'Indian public health system in critical care'

India ranks 141 in the list of 190 countries surveyed for total health expenditure per capita. In the context of COVID-19, the domestic health sector needs to introspect and review the vulnerabilities in existing systems. The Rs 69,000 crore allocated for the healthcare sector in the 2020-21 Union Budget is a mere 1 per cent of the total GDP. These funds are grossly insufficient for the health needs of a highly populous country like India.

Hyderabad: Despite the remarkable progress made over the decades in increasing the average life expectancy and reducing maternal and child deaths; there has not been a coordinated effort in other primary aspects of public healthcare in India.

The country is far from meeting international healthcare standards and regulations.

Even at the national level, there is a stark contrast among different states in terms of availability of medical services.

A healthy population is a prerequisite for any nation’s economic development.

This is why many countries allocate a large percentage of their GDP towards construction and improvement of healthcare systems.

India ranks 141 in the list of 190 countries surveyed for total health expenditure per capita. In the context of COVID-19, the domestic health sector needs to introspect and review the vulnerabilities in existing systems.

The Rs 69,000 crore allocated for the healthcare sector in the 2020-21 Union Budget is a mere 1 per cent of the total GDP. These funds are grossly insufficient for the health needs of a highly populous country like India.

Even though the Planning Commission (2011) recommended giving 2.5 per cent of GDP to the health sector, no government has put the proposal for implementation.

In September 2018, Prime Minister Modi launched the Pradhan Mantri Jan Arogya Yojana (PMJAY) also called Ayushman Bharat to provide free access to healthcare for the underprivileged.

Touted to be the largest health scheme in the world, it provides insurance coverage of Rs 5 lakh for the eligible population.

Based on the economic, caste and social census, 40 per cent of the population i.e. 10 crore families or 50 crore people are the beneficiaries of this scheme.

So far, about 72 lakh people have benefited from this scheme. But the scheme provides coverage only for a limited number of diseases.

Though Ayushman Bharat aimed to establish 1.5 lakh healthcare centres by 2022, not even a quarter of this target has been reached yet.

A report released by the National Health Authority (NHA) - the apex body responsible for implementing PMJAY, highlighted the gaps between different states in terms of insurance payments.

The poorest states (Bihar, Madhya Pradesh and Uttar Pradesh) have utilized funds the least whereas Kerala reported the highest number of hospitalizations under this scheme.

Not a single healthcare centre in any of the 115 Aspirational Districts has partnered with Ayushman Bharat. Even private hospitals in these districts are reluctant to join the program.

Except for Maharashtra and Uttarakhand, most states have empanelled private hospitals in developed districts alone. As per the official statistics, the doctor-population ratio in the country is 1:1456 against the World Health Organization (WHO) recommendation of 1:1000.

To improve this ratio, the government announced linking medical colleges to district hospitals.

Currently, there are 526 government medical colleges across the country. In the past 2 years, the number of seats in these colleges has increased from 82,000 to 1,00,000.

There is a rising disparity between state-run and private hospitals. About 58 per cent of hospitals and 29 per cent hospital beds nationwide are in the private sector.

81 per cent of doctors are employed in the private sector. The Center intends to offer postgraduate courses under the National Board of Examination in hospitals with adequate capacity.

There have been attempts to minimize the role of government in education and public health.

There are fewer amenities for training aspirants beyond MBBS in government hospitals. There is a clear shortage of skilled physicians. Corporate hospitals in the country are equipped with the best range of medical equipment.

They take advantage of government incentives. Some private hospitals can afford to get their doctors trained overseas.

Utilizing their services, the National Board of Examination can facilitate the admission of medical students into PG courses.

The harsh reality is that many medical students are being employed as duty doctors and given graduation degrees without providing them with a chance to interact with patients.

The NITI Aayog proposed linking medical colleges with district hospitals in a public-private partnership basis.

Many private medical colleges do not have hospitals large enough to be affiliated.

The policy think tank asked state governments to allot lands at a cheaper rate to private medical colleges to help them set up hospitals.

Some states have opposing views about this proposal. It is highly uncertain if linking private medical colleges with district hospitals can put an end to doctors’ shortage.

There is an infrastructure dearth in priority medicine in the country. India needs Rs 5,38,305 crore for the creation of priority medical services and infrastructure in the next 5 years.

The Union Health Ministry put forth this proposal to the 15th Planning Commission. Yet, there have been no records of generous allocations towards the creation of healthcare infrastructure. Primary healthcare needs to be strengthened.

India is ranked 120th in the list of world’s healthiest countries. Spain and Italy grabbed the first two spots in the list.

It is noteworthy that Italy is also one of the nations that was severely affected by COVID-19.

Among South Asian countries, Sri Lanka (66), Bangladesh (91) and Nepal (110) have fared better than India.

The pandemic has revealed the shortcomings in the existing healthcare systems.

The first systemic flaw came in the form of dearth in virology labs. Founded in 1952, the National Institute of Virology (NIV) is the biggest virology research institute in India.

It is credited with several wonderful types of research on viruses in collaboration with the WHO.

Unfortunately, it is the only organization in the country that comes to the rescue in the event of an epidemic.

The pandemic stressed the need to establish such institutes in every state. In order to prevent fatal delays in diagnosis or treatment, more virology labs must be set up in each corner of the country. Such labs help a great deal in identifying the sources of highly contagious infections.

Especially in COVID-19 times, the NIV extensively studied the nature of coronavirus besides researching the extent of its symptoms and spread.

Crises such as the current COVID-19 continue to destroy livelihoods as long as people condemn the system’s functioning during a public health emergency but otherwise choose to remain complacent. Demonetization and GST have wrecked the domestic pharma industry.

In the present circumstances, the pharma sector needs a major boost in the form of incentives and investments.

China supplies active pharmaceutical ingredients (API) for the majority of drugs. Going by the current scenario, overreliance on China can prove a losing move.

Hence, it is imperative to revitalize the domestic pharmaceutical industry. Public health and national development interrelate with each other.

It is time policymakers do away with quick-reliefs and focus on long term strategies for strengthening the country’s health sector.

A recent National Sample Survey report found that an increasing number of Indians are getting sick due to infections such as malaria, viral hepatitis, dysentery, dengue, chikungunya, chickenpox, measles,

encephalitis, filariasis, typhoid and tuberculosis than from other ailments. The government must allocate large amounts as funds to address these issues.

If common infections alone need significant funds and resources, how prepared should our healthcare systems be to tackle a pandemic like corona?

Governments need to recognize the importance of massive fund allocations in order to build crucial infrastructure and reform the public health sector.