It is no secret that the two areas where India has failed its people most are education and health. But a recent report in Lancet, the prestigious British medical journal, brings home starkly just how bad that failure is - most Indians pay up to 78% of their medical bills themselves.

The only country worse off as far as private spending on health is concerned is Pakistan, where the figure is 82.5%.

One of the primary authors of the analysis, Dr AK Shiva Kumar, is part of the prime minister's expert group on universal health coverage. He points out that 39 million people are pushed into poverty because of ill-health every year. Almost 30% of rural India cannot afford any kind of treatment at all, up from 15% in 1995. This is a terrible demonstration of how the situation has deteriorated over the years.

Of course, none of this should be a surprise. Even though we boast about our hi-tech speciality hospitals and newspapers are full of cutting age medical procedures carried out in our hospitals, the fact is that we do not even have primary health centres in most villages. People travel for miles to get treatment and can be treated so shoddily at government hospitals -that they prefer private treatment. Public spending is 0.94% of our GDP - among the lowest in the world. How bad the situation is can be measured by the fact that India leads in infant and maternal mortality rates - with figures much worse than the poorest region of the world - sub-Saharan Africa.

As we aim to become a major global player, we have to realise how urgently we need to set our own house in order. While our public health system flounders, our private hospitals rake in crores. Most will have some reason why they cannot treat lower income patients and thus cannot be relied upon. The onus has to be on public health. Unfortunately, the landscape between dismal public health and exorbitant private care is usually populated by quacks who provide some sort of affordable treatment.

While we share in the reflected glory of the India story, we need to work hard to make sure that the story is not a nightmare for most of our population.