How surgical care in India is a neglected part of public health

Source: This post has been created based on the article “How surgical care in India is a neglected part of public health” published in “The Hindu” on 9^th January 2024.

UPSC Syllabus Topic: GS Paper 2 Social Justice – Issues relating to Health

News: The article discusses the issues with surgical care in India. It also highlights the reasons for a lack of access to surgery.

What are the issues with surgical care in India?

1. Lack of Access: Like most low-and middle-income countries, India lacks access to surgical care. More than 90% of rural Indians are estimated to not have access to surgery when required.
2. Neglect in Health Policymaking and Planning: Lack of access, preventable disease burden due to surgery, and the economic toll of surgery on society are still not considered a part of mainstream public health.
   It has received little attention in the recent National Health Policy 2017.
3. No NSOAP: Since the publication of LCoGS, many countries initiated National Surgical Obstetric Anaesthesia Plans (NSOAPs) or equivalent policies. India presently has no NSOAP.
4. Lack of Investments: Lack of investments in data for monitoring and evaluation of surgical care indicators has also been a major roadblock.

How is surgical care undertaken in India?

India’s current surgical system is based on civilian initiatives and subnational programmes — including countless surgeon-led small private establishments and government district hospitals.

What do LCoGS indicators state about the situation of surgical care in India?

Low number of surgeries: In 2019-2020, India recorded more than 14 million minor surgeries (surgeries which do not require general or spinal anaesthesia). According to the Lancet Commission on Global Surgery (LCoGS), this is much less than the actual requirement of surgeries.

Low rate of surgeries: It is somewhere between 166 and 3,646 surgeries per 1,00,000, depending on the setting, population, and other factors. For New Zealand, this figure is 5,000 surgeries per 1,00,000 people.

What are the reasons for a lack of access to surgery?

India’s limited data on LCoGS indicators reveals several reasons for this:

First, the inability to reach the hospital on time. This is due to a lack of facilities, poor road network, and lack of vehicles. These problems are more common in rural and hilly areas (with more than 2-3^rd of the population).

Second, lack of necessary resources for treatment. For instance, a surgeon, an anaesthetist, and some other clinical staff are essential to perform surgery. The size of this trained manpower workforce is small in several parts of India.

Third, disparities based on location, incomes, etc.

Fourth, issues over the quality of surgical care. This quality depends on the training of the surgeons, the availability of necessary equipment, etc.

Fifth, the financial burden on people who are forced to seek care in private hospitals. This is due to the absence of universal healthcare coverage and limited surgical care in public health facilities.

Question for practice:

What are the reasons for a lack of access to surgery in India? What steps can be undertaken to improve this sector of India’s healthcare?