A re-look at India’s broken healthcare

infrastructure!
By M.Y.Siddiqui

Covid-19 induced pandemic since early 2020 has brought
untold miseries to India with unprecedented loss of lives, livelihood,
loss of jobs, innumerable/unaccounted/undercounted deaths for
shortages of medicines, for lack of oxygen, lack of beds, people dying
on roads, on pavements of hospitals, black marketing of life saving
drugs, black marketing of oxygen, indignity in deaths for cremation
or burial of loved ones, never ending serpentine queue of dead
bodies at crematoria and burial grounds, mismanagement in
vaccines, deaths of more than 1000 medical doctors registered with
Indian Medical Association, overcharging by private hospitals,
government denying all that, glaring failure of leadership, resulting in
all round collapse of modern healthcare that put spotlight on massive
failure of the government to maintain a modicum of barest minimum
medical care (Medicare). This calls upon the government to re-look at
public health care and revamp it to the advantages of the people so
that they may not have to meet the same fate for want of medical care
as in the current pandemic and left uncared for, sobbing and grieving.
Despite wide appreciation of frontline health warriors, their
uncanny commitment and unparalleled services to the people,
medical care in India collapsed during the pandemic compelling
people to analyse reasons for such collapse of health infrastructure.
Since Independence in 1947, country’s defence budget went up by
about 9 per cent annually making India the third largest military
spender in the world in 2019; its spending on health sector has been
coming down. Government’s spending on health sector stuck around
1 per cent of GDP for about 15 years. In 2004, the Union Government
made a commitment to increase public spending on health by 2-3 per
cent of GDP over the next five years. A similar commitment was made
and reiterated in 2017 National Health Policy to increase spending
on health to 2.5 per cent of GDP by 2025. Till now no significant
increase in health budget has come forth. During the pandemic,
private health sector’s contribution has been negligible less than 10
per cent, according to official sources. Private health services failed to
take critical load of Covid-19 patients, besides charging exorbitant
rates for treating pandemic afflicted patients.

Since Independence, successive governments built a robust
system of primary health centres in big villages, cluster of villages (in
each village panchayt) supplemented by district hospitals. This
system, however, collapsed due to the pressure from business
lobbies, which entered healthcare system of India by 1990. Basic
infrastructure in primary health care included maternal, child
healthcare services. Specialised healthcare services were provided
through government hospitals in the urban areas. Since 1951 the
number of doctors in the country has increased nine times to about
12 lakh (1.2 million) now, average growth of doctors per 10,000
population has increased only by three times. In fact, actual number
of doctors is 18 lakh (1.8 million) with remaining six lakh (0.6
million) having gone abroad for greener pasteur. Additionally, India
has fared poorly in its Universal Health Coverage (UHC), a barometer
set by the United Nations (UN) to judge health services to people by
all countries. UHC is critical to ensure that all, especially the
vulnerable and marginalized groups, like women, daily wagers,
homeless; migrants are cared for at the negligible cost. UN has
included achievement of UHC by 2030 in its Sustainable
Development Goals and proclaimed December 12 as the
International Universal Health Coverage Day.

Planning Commission in 2010, guided by a high level expert
group on UHC for India, envisioned UHC as a means to ensure that all
people could access preventive, curative, rehabilitative and palliative
health services of assured quality. As of now, however, it cannot be
said that India has achieved any of the parameters of the UHC. Poor
medical care is alluded to crass commercialization of medical system
from education to management for the current sorry state of
healthcare. Medical education has been made expensive and
corruption seeped in for undergraduate and post-graduate medical
education for people with deep pockets only in the private medical
institutes, which have outnumbered the public medical institutes.
Despite such medical students or future doctors, committed
professionally to the ethics and professional standards, in reality,
they try to recoup the investment, once they become active
professionally. Corporate hospitals that lure doctors at fat salaries
further muddy the waters, always under pressure to generate more
medical business guided by profit generation of the enterprise.
Further, generalist bureaucrats manage healthcare facilities, making
it expensive and source of corruption.

Other problems that inhibit health outreach to every body
include non-professionals manning drug pricing control leading to
seeping corruption that help increase prices to 400-500 per cent
higher than the actual drug manufacturing cost, country being
pharmacy of the developing nations notorious for producing large
number of spurious drugs, generic medicines not being encouraged
for lack of assured quality, making a patient shell out a bigger price
for a medicine which might have cost a few rupees to manufacture.
Added to these, treatment in mushrooming private specialty and
multi-speciality hospitals has become costlier, as such hospitals are
guided more by the profits than for providing cure or welfare. Still, all
is not lost. There are way forwards in that whole medical
infrastructure needs to be restructured to provide universal and cost
effective medical care. Medical education be brought hundred
percent under government control and liberalized to expand medical
infrastructure to bridge the gap between demand and supply of
doctors.

Some other important measures needed to be taken include
every certified doctor by law mandated to work in primary
healthcare centre to understand totality of people’s health problems
and be empathetic to patients, introduction of fair and transparent
mechanism to provide drugs at least cost to the patients to generate
reasonable profits for manufacturers, prohibit by law pharmaceutical
companies approaching individual doctors at hospitals to promote
their products, ensure management of hospitals in government
hands and not the private sector to ensure cost effective medical
facilities to every citizen, all these to help India to come out of vicious
cycle of corruption and nepotism in health care!

Powered by Froala Editor