Modiji, at the Global Ayurveda Festival in Kozhikode in February last year, had said, “India can be a leader in making affordable, holistic health care available to the world.” It is one of those many ‘jumle’ that Modiji has been pleasing Indians for long now; however, given the current scenario, it doesn’t seem to be a possibility, at least in the near future.
While the GDP has witnessed a jump, the disparities between the rich and the poor have grown too. This gap in the economic status of the two has deliberating health and social consequences. Though we can boast of a few achievements including a decline in infant and under-five mortality rates as well as eradication of diseases like polio, guinea worm disease, yaws, and tetanus; communicable and endemic diseases are still troubling the people of the second largest populated country in the world. In addition, non-communicable diseases (NCDS) contribute to 60 percent of overall deaths in country, with cancer, diabetes, and heart and chronic pulmonary diseases causing nearly 80 percent of all NCD-related deaths.
Challenges in front of Indian Healthcare Delivery System
It is difficult to understand why a country like India, which our leaders project as a potential world power, is unable to protect the lives of its own people. Is our healthcare delivery system crippled? At least statistics say so. Let’s have a look:
- India is drastically short of health workforce.
- India has a density of 7 physicians per 10,000 people against the global average of 13.9.
- The country houses 17.1 nurses per 10,000 people against the global average of 28.6 (World Health Statistics, 2015).
- The nurses-to-physicians ratio is around 0.6:1, against 3:1 in some of the developed countries.
- The picture is even worst in rural areas, as most doctors and hospital beds cater to urban population, which is only 20 percent of the India’s population.
Furthermore, the migration of Indian healthcare resources to developed nations or we can say the inability of the Government of India to retain talent, particularly in healthcare, is also costing India heavily. A recent study published in the BioMed Central (BMC) analyzed the migratory causes among Indian health workers. The study reported that low remuneration, poor working conditions and work overload, concern with status of the profession, and lack of opportunities for professional advancement are among the major causes of workforce migration in healthcare.
The Possible Solutions
Jai Prakash Narain, former Director, Communicable Diseases/SDE, WHO/SEARO, in his report, Public Health Challenges in India: Seizing the Opportunities, proposed certain suggestions for treating the ailing healthcare system of India.
Among the major suggestions were included:
- To invest more in health and recognizing disease prevention and health promotion as the topmost priority
- An increase in government health expenditure from 1.3 percent of GDP at present to at least 2.5 percent, by the conclusion of the 13th Five-Year Plan (2013-19).
- Of the total health budget allocation for health, a minimum of 80 percent should be spent on health promotion, disease prevention, and bettering the quality of health services at the primary care level.
- Improving the process of service delivery through three steps:
Assessing existing public health system and facilities
Bringing improvements basis the findings of the assessment including augmented human and material resources
Monitoring their performance and fixing accountability in a systematic manner
- Make all efforts to fill vacant posts through efficient recruitments, and build skill of the existing staff through training activities and by creating enabling environment including adequate facilities for health workers to stay in rural areas
- To enhance skill training activities, health can leverage with and benefit from the national skill development mission launched by the Prime Minister in August 2015.
- Focus should be on strengthening a widespread research and innovation culture throughout the country and generating homegrown data, obtained through surveillance, research, and monitoring and evaluation (M&E).
The Million Dollar Question: Who will bell the cat?
Amid these suggestions, the biggest question would remain who would ensure the efficient implementation of all these recommendations and even the government polices for that matter, most of which would never go beyond the words and the paper. The major loophole, as we believe, is the absence of a specialized system that could professionally handle the process, employing expert resources at each level of operation and maintaining proper coordination across levels, with an efficient mechanism at the apex to monitor the process as a whole.
It is evident that most of the deterrents to a seamless healthcare delivery chain in India lie outside of health sector. Therefore, potent actions need to be taken to overcome these deterrents. In a country with a vibrant civil society, dominating private health sector and an advanced biotechnological and research capacity, making policies is not enough. In fact, programs require a powerful driver to ensure that transparency, integrity and accountability are maintained at all levels.