World Health Day: Structural problems in Indian healthcare system

Healthcare is considered to be an important benchmark for development index for any country. Unfortunately, even after 70 years of independence, affordable quality healthcare facilities for the common Indians are still a myth. It doesn’t imply that technological advancement in India in healthcare is not up to the mark; rather there a sharp contrast in mass healthcare as affordability has become a serious issue. Rural population of India, which comprises of 70% of the total population, is still deprived of the latest innovations and technologies in healthcare.

Be it the ever increasing supply-demand gap, low insurance penetration or costly treatment of terminal diseases - there is an urgent need to relook the healthcare sector at present. The proposals of National Health Policy under Ayushman Bharat announced in Union Budget 2018 definitely look to be promising from a bigger perspective. Although the budget has allocated Rs 1200 crore for a major overhaul, still there is amid food for thought. The lack of skilled health personnel in both urban and rural sector is a critical issue in India including front line health workers, mid level care providers and allied health professionals. No doubt, PPP model can be a good alternative to existing system. Side by side, strategic purchasing along with maintaining standard management guidelines, negotiating costs and consistent monitoring of Healthcare service provided can definitely change the scenario.

According to Mr Nageswaran C K , Facility Director , Fortis Malar Hospital, Chennai ,” The existing healthcare infrastructure is just not enough to meet the needs of the population. There is no enough supply of operating beds –, especially in smaller towns. In smaller towns doctors and the patient ratio is low. Lack of trained nurses and primary health centers is also one of the basic problems in Indian healthcare infrastructure and tertiary health centers are mainly in large cities. The Medico-legal issues still plague the doctors. There are also high import duties for high-end medical equipment and consumables making the investment very high and there is a lack of infrastructure for end-of- life care. There is no subsidy on land, power, and other inputs for private hospitals – but the tremendous pressure to keep prices low. Anyhow, the primary need is to strengthen the infrastructure in smaller towns and rural areas. The government should also encourage and incentivize the doctors to work in rural areas.

According to Dr. Usha Manjunath, Director IIHMR,”National Health Protection Mission is a positive step, but implementation is tough and time lines for positive impact are difficult to be predicted. With increasing use of high end technology in everyday practice is further pushing the healthcare costs up. Essential medical drugs and technologies is another key aspect of healthcare infrastructure. Success of Jan Aushadhi in some areas needs to be replicated across the nation. Price regulation of medical products and drugs continue to be taken up. Health Information System, data quality, accuracy, completeness, security and integration issues still need to be addressed. We have a long way to go in using HIS for evidence based public health programmes, measuring of outputs/outcomes, EMR and Clinical Information Systems. A lacuna in Leadership from political to organizational levels across public and private health sector is hindering all aspects of health system functioning in the country. “In India, barring the Centers of Excellence, both in the Central and State level, most other government hospitals lag behind private ones. In terms of service to the community, government hospitals are overcrowded and maintenance of infrastructure of facilities and hygiene is poor. Comparatively, decision making for purchase, maintenance and utilization of medical equipment is much better in private hospitals. Recruitment of medical personnel is specialty care is difficult in government hospitals especially in smaller towns and remote areas.. Implementation of regulatory mechanisms and quality control is highly variable in most hospitals. Thus a far sighted approach with regard to basic healthcare infrastructure can definitely bridge the gap between urban and rural spheres and definitely help India in affordable quality healthcare, which can pave a new path in medical tourism too.