Health for all remains a distant dream . . . . By Nidhi Saxena
Most Indians, who pride themselves on being part of the world’s largest democracy, miss a heartbeat when they read about India’s grossly inadequate healthcare infrastructure. Not enough hospital beds (less than nine for 10,000 patients). Not enough doctors (just seven per 10,000 patients). Not enough medicines. Not enough preventive healthcare and equally inadequate post hospitalisation home healthcare.
And reading about mothers giving birth to babies by the roadside, patients being turned away by hospitals and cases of victims blinded after botched up eye surgeries can be plain depressing.
Agreed, India has needed to prioritise its welfare and social sector deliverables in the last many decades. Food and Education took priority over healthcare. Basic services like water, sanitation and sewage systems at best remained patchy barring some larger towns. Village ponds continue to serve drinking, washing and bathing water needs of humans and their livestock.
Access to government funded primary healthcare centres and hospitals for succour to the poor in the far flung places often proved to be woefully inadequate. Private doctors provided bulk of the primary healthcare needs of those who could afford it.
Some of the recent government announcements related to healthcare — several new All India Institutes of Medical Sciences, more centres of excellence in healthcare, installation of dialysis units at district hospitals in a PPP mode, lower customs, excise duty for dialysis equipment, removal of VAT on mammography machines and consumables in Maharashtra, on the spot examination for breast cancer for women visiting the gynaecology and dental OPDs at the government hospitals in Punjab, 10,000 more hospital beds in Delhi, Jan Aushdhi stores for free — are both encouraging and worthy.
However, a question I ask myself, like many other Indians, is this enough? How many more layers of band aids do we need to fix an already under provided healthcare system for the needy, under privileged and underserved — and we have 400 million of them. The public healthcare system is clearly underprovided. Ironically instead of growing, healthcare expenditure has dropped from 4.5 percent of the GDP in 2004-05 to 4 percent in 2015. And only 1 percent is contributed by the public sector, among the lowest globally.
Reports suggest that the bulk of the healthcare budgets go towards salaries of doctors and staff. Budget heads for capex, consumables, running and maintenance expenses for expensive equipment and training that work out of silos lead to situations where the equipment is underutilized as patients continue to cry for medical facilities.
Healthcare needs a bigger mindshare of the healthcare planners. India needs to re-define its vision for healthcare. The plan must also focus on fixing issues of providing clean safe water. In our zest to build toilets as part of Swacchh Bharat campaign it’s essential not to forget that we also need a a robust sewage system that works and is built to last.
My limited experience in building a technology-based clinical research organisation and now building a technology-led home healthcare business tells me that scaling up must rest its foundations on the following five pillars:
Capacity Building: There is need to focus on capacity building: preparing enough doctors, technicians, paramedics, nursing staff that we need not today but in 2025. The process of preparing fresh medical graduates and specialists takes a minimum of 5-10 years — an area that needs activation and acceleration push right away.
Healthcare Infrastructure: We need to modernise and build adequate healthcare infrastructure at the district level by funding it adequately. Seventy per cent of India still lives in rural areas with limited access to hospitals and clinics. And seventy per cent of healthcare expenditure in India is out of pocket (with insurance still not penetrated enough). Obviously once the modern facilities are in place the government needs to staff them with trained doctors, specialists, paramedical and nursing staff. What will make the difference is creating a well-run hospital system by focusing on building a motivated, committed system that delivers with empathy and care.
Technology Induction: Any plan to revamp the healthcare must rely on appropriate induction of technology. From equipment that is at the cutting edge of technology, to use of Information Technology for Lab Tests, X-Rays and CAT Scans to Dialysis machines to Surgical Robots, the hospitals must have all of them. This will allow premier healthcare institutions to focus on research and offer consultation and mentoring to doctors in district hospitals seamlessly. Today, wireless technology, electronic health records, wearable sensors make it possible to remotely deliver healthcare and these must be part of the infrastructure push.
Innovation and Entrepreneurship: Start ups in the healthcare and wellness space with problem solving solutions can help in providing accessible healthcare. There have been significant PE investments in the healthcare start up space, giving birth to innovative delivery models. But equally, there should be more PPPs and policies that should give impetus to start ups in the healthcare ecosystem.
Home Healthcare: Fast paced work environment leading to work-life imbalance is throwing up newer health challenges. India’s aging population is not doing any good by throwing up increasing incidence of Cancer, Alzheimer’s, Parkinson’s, Stroke and Cardiac issues. It is time for families to brace up for long life-spans of elders and parents. Caregivers, especially in nuclear and single child families, could face challenges that no one has imagined.
We need to build reliable home healthcare infrastructure, anticipate the need for growing need for old age homes as also focus on building a cadre of doctors specialising in geriatrics. The government needs to set its eyes on building an integrated plan which completely transforms healthcare system and one that works for an average citizen.