Healthcare in India has made great progress, but challenges remain

Source: The post is based on the article “Healthcare in India has made great progress, but challenges remain” published in The Indian Express on 29^th March 2023.

Syllabus: GS 2 – Issues Related to Healthcare

Relevance: challenges with healthcare

News: The article discusses the progress made in healthcare and associated challenges.

What are some of the progresses made in healthcare?

It was believed that India would achieve a total fertility rate of 2.1 only by 2041.

However, as per the recent National Family Health Survey (NFHS-5), India achieved it by 2020 and hospital deliveries even in the backward states have increased to 89 percent. However, challenges in healthcare still remain.

What are the challenges with healthcare in India?

Diseases: Cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs) and diabetes are prevalent. These are caused by an unhealthy diet, lack of physical activity and use of tobacco and alcohol.

As per a report, the proportion of deaths due to non-communicable diseases (NCDs) has increased from around 38 percent in 1990 to 62 percent in 2016.

Obesity has increased from 19 per cent to 23 per cent between NFHS-4 and NFHS-5. This increases the risk of diabetes, hypertension, and CVD.

Infrastructure: The government is building primary healthcare by establishing health and wellness centres. However, as per a recent report, there is a huge variation between states.

For example, some states like Mizoram and Gujarat had better healthcare arrangements in their health centres while the situation was grim in Jharkhand and Uttar Pradesh.

Urban areas: The challenge in the urban areas lies in bridging the gap in hospital services between large urban agglomerations and tier II and tier III cities.

As per a Lancet report, the provision of core health services is not uniform across state-run district hospitals. 

For example, while only 16 percent of the district hospitals in Tamil Nadu offered all key services, it was just 1 per cent in Mizoram and UP.

Private hospitals: Private hospitals own two-thirds of the country’s hospital beds.

Large hospital like Apollo, Fortis, Max, account for just 4-5 percent of the beds while standalone hospitals and nursing homes provide 95 percent of private hospital beds. 

However, standalone hospitals and nursing homes are unable to provide multi-specialty, leave alone tertiary and quaternary care.

Therefore, there is a need to bridge the gap between services available in the metros and big cities and in districts. This can be done by making the centrally-run hospital and the district hospitals fully functional.

Health Insurance: Schemes such as the Ayushman Bharat, the Employees State Insurance (ESIC), and CGHS have covered nearly 74 percent of Indians.

However, millions remain uninsured. Out-patient doctor consultation costs, diagnostics, and drugs account for the 50 percent of out-of-pocket (OOP) personal expenditure.  

It is, therefore, essential to provide insurance for the unorganised middle class and to include identified out-patient costs.

Artificial Intelligence (AI) and digital technology: These would bring revolution in healthcare. However, ethical and regulatory concerns remain.

Due to this, Indian Council of Medical Research released guidelines for the lack of accountability for machine-made medical decisions. However, regulations are also needed for substandard institutions and for unqualified medical practitioners.