India’s healthcare system has been battling various issues, including the low number of institutions and less-than-adequate human resources for quite a while now.
Essentially, a three-tier structure defined the Indian healthcare system — primary, secondary and tertiary care services. The Indian Public Health Standards (IPHS) states that the delivery of primary healthcare is provided to the rural population through sub-centre, primary health centre (PHC), and community health centre (CHC), while secondary care is delivered through district and sub-district hospitals. On the other hand, tertiary care is extended at regional/central level institutions or super specialty hospitals.
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While there is an urgency to focus on all the three levels of primary, secondary and tertiary healthcare, it is imperative that the government look towards improving primary healthcare as a public good.
India has been struggling with deficient infrastructure in the form of lack of well-equipped medical institutes for quite a while now. To add to it, the rate of building such medical teaching or training facilities remains less as compared to the need of the hour.
For a considerable time, the government regulation mandated that private medical colleges must be built on at least five acres of land. As a result, quite a few private colleges were built in rural areas, where it became quite difficult to recruit adequately qualified, full-time doctors due to lack of proper living conditions, besides low pay scales.
It is only now that the newly-constituted National Medical Commission (NMC) has put forward the idea to do away with the requirement of minimum five acres of land for setting up a medical college.
Further, the commission has proposed to curtail the minimum number of beds required as a proportion of the number of seats in the college.
In addition, the new regulations have also laid down the requirements for lecture theatres, libraries, laboratories, minimum bed requirement of the attached medical college, and location of faculty offices and accommodation of students.
One of the most pressing problems in India remains a severe shortage of trained manpower in the medical stream, this includes doctors, nurses, paramedics and primary healthcare workers. The situation remains worrisome in rural areas, where almost 66 per cent of India’s population resides.
The doctor-to-patient ratio remains abysmally low, which is merely 0.7 doctors per 1,000 people. This is compared to the World Health Organisation (WHO) average of 2.5 doctors per 1,000 people. Improving this situation continues to remain a long-term process.
The issue can be suitably addressed by increasing the capacity of existing teaching and training institutes while adding new ones in the long run.
Even prior to the outbreak of the Covid-19 pandemic, healthcare facilities had been feeling the strain due to unmanageable patient-load. Moreover, serving a population of 1.4 billion remains a Herculean task in itself when it comes to suitably managing healthcare facilities.
There is a need to adopt technology wherever possible to streamline the operational and clinical processes for healthcare facilities in order to manage efficient patient flow. In addition, there is the challenge to think beyond the obvious and promote virtual care protocols, and telehealth services, which can be leveraged to reduce the patient-load burden to a large extent.
The latest National Health Policy (NHP) 2017 highlights the ‘Health for All’ approach to provide assured healthcare for all at an affordable cost. However, there is scope to do much more under the NHP 2017. Ideally, the public health policy needs to be focussed towards proactive healthcare, not reactive healthcare.
Besides, in the case of the government’s Ayushman Bharat scheme, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the universal health insurance scheme, has received considerable attention and resources than the health and wellness centres (HWCs) component. This asymmetry needs to be suitably addressed for the growth of healthcare in the future.
While public hospitals offer free health services, these facilities are understaffed, poorly equipped, and located mainly in urban areas. It is a known fact that accessible and affordable healthcare in the public sector can considerably reduce the rise in dependence on private institutions. However, governmental facilities leave no alternatives but to access private institutions and incurring high out-of-pocket expenses in healthcare. Most health services are, therefore, provided by private facilities, and 65 per cent of medical expenses in India are paid out of pocket by patients.
A possible solution to address the issue could be to increase the adoption of health insurance. In this regard, the government and private institutions both need to work together. Adoption of digital insurance processing solutions integrated with the healthcare ecosystem for faster turnaround time for insurance processes will also motivate adoption of health insurance.
What primarily ails the healthcare system is that there has been a general lack of focus on the vertical from the government. For years now, knee-jerk reaction work is being witnessed towards the improvement of quality of service.
To sum it up, there is an urgency to make healthcare service and service providers more transparent operationally. This will help ensure people and processes can be made easily accountable to provide better healthcare services. It is only then that the healthcare system can breathe a bit easier.
(The author is Executive Director & CEO, Manorama Infosolutions)
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