The ongoing pandemic has given us a unique opportunity to transform India’s health system, which needs to be prioritised and escalated through infrastructure, investment and man- power. By undertaking radical reforms, India will not only be able to save lives and protect house- holds slipping into poverty due to catastrophic illnesses but also significantly boost economic growth.
The Indian healthcare story has achieved notable successes. We are the pharmacy of the world; doctors and nurses from India have excelled and distinguished themselves across the US and Europe; private hospitals provide health- care to almost 70% of India and have been a key driver of medical tourism.
Yet, the Indian healthcare system suffers from major weaknesses. The government (Centre and states together) spends a mere 1.13% of GDP on health. Almost 62% of healthcare spending is met through out-of-pocket expenditure by house- holds. And as much as 98% of healthcare facilities in India are provided by those who employ fewer than 10 people. This has led to a highly complex and fragmented delivery of health services.
Individual health records are all manual and with such a large number of individual transactions, there are huge challenges of market failures and governance.
What does India need to do to create a vibrant, dynamic and progressive 21st century health system?
First, it’s been observed that countries with strong primary healthcare systems have better health outcomes, lower inequalities and much lower costs of care. We need to strengthen primary healthcare in India. The creation of 1,50,000 health and wellness centres by 2022 by transforming existing sub-centres and primary health centres under the Ayushman Bharat Scheme is a major move in this direction.
Currently, the primary healthcare service is largely focussed on hospital based curative services, which fail to provide a continuum of care. The healthcare system is fragmented with focus on disease-centric programmes rather than integration of programmes. We need to design integrated and comprehensive ways of delivering primary healthcare. This is the critical paradigm shift that India needs. There’s also a need to strengthen district and subdistrict hospitals to provide high quality referral cases.
Second, there’s endemic shortage of qualified doctors across the country, especially in rural areas. India’s current doctor population ratio of 0.7:1000 is significantly lower than the global average of 1.72:1000 and the WHO norms of 1:1000. It’s imperative to address this imbalance urgently on account of the crisis precipitated by COVID-19.
At the core of this is augmenting the number of medical seats in the country. Current norms for undergraduate and PG faculty for PG courses must be radically relaxed. We also need to rationalise the high capital costs required for land, building equipment for establishment of medical colleges. The cost of producing a doctor is the highest in India and currently, over Rs 250 crore capital expenditure is required for establishing a 150 seat college. This is just too high and existing norms need to be modified.
Third, we need widespread opening of medical schools across districts throughout the country. This will provide an opportunity to local students to acquire medical education within their district and state, thereby encouraging them to continue in their district serving the needs of the local population. There are 22 times more engineers than doctors in India. As a result, self-styled doctors without formal training provide up to 75% of primary care visits.
We need widespread opening of medical schools across districts throughout the country. This will provide an opportunity to local students to acquire medical education within their district and state, thereby encouraging them to continue in their district serving the needs of the local population.
Fourth, there’s been a major surge in non- communicable diseases. There’s also an increas- ing demand for mental health and palliative care services. A vast segment of our population goes below the poverty line on account of these diseases. Fifth, we need to undertake reskilling of human resources and utilise them fully. For instance, nurses in the UK, Thailand and African countries are increasingly taking doctors’ role at the primary level. There have been commend- able examples, such as Chhattisgarh’s three-year community medical course. India also needs to develop bridge courses for dental and Ayush doctors and utilise them as community doctors. The measures initiated by the government for reforming the Medical Council of India need to be extended to the Dental and Nursing Council of India.
Sixth, substantial funding has to be earmarked for health research, with focus on developing novel diagnostics, drug molecules, therapies, morbidities and surveillance for diseases. We must create an enabling environment so that products are designed, developed, validated and technologies converted into products. A good example is the dengue ELISA test and the COVID- 19 ELISA tests developed by ICMR.
Lastly, we need to harness the power of digital health as a critical enabler for transforming the health system. India must use technology to leapfrog and become a model for digital health adoption. This would require a unique identity for patients and putting order into patient flows, doctor workflows, care plans, medication and diagnostic results, all of which generate data. A national health stack will facilitate collection of comprehensive healthcare data across the country. This will enable everyone in the health sector to be linked digitally. Data produced can provide valuable information, which can be analysed to improve the health system. This will fuel mobile technologies, telemedicine application, use of AI and cloud-based solutions.
India’s health sector can emerge as its biggest driver of growth and employment in pharmaceuticals, bio-pharma, hospitals, doctors, nurses and medical equipment. It has a huge multiplier impact on the economy and on the lives of its citizens. For this, it needs key policy reforms with a major emphasis on primary healthcare
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