India’s health system will need to add 3.6 million hospital beds, 3 million doctors and 6 million nurses over the next 20 years to meet the needs of the growing population, consultants PWC India estimate. Reuters found that officials and health experts blamed a tortuous procurement process, political wrangling and bureaucratic incompetence when they studied the under utilization of funds by most public health care organizations. Fearing corruption charges, officials work in an environment of “procurement phobia” and routine requests are held up for years. Rajiv Gandhi Super Specialty Hospitals has sat for a decade on 13 acres of prime Delhi landscaped land with 650 empty rooms, as X-Ray machines have no operators, and doctors and other equipment will not be procured for many years at the current rate, is one example. The budgets are left unspent for most government hospitals, as ‘it takes ten agencies to clear the laying of the first brick’; or the requests for doctors disappear into a quicksand of bureaucratic bungling.

India records the world’s highest number of deaths during pregnancy and high rates of child mortality from diarrhea, pneumonia and measles. It spends less than 1% of its GDP on Healthcare, putting it in the race to the bottom with Afghanistan and Sierra Leone. The result is either expensive private care, or no care at all for most of its population. It has 1 doctor for 1,400 patients which is less than even neighboring Pakistan, and there is no plan to improve on these statistics, as budgets will continue to be allocated and not spent given the past history.

ASSOCHAM estimated in 2013 that India’s private hospital sector would grow at 20 percent annually and become a $125 billion market by 2017. Today 80% of the care is provided by the private sector and it will continue to grow as the public facilities have neither the vision nor the administrative capabilities to provide efficient care facilities. Mr. Modi may want to improve this critical area for the well being of his people, but the inefficiencies and mind sets of public sector employees do not point to any near term improvements. With the rise of Kejriwal and Modi on anti corruption platforms, I only expect the procurement phobia to increase as any public employee who does his duty, will also be exposed to witch hunts for corruption.

While a lot of good work has been done in India by tackling infectious diseases and increasing longevity of its population, it is a drop in the bucket. We need to change the mindset of the administrators and let the professionals run health care. Whether it is done through public private partnerships or disinvestment of these facilities to let private sector take them over and run them is up to the government. I do not expect anything to change anytime soon in India, as the road to health for the people needing health care; is dependent on the good intentions, of its new leaders. Campaign slogans rarely turn into effective policy, as a dynamic democracy has its own unique challenges.