Checks & Balances: The pandemic experience has put the focus on India’s healthcare infrastructure, especially in rural areas. In the online discussion moderated by Sweta Ranjan, experts discuss the sector’s challenges and solutions
GN Bureau | June 11, 2022
Two years ago, little did we know that the pandemic will bring out the real state of the health infrastructure in the country. The entire healthcare infrastructure across the globe took a major hit, and India was no exception to it. Challenges were high and despite initial hiccups, the healthcare system in India managed to withstand the pandemic.
For India, despite a heavy loss of lives, one good thing that happened was the country learnt to prioritise the healthcare ecosystem. Both the government and the private players made several changes in the overall healthcare sector to create a stronger healthcare ecosystem. The nation is keen on strengthening and prioritising the government’s role in the overall shaping of the health systems, spanning investments, organisation of services and service delivery, cross-sectoral actions, technology, human resources, and more.
KPMG, in its recent report titled '15 top priorities for transforming Indian healthcare: The 2024 agenda', has identified the most necessary action points for transforming and strengthening Indian healthcare.
KPMG says, “Certain national priority areas should be identified to pave the way for the transformation of the healthcare industry. To plan for the overall strengthening of the Indian healthcare system, the government, as well as the private players, need to kick-start their journey and ensure that necessary steps are taken at the right time. This point of view highlights key action points for the Indian healthcare system as the need of the hour to prepare us for the transformation about to happen in the coming decade.”
The top 15 priorities for transforming Indian healthcare and achieving the 2024 agenda include: expanding financing for 'Healthy India'; promoting 'Healthy India' as a mass movement; launching a Healthcare Sector Promotion Programme; ensuring health coverage for all; strengthening the primary care system; redefining and reviving public-private partnerships; driving Ayushman Bharat Digital Mission (ABDM) till the last mile; 'National Health App' for aggregating healthcare services across the value chain; 'National Task Force' for healthcare workforce development; building a 'National Medical Network'; developing 'National Health Quality Index' and transparency system; strengthening Medical hubs/Medicities across India; stepping up the national surveillance system; utilising Telemedicine, Virtual care, and Metaverse; and decarbonising the healthcare system.
The latest edition of ‘Checks and Balances’, an online discussion hosted by Sweta Ranjan in which experts debate governance issues, takes up the question of the Indian healthcare ecosystem: lacunae and measures to strengthen it.
Watch the episode here:
Cardiothoracic surgeon Dr Surpreet Chopra, chairperson, SC Heart Foundation, a charitable organisation that functions in the Health sector, says that the disconnect between urban and rural healthcare is a matter of worry. She cites data to make her point, “India's population is 140 crore and 65-70 percent population belongs to the rural area. You will be surprised to know that out of total existing hospitals in the country 20 percent of hospitals cater to the rural areas. Out of the total hospital beds in the country only 10 percent are available in the rural sector. There is an acute shortage of doctors, healthcare workers, and staff. Primary health centres (PHCs) don't have basic facilities of blood testing. In recent times we have seen many rules have been changed to strengthen the system. Be it oxygen plants, medicines availability, or availability of doctors, things are changing. Retired doctors have been called back to join the workforce. But a lot more needs to be done.”
Dr Akash Anand, medical superintendent, Tata Memorial Centre (TMC), Varanasi, says, “The rural-urban divide is immense. The government has taken steps to bridge the gap but it requires more concentration. Doctors posted in the rural areas need to be incentivised. Till the time doctors do not show willingness to practise medicine in rural areas, the rural-urban gap cannot be filled."
He is hopeful that the lessons learnt from the Covid pandemic will not be forgotten. He suggests that the nation should replicate the efforts in managing the bigger killers in India like tuberculosis, malaria, dengue and typhoid.
Dr Anand says, “In some states, junior residents practising MD or MS have mandatory postings in villages. This is because 80 to 90 percent healthcare needs in a rural area can be handled or treated by them. The remaining 10 to 20 percent should visit bigger cities for treatment. The problem arises when people go to bigger cities for malaria or typhoid treatment. We need to strengthen PHCs throughout the country, so that we don’t burden the tertiary care referral centres.”
The health infrastructure in India is growing immensely but still lags considerably behind the developed world. Dr Aseem Mishra, surgical oncologist at TMC, Varanasi, suggests that all stakeholders need to show grit and determination to uplift standards of primary and secondary healthcare. He says, “Government policies and efforts have sped up exponentially. Ayushman Bharat and National Health Mission are a kind of insurance. Through digital mission we are trying to connect the urban rural divide but we tend to deviate from our focus. We should be handling diarrhoea which is the most common cause of under five years of age mortality in the country, maternal mortality, infections which are the most common cause. It may be secondary to diabetes and hypertension.”
He continues, “In the last survey in 2017 we calculated that around 70 million people in India are diagnosed with diabetes and 23 crore people are suffering from hypertension. If we think we can give relief to people through government policies then we are going in the wrong direction. This kind of data suggests that we need to focus on preventive healthcare and strengthen the primary healthcare sector.”
Dr Pratibha Dogra, respiratory and sleep physician, finds the answer in public-private partnership (PPP). She points out that during the pandemic both the public and private sectors worked together and assisted the nation in taking control over the situation. She says, “During the pandemic the government learnt that for critical care the role of private hospitals would be important. I am proud to be an Indian doctor, we have proven ourselves to be the best. Private hospitals backed the government to come out of the problem, so the answer lies in the PPP.”
Citing examples of successful partnership between the government and private firms in the energy and transportation sector, Dr Dogra suggests, “In India healthcare needs care. The government has the strength of PHCs and volume, the private hospitals have the strength of expertise and super speciality. We need a seamless connection between the PHCs and the topnotch hospital facility.”
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