The covid crisis has lifted the curtain of a struggling health system in India. What steps are required to develop a universally accessible and quality health system in India?
The COVID-19 outbreak has pushed India’s healthcare sector into ICU. Infrastructural inadequacies, shortage of human resources, lack of adequate funding and huge interstate and interregional variations in the availability of health services have been the major impediments in India’s COVID-19- containment strategy. India’s public expenditure on health as a percentage of GDP is a little over 1%, one of the lowest in the world, according to the National Health Accounts’ estimate. A higher funding is only the first of the many steps required to improve the shattered healthcare system of India. The Indian healthcare system is too dependent on the private sector, which is exploitative, unregulated and expensive even for the middle class. WHO’s health financing profile for 2017 shows that close to two-thirds of expenditure on health in India is out of pocket, while the world average is just 18.2%. Over 63 million Indians are faced with poverty every year due to health costs alone, according to government estimates. In order to create a universally accessible healthcare, it is imperative to rebuild the public health infrastructure so that private sector acts like an available option, not the only option available.
Availability of qualified doctors and beds in emergency cases is another problem in Indian healthcare infrastructure, both physical and human infrastructure. There are only 0.7 hospital beds per 1,000 people in India with variations across states, according to the World Bank. Similar is the case with physicians, where India has only 0.857 doctors per 1,000 people. In order to make a strong and vibrant healthcare sector, it is important to invest in physical as well as human infrastructure. Despite availability of well qualified young people who are willing and able to become doctors, limited seats in medical colleges forces the youth out of the profession. It has also made medicine profession highly competitive and vulnerable to corruption. There is an urgent need to convert our young population into qualified doctors in large numbers.
Due to easy availability of medicines over the counter, the Indian medicine system has become too dependent on curative healthcare. Advanced countries like United Kingdom have improved the overall health of its people by focusing on preventive healthcare. The focus in India needs to shift from over medication towards a healthy lifestyle. Due to collusion between pharma companies, doctors and insurance companies, a healthcare based on medication and hospitalization has become the norm. Preventive healthcare automatically reduces the need of heavy investment in healthcare infrastructure.
Primary healthcare through “health and wellness centres” can reduce the financial and psychological burden on families. Presently, the sick are either ignored completely or treated directly in tertiary care centres, which is expensive for even the middle class. According to the National health policy 2017, health centres be established on geographical norms apart from population norms. To provide comprehensive care, the policy recommends a matching human resources development strategy, effective logistics support system and referral backup. This would also necessitate upgradation of the existing sub-centres and reorienting PHCs to provide comprehensive set of preventive, promotive, curative and rehabilitative services
Malnutrition, especially micronutrient deficiencies, restricts survival, growth and development of children. Empowerment of AASHA and Anganwadi workers at the local level through regular training, proper infrastructure and awareness programs can help in micro nutrient supplementation, food fortification, screening for anemia and public awareness at the local level. Malnutrition is the first step in preventing reliance on the tertiary healthcare system in the long run.
Covid-19 has brought to attention the importance of Universal Immunisation. India is one the few countries in the world affected by diseases like Polio.
Realistically, India has a long way to go before it’s healthcare system can compete with the developed nations. However, with the available of world’s best pharma companies and human mind, it can speed up its process of transformation to create a strong and vibrant healthcare system.