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SANSAD TV: PERSPECTIVE- BOOSTING HEALTH INFRASTRUCTURE

 

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Introduction:

Prime Minister Narendra Modi launched PM Ayushman Bharat Health Infrastructure Mission which will be one of the largest pan-India scheme for strengthening healthcare infrastructure across the country. This mission will have three major aspects with an aim to strengthen the critical healthcare network from village to block to the district to the regional and national level in the next 4-5 years. It will provide support for more than 17000 rural Health and Wellness Centres in 10 High Focus States and establish 11,024 urban Health and Wellness Centres in all the States. Critical care services will be made available in all the districts of the country with more than 5 lakh population, through Exclusive Critical Care Hospital Blocks, while the remaining districts will be covered through referral services. People will also have access to a full range of diagnostic services in the Public Healthcare system through Network of laboratories across the country. It will also work towards building up trained frontline health workforce to respond to any public health emergency. To further analyse this new mission and the need for boosting health infrastructure in the country.

Ayushman Bharat Health Infrastructure Mission:

  • The scheme aims at strengthening healthcare infrastructure across the country.
  • Its objective is to fill gaps in public health infrastructure, especially in critical care facilities and primary care in both urban and rural areas.
  • Through this, critical care services will be available in all the districts of the country with more than five lakh population through exclusive critical care hospital blocks, while the remaining districts will be covered through referral services.
  • People will have access to a full range of diagnostic services in the public healthcare system through a network of laboratories across the country, and integrated public health labs will be set up in all the districts.
  • Integrated public health labs will also be set up in all districts, giving people access to “a full range of diagnostic services” through a network of laboratories across the country.
  • An IT-enabled disease surveillance system will be established through a network of surveillance laboratories at block, district, regional and national levels.
  • All the public health labs will be connected through the Integrated Health Information Portal, which will be expanded to all states and UTs.

Current state of India’s health infrastructure- World Bank data:

  • India had 85.7 physicians per 1,00,000 people in 2017 (in contrast to 98 in Pakistan, 100 in Sri Lanka and 241 in Japan).
  • 53 beds per 1,00,000 people (in contrast to 63 in Pakistan, 79.5 in Bangladesh, 415 in Sri Lanka and 1,298 in Japan).
  • 172.7 nurses and midwives per 1,00,000 people (in contrast to 220 in Sri Lanka, 40 in Bangladesh, 70 in Pakistan, and 1,220 in Japan).
  • India has among the highest out-of-pocket (OOP) expenditures of all countries in the world- 62% of the total health expenditure in India is OOP.

COVID-19 triggered an introspection of India’s Healthcare System:

  • Treatment and Viewing of Healthcare System: The headlines of the tragic loss of lives, the exponential increase in cases, economic morass and social disruptions have emerged a deeper subtext on how the healthcare sector is viewed and treated.
  • Emergence of Reports on Healthcare’s Problem: The pandemic has raised reports on longstanding problem of healthcare workers protesting the shortage of equipment, patients charging doctors and hospitals for profiteering, policy makers issuing edicts against providers and reported cases of hoarding of essential medicines.
  • Increasing lack of interest between stakeholders of the Healthcare System: The growing lack of trust between patients and their doctors and providers and the wider mistrust between policy makers and the industry found fresh ground during the pandemic

Indian healthcare on the cusp of a digital transformation:

  • Healthcare has become one of India’s largest sector, both in terms of revenue and employment.
  • Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment.
  • The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
  • Indian healthcare delivery system is categorised into two major components – public and private.
  • The Government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas.
  • The private sector provides majority of secondary, tertiary, and quaternary care institutions with major concentration in metros and tier I and tier II cities.
  • India’s competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries.
  • The cost of surgery in India is about one-tenth of that in the US or Western Europe. India ranks 145 among 195 countries in terms of quality and accessibility of healthcare.

Reasons and causes for this:

  • Low public health expenditure– 1% of GDP 2013-14 and 1.28% in 2017-18 (including expenditure by the Centre, all States and Union Territories).
  • Centre is the key player in public health management because the main bodies with technical expertise are under central control. The States lack corresponding expert bodies such as the National Centre for Disease Control or the Indian Council of Medical Research.
  • States also differ a great deal in terms of the fiscal space to deal with the novel coronavirus pandemic because of the wide variation in per capita health expenditure.

Inter-State variation in per capita health-care expenditure (between 2010-11 to 2019-20):

  • Kerala and Delhi have been close to the top in all the years.
  • Bihar, Jharkhand and Uttar Pradesh have been consistently towards the bottom of the ranking in all years.
  • Odisha is noteworthy as it had the same per capita health expenditure as Uttar Pradesh in 2010, but now has more than double that of Uttar Pradesh.

Measures needed to strengthen the existing state of Health infrastructure in the country are:

  • There is an immediate need to increase the public spending to 2.5% of GDP, despite that being lower than global average of 5.4%.
  • The achievement of a distress-free and comprehensive wellness system for all hinges on the performance of health and wellness centres as they will be instrumental in reducing the greater burden of out-of-pocket expenditure on health.
  • There is a need to depart from the current trend of erratic and insufficient increases in health spending and make substantial and sustained investments in public health over the next decade.
  • A National Health Regulatory and Development Framework needs to be made for improving the quality (for example registration of health practitioners), performance, equity, efficacy and accountability of healthcare delivery across the country.
  • Increase the Public-Private Partnerships to increase the last-mile reach of healthcare.
  • Generic drugs and Jan Aushadi Kendras should be increased to make medicines affordable and reduce the major component of Out of Pocket Expenditure.
  • The government’s National Innovation Council, which is mandated to provide a platform for collaboration amongst healthcare domain experts, stakeholders and key participants, should encourage a culture of innovation in India and help develop policy on innovations that will focus on an Indian model for inclusive growth.
  • India should take cue from other developing countries like Thailand to work towards providing Universal Health Coverage. UHC includes three components: Population coverage, disease coverage and cost coverage.
  • Leveraging the benefits of Information Technology like computer and mobile-phone based e-health and m-health initiatives to improve quality of healthcare service delivery. Start-ups are investing in healthcare sector from process automation to diagnostics to low-cost innovations. Policy and regulatory support should be provided to make healthcare accessible and affordable.

Conclusion:

India needs a holistic approach to tackle problems in healthcare industry. This includes the active collaboration of all stakeholders’ public, private sectors, and individuals. Amore dynamic and pro-active approach is needed to handle the dual disease burden. A universal access to health makes the nation fit and healthy, aiding better to achieve the demographic dividend.