Would you truly term this as development wherein hospitals in the urban parts are providing world-class services to a trivial proportion of Indians while residents of rural areas do not even stand a chance to consult an authentic medical practitioner? How many of us will take a chance to move to one of the government hospitals for medical services? If not for consultation, try visiting any state backed hospital of India, and I am sure that your mere perceptions of lengthy queues and shortage of beds would change when you will observe doctors’ aides prescribing medicines to the sick, absence of basic amenities (water, lavatories, and chairs), disordered administration, and nil grievance resolution measures. Shocking is the fact that 70 percent of Indian households rely on private medical sector just because the public one is hopeless.
Prior to demanding government’s attention towards the heath domain, let us know why at all we need a highly robust, responsive, and affordable healthcare system. Sad is the fact that while on one hand our economy grew at 50 percent from 2001 to 2006, the malnutrition rate dropped by just 1 percent. Next is our ever-high infant mortality rate. More than 1.7 million children of our country die every year prior to even crossing the first year of their lives. As per the number of HIV infected patients, India stands at the third position globally. If you talk of Rabies, we are at the top. Dengue, Hepatitis, Pneumonia, and Tuberculosis are a few other evil holdbacks. While the WHO guidelines demand 3.5 beds per thousand citizens, India is way down at just 0.9 beds per thousand.
Now let us know what is holding us back. Foremost, being the second most populous country of the world, and accounting for more than 20 percent of world’s liability of disease, we are among the bottom five countries with lowest spending on public health. How can you even expect the milieu to advance when mere 1.5 percent of the GDP is expended on public health? Second, with just 0.6 million doctors and 1.5 million nurses, we have just one doctor for every 1800 Indians (WHO recommends one doctor for every 600 people). Bad governance and corruption in almost every of the state backed project, for instance the NRHM, are too some key concerns. Next, with an extraordinary spread of private hospitals and costly diagnosis and cure, mere 20 percent of Indians are capable to afford healthcare insurance.
The primary measure that can uplift the healthcare sector is undoubtedly a hike in the amount of government spending to anything close to 5 percent. Next, when will we start thinking of preventive healthcare rather than curative healthcare? Precautionary measures ranging from nutrition and counseling on hygiene to prenatal care and vaccinations are much-needed. To cover up the deficiency of doctors, medical colleges in every district, wherein PPP model can be adopted, have to be set up. A recent article in the TOI revealed how private medical colleges are producing money-minded doctors by charging capitation fee of up to INR 1 crore. A committee has to be formed by the GOI to curb such mala fide practices and to uncover underlying facts. Also, the new government must think of lessening duty on life-saving drugs and key medical equipment, along with incentivizing their in-house production and R & D.
The GOI, though, is expending a large amount to ensure that state-backed hospitals provide adequate medical services, misuse and mishandling of this fund is not at all an unknown fact. Absence of doctors during working hours, unauthorized selling off of medicine, corruption in the process of diagnosis and admission, and unnecessary strikes are what that leave patients with no other option than to approach private hospitals or even die at the gates of state-backed hospitals. Such large scale malpractice, if not curbed with immediate effect and with workable measures, would never allow the poor to avail proper medical services. Herein, proper audits and technology-driven attendance system in government hospitals can deliver apt outcomes. Recurring cases of strikes, causing long absence of medical services, have to be curbed anyhow.
Next, with 100 percent FDI allowed under the automatic route, India should have had every of its city equipped with at least moderate quality hospitals. Then why are most of the doctors busy to the core handling long queues, wherein the patient just not have to suffer from the illness, but also due to the time involved in getting through the queue? Herein, it is very much vital to identify the underlying reasons as to why not all those who can afford expensive treatment are able to avail the same. For sure, scarcity of proficient medical practitioners, along with limited demand (due to less prevalence of medical and health insurance) is accountable.
Tertiary healthcare, the third level of healthcare system wherein specialized consultative care is provided via Intensive Care Units and advanced diagnostic support services, remains an area of concern when we talk of its availability and affordability to people in Tier B and C towns. Not at all can we expect attainment of basic essentials for all Indians unless tertiary health services are made easy to get to. Extraordinary measures are also to be undertaken to accord requisite admiration to the services of nurses in India. Of 20 lakh registered nurses in India (as per INC), almost everyone is ill-paid and loaded with too much work. Still, when they are on duty, they are more obedient than the doctors. Furthermore, commercialization of medicine and undue marketing causing inflated prices are to be curbed, else easy accessibility can never be attained.
Liability for negligence is almost absent when we talk about this white collar profession. While I have talked about unqualified persons delivering medical services in rural areas, it is also vital to take note of medical malpractice by some qualified doctors across India. The Medical Council of India, a statutory body liable for upholding high ethics in medical practicing and education services, comprises of just a couple of non-medical experts as vigilance officers with rest as doctors. Also, not every medical service provider can be regarded as dishonest towards the profession or the society; however those rare fishes polluting the pool have to be taken care of. Herein, the government needs to think of deploying more and more officers in the MCI from administration and other eminent spheres.
HIS (Health Information Systems), automated supply chain management, and quick disease surveillance are a few measures that can surely boost our healthcare domain. Also, while the government is planning for more AIIMS to covers more states, it has to be ensured that services are available on the basis of number of residents so as to cover a large chunk. How can we even forget that our Ayurveda existed even prior to somebody thought of the Allopathic branch? The aptitude of Indians is beyond comparison; however feasible and swift actions are expected from the government. Unless the discomfort of the sick common man is felt by the MCI, the doctors, and the government officials, the milieu will never change. Let us hope that the common-man-turned-PM Mr. Modi would collaborate resourcefully with states to bring in a revolution.