Degrading status of India Public Health System

Context

• India’s public health-care sector has been ailing for decades.
• According to the latest Global Burden of Disease Study, India has the 154th rank, much below China, Sri Lanka and Bangladesh.

What is Public Health Care System?

• Public health Care systems are commonly defined as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction.”
• This concept ensures that all entities’ contributions to the health and well-being of the community or state are recognized in assessing the provision of public health services.

What are the dimensions of Public Health Care system?

• Public health agencies at state and local levels
• Healthcare providers
• Public safety agencies
• Human service and charity organizations
• Education and youth development organizations
• Recreation and arts-related organizations
• Economic and philanthropic organizations
• Environmental agencies and organization.

Proof of degrading Indian Healthcare system

• India’s total healthcare expenditure is 1% of its GDP(1.2% public expenditure) which is one of the lowest in the world.
• Doctor patient ratio is meager 1:1661
• India’s per capita gross national income (on PPP basis) in 2012 was $3910, life expectancy 65(2011), Infant Mortality Rate (IMR) 47(2011), immunization coverage 72% (2011), whereas for Bangladesh, it is $2030, 69, 37, 96% respectively.
• Life expectancy at birth has risen to 65 years from 32 years in 1950.
• IMR has come down from 129 deaths in 1971 to 42 in 2012. Small Pox, Guinea worm and Poliohave been eradicated.

What are the major concerns?

• Abysmally low spending on Public Health – meagre 1.2% against WHO recommendations of 5% public spending on Health.
• Neglect of health care institutions at lower strata i.e. PHCs.
• The focus has been on building AIIMs like institutions at all India level but PHCs and CHCsdon’t get much attention.
• Poor infrastructureand inadequate human resource at all levels in hospitals.
• Doctor patient ratio is meager 1:1661, and at lower levels, the necessary equipment are not available, even the buildings are not in a proper condition.
• That is why people often go to public hospitals only for the smaller diseases, and not for the grave ones in which they have to get admitted in hospitals.
• The focus of policymakers has been to address the demand-side issues rather than the supply-side inefficiencies.
• This is evidenced by the focus on improving hygiene and environmental concerns to prevent the spread of ailments and diseases.
• Governance deficit and regulatory capturearise due to myriad laws and regulations which impede the normal development of this sector.
• Many alternative healthcare practicesexist and have been serving people since ages but it has not got adequate attention of the government since long.
• Disparity in rural-urban areas. IMR is 46/1000 in rural areas whereas it is 28/1000 in urban India.
• The inefficiency in the sector also creeps up with the widespread corruptionthat ails both the public and the private sector.
• Privatesector is also not efficient enough. Many of them indulge in malpractices by selling substandard and even counterfeit medicines, prescribing unnecessary drugs and tests, receiving commissions for referrals, requiring unnecessary hospital admissions and manipulating the length of stay.

What are the solutions?

• Top priority should be given to primary health care services, includingearly management of health problems and better quality of care.
• Strengthening primary health care delivery by ensuring the basics such as universal immunization can greatly reduce morbidity and lower the costs of curative care.
• It will lower the burden of higher strata of hospitals where the cost of treatment is high.
• India requires an integrated action on health care to make it universally accessible and affordable at the same time.
• This will also have a positive impact on poverty and growth.
• Recognizing the massive need for expanding the reach of health care services, the government needs to evolve new and innovative ways of engaging the private sectorespecially in the provision of tertiary care.
• A National Health Regulatory and Development Frameworkneeds to be made for improving the quality (for example registration of health practitioners), performance, equity, efficacy and accountability of the health care delivery across the country.
• It should put out standard treatment guidelinesfor public and private providers, frame a patients’ charter of rights, engage with professional associations and civil society, and establish a regular audit system.
• India needs to increase its expenditure on health sectoras a percent of GDP (1.2% now), with active participation of state governments who bear close to two-third of public expenditure on health sector.
• Focus needs to be on preventive health measureand successful implementation of
• The potential of alternative health care should be recognized and there should be more focus on research in these areas.
• Efforts should be put towards successful implementation of government schemes related to health sector.

What are the expenditure on Public health care in India?

• Though ‘health’ is a State subject, States have been reducing their health-care spending efforts in relation to total government spending.
• The gravity of the situation is understood better when we juxtapose this with the 25-30% increase in the State’s population during the same period.
• These statistics show that health has never been a political priority.
• The patterns of public expenditure on health show that the provisioning of curative care through hospitals received disproportionate policy significance.
• Ignoring overwhelming evidence that it is preventive health care and public health actions that have brought down periodic episodes of infectious disease outbreaks or epidemics.
• Scientific discoveries, technological improvements and government efforts to improve sanitation and hygiene have successfully controlled infectious diseases globally.
• The government’s lack of understanding of the importance of public health has been the reason behind it.

What is the history of Indian Health Care System?

• India’s Ministry of Health was established with independence from Britain in 1947.
• The government has made health a priority in its series of five-year plans, each of which determines state spending priorities for the coming five years.
• Article 47under part IV (DPSP) states that “Duty of the State to raise the level of nutrition and the standard of living and to improve public health”.
• Health is a state subjectunder 7th schedule of the constitution.
• The National Health Policy was endorsed by Parliament in 1983. The policy aimed at universal health care coverage by 2000, and the program was updated in 2002.

Government initiatives on Health care system

• The health care system in India is primarily administered by the states.
• India’s Constitution tasks each state with providing health care for its people.
• In order to address lack of medical coverage in rural areas, the national government launched the National Rural Health Mission in 2005.
• This mission focuses resources on rural areas and poor states which have weak health services in the hope of improving health care in India’s poorest regions.
• India has a vast health care system, but there remain many differences in quality between rural and urban areas as well as between public and private health care.
• India is also a popular destination for medical tourists, given the relatively low costs and high quality of its private hospitals.

What is the Indian three tier health care structure?

• The foundation of the government’s healthcare system rests on a three tier structure.
• Health sub-centers in villages act as the first point of contact and take care of essential health needs, including treatment of minor ailments, family planning, nutrition, immunization and diarrheal control.
• The second tier consists of primary health centers, which serves as a referral unit for sub-centers and provide integrated promotive, preventive and curative health care.
• The third tier is made up of community health centers, 30 bed hospitals that serve as a referral unit for primary health centers.
• In addition, around 8000 hospitals function as the secondary tier for health care for the rural population and as the primary tier for the urban population.

What are the issues with private sector healthcare system?

• The private sectorin health is highly fragmented.
• At one end there are private health practitioners with little medical knowledge or formal training.
• At other end there are top rated private hospitals that cater to both Indian and foreigners who can afford to pay for often expensive care.
• Between these two extremes, other private providers range from small private clinics to hospitals, some for-profit entities and some not-for-profit.

What are the required recommendations?

• The lack of awareness and monitoring of diseases as well as the steps needed to eradicate them pose a serious challenge to the health-care problem.
• The success of polio eradication in the country provides a case in point.
• It was the result of incessant awareness campaigns and active participation of all stakeholders from healthcare providers to the beneficiaries, supplemented by strict monitoring by the government.
• This kind of holistic approach is required for tackling the large number of diseases that still exist in India and are proliferating among its vulnerable population.
• India remains one of the few countries where both communicable and non-communicable diseases are so largely prevalent.
• The changing disease patterns pose another serious challenge to the health-care sector and finding innovative drugs that can cure a large number of diseases should remain a priority.
• State governments should also draw up blueprints for universal health coverage and begin experimenting and innovating with pilot programmes.
• Learning by doing is the only way forward to paving the way for a healthy India.
• Strong political commitment and effective stewardship are needed if India has to solve the existing, and yet to come, health sector problems.