[Answered] Why does Healthcare elude India? What reforms are needed in Healthcare before India can have a fundamental Right to Health for all Citizens?

Health care is providing services for promoting, maintaining, monitoring or restoring health. Health care is not only important to the well-being of citizens; it also enhances the productive capacity of its population thereby enhancing economic growth of the country.

Its importance is acknowledged in Article 47 under DPSP -Duty of the State to raise the level of nutrition and the standard of living and to improve public health.

Reasons behind health care deficits in India:

    • Inadequate health-care infrastructure – latest KPMG report, around 80 per cent of all doctors and 75 per cent of dispensaries serve 28 per cent of the population.
    • Lack of adequate focus on preventive health care – Though efforts are being put to improve hygiene and environmental concerns to prevent the spread of diseases, they are yet to match the demand. Hygiene plays an important role in limiting the spread of communicable diseases whereas lifestyle plays a role in non-communicable diseases. Though awareness is being improved much needs to be done.
    • Dismal health-care expenditure – low at 4.1 per cent of GDP. The way these funds are disbursed to the States and utilized adds to the problem, considerable delay in disbursal of funds for utilisation in critical government schemes rendering them ineffective.
    • Governance deficit – widespread corruption that ails both the public and the private sector.
  • Lack of awareness and monitoring of diseases – Holistic approach as followed for polio eradication- awareness campaigns and active participation of all stakeholders from healthcare providers to the beneficiaries, supplemented by strict monitoring by the government need to be followed for other proliferating diseases.
  • High out of pocket expenditure – 69% of total health expenditure which is thrice the global average
  • Inadequate primary health care
  • Poor Doctor- patient, nurse- patient ratio
  • Proliferation of sub standard medical colleges

Reforms needed:

  • Universal primary health care so that providing health as a ‘right’.
  • Increase spending on health to 2.5-3% of GDP ( Presently the govt spending is just 1- 1.15% which compares poorly even with Sub Saharan countries)
  • Build trust in public health care and effective regulation & monitoring of private health care
  • Address supply-side inefficiencies– like improving the availability of health care professionals, increasing funding and infrastructure – Create centralized system for procurement of drugs and distributing them through states.
  • Develop a holistic system health care where all systems of medicines can be appropriately used
  • Learn from international best practices as UK’s National health service (NHS) model.
  • Reforms in MCI can go a long way in addressing the deficiencies in the medical education system

Moving from delivery of health care services through govt schemes like NHM, Pradhan Mantri Swasthiya Bhima Yojana, Universal health insurance scheme etc to making health care a fundamental right needs change in the way we look at public health as national priority. It requires restructuring the working of public health care along with putting in place systems for health reporting, financing and the way these finances are spend. A robust & vibrant public private partnership would help in building an affordable, accessible and effective health care system.

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