Intended for healthcare professionals

Analysis Health in South Asia

The rise of private medicine in South Asia

BMJ 2017; 357 doi: (Published 11 April 2017) Cite this as: BMJ 2017;357:j1482

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  1. Amit Sengupta, associate global co-ordinator1,
  2. Indranil Mukhopadhyaya, health economist2,
  3. Manuj C Weerasinghe, senior lecturer3,
  4. Arjun Karki, former vice chancellor4
  1. 1People’s Health Movement
  2. 2Public Health Foundation of India
  3. 3Department of Community Medicine, University of Colombo, Sri Lanka
  4. 4Patan Academy of Health Sciences, Nepal
  1. asengupta{at}

Amit Sengupta and colleagues describe how stagnant public investment in health in South Asia has seen a growth in private practice and may hamper efforts to enable universal health coverage in the region

Healthcare services in South Asia are characterised by low public investment, dependence on services provided by the private sector, and very high rates of out of pocket (OoP) expenses as the principal source of health financing. Only the sub-Saharan Africa region has worse public health indicators than those seen in South Asia (with the exception of Sri Lanka), such as life expectancy, malnutrition, and infant and child mortality rates.1 South Asia is the only region in the world where health expenditure fell between 2000 and 2006.1 In this paper we examine the evidence regarding the growth and characteristics of the private health sector in South Asia, the drivers of their sustenance and growth, and the implication of these for public health outcomes.

Current trends in private health expenditure

The majority of people in South Asia depend on private healthcare services, and this trend is accompanied by stagnant public investment in health (Table 1).2

View this table:
Table 1

Private health expenditure (PHE) in selected countries South Asia: 2000-12

Government expenditure on health as per cent of gross domestic product (GDP) in the region is just above 1% (with the exception of Nepal)—well below the average for low and low middle income countries, and significantly lower than the global average (4.9%). There has been a small increase in government expenditure (as per cent of GDP) in India, a definite increase in Nepal and Pakistan, but a sharp decline in Sri Lanka.

Private health expenditure (PHE) accounts for about two thirds of total health expenditure (THE) in the region, similar to trends in low and low middle income countries but much higher than the global average …

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