Asia were for Medical treatment, with Maldives and Afghanistan accounting for the most. Since 2014 when the Bureau of Immigration, Ministry of Home Affairs discontinued the disembarkation card, data regarding the purpose of the visit is not available. Now the Ministry of Tourism publishes Visa Type data, which shows that the number of Medical Visa issued, have increased from 2.4% in 2014 to 6.4% 2019.
Source: Bureau of Immigration. Ministry of Home Affairs, Government of India
India is becoming a hub for medical treatment; particularly for the global south due to the cost advantage it poses as compared to other countries and its expanding corporate style health infrastructure. As per the Medical Tourism Association in 2019 India was one of the cheapest countries in terms of health service, particularly in South and South-East India. A Heart Bypass in India costs 7900 USD whereas; the cost was as high as to 26000 USD in South Korea. For South Asians, India becomes a preferred destination due to the availability of quality health service at a low price coupled with the fact that language and culture do not act as an impediment. Dental Tourism alone accounts for 10% of the total Medical visits in India, 4 as the cost of the dental Implant in India was around 900 USD in 2019 compared to 1720 USD in Thailand, 1500 USD in Malaysia and 2500 USD in Singapore.
Source: Medical Tourism Association, 2019
Covid-19 and South Asia
On January 2, 2020, when the Government of Nepal launched the ‘Visit Nepal Year 2020’ with a target of attracting two million tourists in 2020, little did it know that it would be the first country to have a Covid-19 Positive case in South Asia. The first case in Nepal was reported on January 3, 2020, when a native student, who had returned from Wuhan, developed symptoms. The Ministry of Health and Population, Government of Nepal, took immediate notice of the matter, establishing checkpoints, 24×7 helpdesks, isolation beds and augmenting the health infrastructure. On March 31, 2020, when Nepal, officially ended its ‘Visit Nepal Year 2020’ it was under a nationwide lockdown and the total positive cases were rising exponentially. A similar measure was seen in neighbouring countries, Pakistan closed all its borders, banned international flights and shut down educational institutional, falling short of a complete lockdown. In Afghanistan, President Ashraf Ghani prohibited large public gathering and closed down public spaces that attracted crowds. The City of Kabul was under partial lockdown from March 27, 2020, with only grocery stores and Banks allowed to be open, public transportation was restricted with limits put on passengers, but as the number of cases rose, on April 12, 2020 lockdown measure were made stricter with penal charges for violation of the lockdown. Bangladesh Imposed Lockdown from April 5, 2020, for a week and Bhutan & Maldives banned international travel and closed down educational institutions. Sri Lanka followed the same measure, banning international travel and imposing complete lockdown in some cities like Colombo while partial lockdown in others.
India was the South Asian Country that faced the worst of this crisis in all aspects The country reported the highest number of positive cases and as of May 23, 2021, it accounted for ninety-one per cent of the total Covid cases reported in South Asia. It imposed one of the harshest lockdowns in the sub-continent for 71 days, which was followed by series of unlocking measures.
Source: Centre for Systems Science and Engineering
Collapse and the Ripple Effect
“I had to take my father for a Hip Surgery to Chennai. His surgery was due in June 2020, but due to the pandemic, I could not go. My best hope was late 2020 or early 2021, but with the crisis in India. I really don’t know what to do. I am exploring alternative options, but that might be expensive” says Dola from Dhaka, who was scheduled to come to India for her father surgery, but it has been almost a year since she had to delay the visit. A similar story was narrated by Shariyar Ahmed who used to regularly visit India for cancer treatment but could not come due to the pandemic. Though the situation is in control in Bangladesh, the prevailing conditions in India give no respite to South Asians who looked up to India for quality and affordable health services. The words of Dr Jalil Parkar, Mumbai based Pulmonologist that “that is worse than world war two” is enough to highlight the state of affairs in India. The very fact that people are gasping for air, and struggling to get a bed with oxygen, brings a question: is India prepared to be regional health hub? Mandira From Kathmandu says, “This crisis in India particularly with the second wave has made me realise that I have to look for healthcare alternatives. Earlier, my late father used to go India for his heart related ailment, but I am not concerned about my mother and in-laws”. The daily images of India with people struggling to get beds, oxygen and medicine highlight the fact that the collapsing health infrastructure is not adequate enough for its own people, how will it be able to absorb the people from the sub-continent.
Health Expenditure in India for the Fiscal year 2018-19 was 1.28% of the GDP, which was lower than that of Maldives, Nepal, Bhutan which were spending 9.4%, 5.8%, 3.06% of there GDP respectively for the same year.
Source: World Health Organisation Global Health Expenditure Database
As of 2019, India had one doctor per 1445, falling below the World Health Organisation norms of one doctor per 1000 person. Though WHO has not prescribed any global norms for the density of hospital beds per population data from the World Bank shows that there were 0.5 beds per 1000 population for the year 2017 in India. This was lower than Sri Lanka 4.2 (2017), Bhutan 1.7 (2012), Bangladesh 0.8 (2016) and Pakistan 0.6 (2017).
South Asia is already facing challenges with communicable and non-communicable diseases, and without adequate doctors and health professional, it is relying mainly on general practitioners, who lack professional medical competence. The growth of Private hospitals in India and investment in central Institution like the All India Institute of Medical Sciences (AIIMS) has added space in India, and this coupled with the growth in the generic drugs industry has made specialised health care affordable and accessible for South Asian. This, however, poses another challenge for India, as the demand for its health services is limited to its border.
About the authors:
Vjay Paul is the Assistant Professor, Department of Humanities & Social Science, Graphic Era (Deemed to be) University. Dehradun. Jyoti Kamboj is a Health Activist based in Sri Ganganagar, Rajasthan.
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The views expressed in this article are the author's own.