Union rural development minister Jairam Ramesh on Friday said public health system in the country had "collapsed", noting that even poorer countries like Bangladesh and Kenya have superior health indicators.

In a candid assessment of the country's health sector, Ramesh also said 70 percent of the health expenditure is met from private sources, making it a "unique" country. This was the "single most important" reason for indebtedness in rural areas, he added.

"Today the single most important reason for rural area indebtedness is expenditure on health. We all know that the health system in India has collapsed. India is unique country in the world where 70 percent of the health expenditure is private expenditure," he said at the Hindustan Times leadership summit in New Delhi.

In many part of India, he said, public health system simply does not exist.

Ramesh also noted that countries all over the world are debating the issue of increasing public spending on health.

To improve the social indices, the outspoken minister wanted states to make a fundamental commitment for creating elected institutions and institutions of participation, noting that such measures has helped states which have abided by this commitment.

In this regard, he noted that in large parts of India where elected representatives are strong or participating institutions are strong, they have better social outputs.

He said the secret of success of Bangladesh and Kenya who have superior infant mortality rates and sanitation facilities are due to empowerment of women. "They have been able to deliver than richer country like India".

Asserting that health would remain his top priority, Ramesh said improvement in hygiene and sanitation has led to improvement in infant mortality rates.
He emphasised that the state cannot abdicate its role in poverty alleviation.

The minister also noted that degradation of the environment contributed to poverty.

During the last 25-30 years, with accelerated economic growth and the pressure that economic growth has brought to bear on our natural resources, it has created this "new animal of ecological poverty that we have to now address," said Ramesh, the former environment minister.