Challenges to Healthcare in India

 

The Indian healthcare scenario presents a spectrum of contrasting landscapes. At one end of the spectrum are the glitzy steel and glass structures delivering High Tech Medicare to the well-heeled, mostly urban Indian. At the other end are the ramshackle outposts in the remote reaches of the “other India” trying desperately to live up to their identity as health subcenter, waiting to be transformed to shrines of health and wellness, a story which we will wait to see unfold. With the rapid pace of change currently being witnessed, this spectrum is likely to widen further, presenting even more complexity in the future.

While there are many challenges, I present five “A's” for our consideration:

1.Awareness or the lack of it: How aware is the Indian population about important issues regarding their own health? Studies on awareness are many and diverse, but lacunae in awareness appear to cut across the lifespan in our country. 

Why is the level of health awareness low in the Indian population? The answers may lie in low educational status, poor functional literacy, low accent on education within the healthcare system, and low priority for health in the population, among others.

2.Access or the lack of it: Access (to healthcare) is defined by the Oxford dictionary as “The right or opportunity to use or benefit from (healthcare)” Again, when we look beyond the somewhat well-connected urban populations to the urban underprivileged, and to their rural counterparts, the question 

“What is the level of access of our population to healthcare of good quality?” is an extremely relevant one.

As thinkers in the disciplines of community medicine and public health, we must encourage discussion on the determinants of access to healthcare. We should identify and analyze possible barriers to access in the financial, geographic, social, and system-related domains, and do our best to get our students and peers thinking about the problem of access to good quality healthcare.

3.Affordability or the cost of healthcare: Quite simply, how costly is healthcare in India, and more importantly, how many can afford the cost of healthcare?

The public sector offers healthcare at low or no cost but is perceived as being unreliable, of indifferent quality and generally is not the first choice, unless one cannot afford private care

Locally, a consciousness of cost needs to be built into the healthcare sector, from the smallest to the highest level. Wasteful expenditure, options which demand high spending, unnecessary use of tests, and procedures should be avoided. The average medical student is not exposed to issues of cost of care during the course. Exposing young minds to issues of economics of healthcare will hopefully bring in a realization of the enormity of the situation, and the need to address it in whatever way possible.

4.Accountability or the lack of it: Being accountable has been defined as the procedures and processes by which one party justifies and takes responsibility for its activities. 

Communication is a key skill to be inculcated among the young professionals who will be the leaders of the profession tomorrow. As leaders in community medicine and public health, we may be the best placed to put this high up in the list of skills to be imparted. A good communicator is better placed to deal with the pressures of the relationships with client, employer, peer, colleague, family, friend, and government.

The five as presented above present challenges to the health of the public in our glorious country. As we get ready to face a future which is full of possibility and uncertainty in equal measure, let us recognize these and other challenges and prepare to meet them, remembering that the fight against ill health is the fight against all that is harmful to humanity.

MAJOR ISSUES FACED BY THE INDIAN HEALTHCARE SYSTEM

According to my knowledge the major issues faced by the Indian healthcare system are:

• Shortage of doctor - As per WHO report the doctor-density ratio in India is 8 per 10,000 people as against one doctor for a population of 1000. Data by India Spread also conveys the same message.
• Finance - Most of the Indians fail to get themselves treated even after knowing about their illness as they are unable to afford the treatment. About 70% of the medical spending is from the patient’s pockets.
• Poor Public Health Infrastructure - Poor public health infrastructure forces people to approach private hospitals for to seek medical facilities which ultimately push them towards poverty. There is a shortage of PHCs (22%) and sub-health centers (20%), while only 7% sub-health centers and 12% primary health centers meet Indian Public Health Standards (IPHS) norms.
• Insurance - Most of the people do not have insurance as they cannot afford it. Government contribution to insurance stands at roughly 32 percent, as opposed to 83.5 percent in the UK.
• Poor healthcare ranking - India ranks as low as 145th among 195 countries in healthcare quality and accessibility, behind even Bangladesh and Sri Lanka.
• Commercial motive - lack of transparency and unethical practices in the private sector.
• Flop schemes - Government has come up with many schemes. But they have failed to improve the system and make it accessible to people. The NHM’s share in the health budget fell from 73% in 2006 to 50% in 2019 in the absence of uniform and substantial increases in health spending by States.

According to my perspective if the charges in private hospitals are high, the middle class should feel comfortable in shifting to government hospitals. That will encourage the private hospitals to keep the charges reasonable. However the poor quality of government hospitals forces the middle-class to use private hospitals even if they cannot afford it. Moreover this encourages private hospitals to prescribe and impose not so required procedures on patients.