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 28th March 2023.

Syllabus: GS2- Issues related to development and management of health

News- The article deals with challenges faced by the healthcare sector in India.

What are the achievements of India in healthcare?

In 2007, it was estimated that India would achieve a total fertility rate of 2.1 only by 2041. India has achieved this by 2020.

High maternal and infant mortality seemed very difficult to overcome in 2010. Ten years later, the latest NFHS-5 findings show that in BIMARU states, hospital deliveries have soared to 89 per cent.

What are the challenges faced by the healthcare sector in India?

Non-communicable diseases – Cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are increasing. They all share four behavioural risk factors — an unhealthy diet, lack of physical activity and use of tobacco and alcohol.

‘India: Health of the nation’s states’ report estimated that the proportion of deaths due to non-communicable diseases has increased from around 38% in 1990 to 62% in 2016.

Obesity has increased from 19% to 23% between NFHS-4 and NFHS-5. Among Delhi’s citizens, 38 per cent were found to be obese, followed by Tamil Nadu and Kerala. This increases the risk of diabetes, hypertension, and CVD.

Inequalities in the state of infrastructure– Since 2018, governments at the Centre as well as the state are establishing health and wellness centres. But a 2022 report by the Centre for Community Medicine in AIIMS found huge variations between states.

Some northeastern states like Mizoram, Arunachal Pradesh and Nagaland were found to have better arrangements. The lowest proportions of primary health facilities were in Jharkhand, Karnataka and Uttar Pradesh.

Inequalities– In urban areas, the challenge is to bridge the gap in hospital services between large urban agglomerations and tier II and tier III cities.

A recent Lancet publication found that core health services are not uniform across state-run district hospitals. Just 16% of the district hospitals in Tamil Nadu offered all key services. In some states, it was just 1%. People have to bank on the private sector.

Large hospital chains like Apollo, Fortis  account for just 4-5% of the beds in the private sector. Standalone hospitals and nursing homes provide 95% of private hospital beds. They are unable to provide multi-specialty, tertiary and quaternary care.

Insurance and high expenditure on health– The other problems centre around low health insurance penetration and the very high personal outgo on healthcare. From 2018, the Ayushman Bharat insurance scheme for 10 crore poor families has been undertaken. Nearly 74% of Indians are either covered or eligible for health insurance coverage.

However, millions remain uninsured. Out-patient doctor consultation costs, diagnostics, and drugs account for around 50% of the total health expenditure.

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

Use of Artificial Intelligence and digital technology– Use of AI for healthcare is welcome. But there are ethical and regulatory concerns related to it. A new dimension has made the regulation of healthcare even more compelling.