Mains 2016: India’s Healthcare – Challenges and Solution

Under performance of the health sector:

1. Abysmally low spending on Public Health – meagre 1.2% against WHO recommendations of 5% public spending on Health.
2. 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 CHCs don’t get much attention.
3. Poor infrastructure and inadequate human resource at all levels in hospitals. Doctor patient ratio is meager 1:1661, and at lower levels, the necessary equipments 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!
4. 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.
5. Governance deficit and regulatory capture arise due to myriad laws and regulations which impede the normal development of this sector.
6. Many alternative healthcare practices exist and have been serving people since ages but it has not got adequate attention of the government since long.
7. Disparity in rural-urban areas. IMR is 46/1000 in rural areas whereas it is 28/1000 in urban India.
8. The inefficiency in the sector also creeps up with the widespread corruption that ails both the public and the private sector.
9. Private sector 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.
   

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Solutions:

1. Top priority should be given to primary health care services, including early 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.
2. 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.
3. 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 sector especially in the provision of tertiary care.
4. A National Health Regulatory and Development Framework needs 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 guidelines for public and private providers, frame a patients’ charter of rights, engage with professional associations and civil society, and establish a regular audit system.
5. India needs to increase its expenditure on health sector as 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.
   • Japan’s rapid growth since the second decade of the 20th century can be understood in light of the higher investment in health and education after the Meiji restoration.
   • Comparing India’s and China’s growth rates, Amartya Sen argues that the main reason for the latter’s explosive growth cannot be attributed to the nature of its government, but to its higher investment in health and education.
6. Focus needs to be on preventive health measure and successful implementation of immunization.
7. The potential of alternative health care should be recognized and there should be more focus on research in these areas.
8. Efforts should be put towards successful implementation of government schemes related to health sector.
   

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Conclusion:

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.

References:

This Article is a part of ForumIAS Mains 2016 Initiative. For a list of all articles that will be published on ForumIAS Portal for Mains visit https://forumias.com/portal/mains2016