Preventive Health Care

Poverty, Malnutrition, Hunger, Substance Abuses, Sanitation, Clean Drinking Water, Food Safety, Immunization.

Curative Health Care

Communicable and Non-communicable Diseases

Issues in India’s Health Sector

Accessibility :
Regional disparity in the provision of healthcare services – Lack of PHCs and CHCs in certain rural areas of the country. Hence rural population are denied access to primary healthcare which aggravates their health problems and eventually become a burden on tertiary health sector which is not equipped to deal with the high inflow of patients.
Inadequate doctor to patient ratio: According to the National Health Profile, India has a million doctors to treat its 1.3 billion Doctors largely render services in urban areas and hence rural population are left vulnerable
Affordability:
- Lack of Public Expenditure: India is currently spending only 1.2% of its GDP on the health sector. This reflects the low level of political commitment for ensuring health care and how it has never been an electoral issue
- Prices of Drugs: Even when medical services and expertise is available and affordable, an average citizen in India spends a large amount of money on drugs prescribed. The nexus between doctors and pharmaceutical companies has often exploited the patients to earn large profits
- No Health Insurance Policy and Minimal Coverage: The citizens spent highest on medical services from out of their pocket
Quality
- Infrastructure: Government hospitals are often ill-equipped to provide specialized care and devices and medical infrastructure are old and need of maintenance and repair. There is also an issue of lack of adequate beds in public hospitals
- Technical Expertise: The NITI Aayog in its Action Agenda points out that India faces a huge challenge in the number, distribution, skill and quality of health care expertise.
- Inefficiency in Regulation and Monitoring Mechanism: Medical Council of India consumed with Nepotism and Corruption means healthcare institutions are neither adequately monitored nor regulated in their management or administration giving them a free hand at providing lacklustre services to citizens

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Triple Burden of Diseases
- Fight with Communicable Diseases: NITI Aayog reports India lost 33% of its DALYs owing to the communicable diseases
- Non-Communicable Diseases (Lifestyle): According to India: The Health of Nation’s States Report brought out by ICMR, 61% of India’s disease burden consisted of CMNNDs till 1990 but fell to 33% in 2016. NCD has replaced this vacuum surging from 31% to 55%.
  - Threats of Rising NCDs
    - Diverse requirements from the health sector that needs to cater to both CMNNDs as well as NCDs
    - The burden of Expenditure: NCD treatment is more expensive as compared to CMNND disease thus putting further pressure on the government’s economic resources
    - NITI Aayog reports a rising morbidity and mortality cost attributed to NCDs
  - Threat of New diseases

Prospective Solutions

Universal healthcare:
- Correct regional disparity in provision of health care Services : Set up PHCs and CHCs in unserved and underserved areas. Recruit greater number of ASHA workers and ensure the smooth functioning so that they can act as bridge between villagers and access to healthcare services.
- Incentivize Service in rural areas: Doctors and nurses should be financially incentivized to serve in rural and remote areas to ensure that people in these areas are not left behind for access to quality medical care
Correcting Affordability
- Rapidly Increase Public Spending: As per NHP, public health expenditure needs to be doubled to 2.4% of GDP from current 1.2%. Even such an increase would pale in comparison to what other countries are spending on their healthcare sector
- Gen Oushadi Shops: To sell affordable medicines in the form of generic drugs to citizens
- Introduce a health insurance policy: The government through the NHPS is aiming to provide such an insurance coverage to 10 crore beneficiaries.
Enhancing Quality
- Strategic Engagement and System Strengthening with Private sector Partnership: Enhance technical, infrastructure and specialized healthcare service quality by forming partnerships with private sector entities
- Raising public spending
- Overhaul Monitoring and Regulation Mechanism : Introduce exit eligibility test for doctors, incentivize working in rural areas and replacing MCI with National Medical Commission

Holistic development of public health addressing all social determinants including nutrition, sanitation and drinking water. The focus on entirety shall be a far cry from the sole focus on provisioning of health care
Preventive> Cure: The public health system through the promotion of healthy life styles, prevention of injuries and detection and control of infectious diseases can achieve preventive cure. The state must then reprioritize its goals to transition from curative to preventive
Role of the Government: The NITI Aayog advices the government to play a stewardship role in setting and enforcing rules to guide the health system. A data driven decentralized model can help in bettering health outcomes

National Health Policy, 2017

First National Health policy in 15 years seeks to ensure universal access to affordable quality healthcare services to all citizens in the country.

Universal Accessible Affordable Primary Healthcare
- Comprehensive Healthcare package including palliative, rehabilitative and geriatric healthcare
- Providing digital health card for access to health services from all over India
- Gen Oushadi Shops to enhance access to affordable generic drugs
Preventive and Promotive Focus with Pluralistic Choice
- Integration of traditional medicines into mainstream health care services
- Co-location of AYUSH with western medical facilities in public hospitals
Make in India for a Healthy India
- Production of Active Pharmaceutical ingredients
- Enables to reduce import of drugs and creation of customized indigenous drugs
- Eases affordability for drugs in market
Fostering Patient Focus and Quality – Assurance Based Approach
- Establishment of National Healthcare Standards Organization
- Maintain Quality of healthcare
Digital intervention
- Electronic Database for access to patient records for all doctors from anywhere in India
- Tele-medicine yielding dual benefits of employment generation and better and equitable access to medical services in far flung regions
- Establishment of National Digital Health Authority
System Strengthening and Strategic Engagement
- Entering into sustainable models of partnerships with private sector entities, both for-profit and not-for profit to improve quality of healthcare services rendered in terms of infrastructure and technical expertise
- Objective to improve access to quality screening, diagnosis, treatment services for cardiovascular, pulmonary diseases and cancer in district hospital through PPP
- Increase Public expenditure to 2.5% of GDP

Primary healthcare

Issues

Coverage: There exists a regional disparity in coverage of PHC network in India. While the average area per sq.km covered by a PHC in Goa is less than 2 sq.km, it is more than 160 in Rajasthan
Human Resource Deficiency: According to Ministry of Health and Family Welfare’s manpower statistics, there are more than 8000 doctor vacancies. Similarly, the female/ANM workforce is short by more than 1000.
Highest out of pocket Expenditure: Medicines are costly and often not available within PHCs which forces patients to go outside and buy medicines at higher cost
Infrastructural Gaps: The Rural Health Survey of 2016 notes that there is a shortfall of 20 to 30% of buildings with regard to PHCs and CHCs. According to the MoHFW, only less than 2% of PHCs meet the Indian Public Health Standards (IPHS) with regard to electricity, sanitation, water supply, diagnostic facility and distribution of drugs.
Lack of Awareness: India’s villages are pulled back by patriarchal, caste and religious ideologies that often neglect healthcare systems. This has impacted the demand of healthcare service
No specialized Care: PHCs are generalist in their service and does not cater to geriatric or palliative healthcare and emergency services. Majority of the mental health centres are urban concentrated.

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Way Forward

Public Expenditure and Private sector participation: The gross infrastructural gaps in PHCs and CHCs can be corrected by increasing public expenditure and exploring systemic strengthening with private sector engagement. Viability gap funding for PHCs in remote areas might be explored
Incentivize Doctors: Doctors can be financially incentivized to serve in rural and remote regions of the country. Medical education system shall be reformed to increase the expertise of doctors via a licentiate exam
Greater recruitment of ASHA workers: A decentralised multi-sectoral health care can only be achieved through leveraging ASHA workers at grass root level to spread awareness among people regarding benefits of primary healthcare and immunization
Decentralized Data Drive Health Delivery System: Better convergence and targeting can be achieved for the work undertaken by AAA workers (ASHA, Anganwadi and ANM) through the usage of micro-data to understand trends and prioritize individuals or households in need of heath care
Mental Health centres in Rural Areas: In the light of farmer suicides and the livelihood crisis that plagues the rural areas, there is a pertinent need to provide mental health care in rural areas. A network of counsellors, psychologists and psychiatrists shall be instituted to deal with the mental problems of the rural population.

Government Interventions

Establishment of Medical Colleges: The government has recently elicited in its budget to transform 24 district hospital to government colleges and hospitals
- Greatly enhance coverage and ease accessibility to PHC services for early diagnosis and treatment
- Strengthening hospital infrastructure and capacity.
- Correct the expertise balance as doctors and nurses as they would be able to specialize without relocation.
Health and Wellness Centres: The government has also outlined in the budget an initiative to establish 1.5 Lakh health and wellness centres across the country to enhance accessibility of PHC to needy citizens
National Mobile Medical Units: To provide doorstep health service delivery
Skill for live Save a Life: Recruitment of ASHA workers to provide decentralized health service and awareness
NHM Free drugs and diagnostics services to correct out of pocket expenses