Transforming healthcare

While India has several healthcare achievements to its credit, including the eradication of small pox in 1977, the triumph over polio in 2014, maternal and neonatal tetanus in 2015 and YAWS in 2016, its 1.3 billion strong population continues to suffer from one of the world’s worst burdens of disease. There is a perceptible rise in non-communicable diseases with ischemic heart stroke leading the list of directly attributable causes at 12 per cent of the population. Diarrhea and related conditions account for 5  per cent of healthcare fatalities while lower respiratory tract infections make up for about 4 per cent. According to the latest National Family Health Survey, 12 out of every 100 women in the age group 15-49 have experienced stillbirth, miscarriages or abortions in their lives. One in 20 children dies before it reaches the age of 5. Tuberculosis continues to ravage the region with at least 27.9 lakh cases reported in 2016 alone.

Low penetration of healthcare services: Then, there is the appalling doctor to patient ratio, which stands at an overall level of 1:1596. The Medical Council of India records 10.4 lakh doctors registered with it at various state branches of the council. But only 8.33 lakh MBBS doctors are in active service. It is estimated that at current population rates, India would require more than 2 million additional doctors by 2030 to achieve even the modest doctor — patient ratio of 1:1000. There are just 25,650 primary healthcare centres across India and nearly 8 out of every 100 of these function without a single doctor on the payroll. This is despite the fact that the Indian Public Health Standards guidelines mandate at least 2 doctors at every PHC. Almost 36 per cent of these PHCs have no lab technician and more than 18 out of every 100 did not have a pharmacist.

Contradictions in healthcare delivery: They say that the state of a nation’s health is a direct reflection of the quality of life its people enjoy. If that were the case then India would be in the unique position where, on the one hand, it possesses a prosperous healthcare industry that is valued at Rs 54,086 lakh crore, and on the other hand, 62 per cent  of its population spends all its savings on out-of-pocket expenditure on healthcare. In other words, although the healthcare industry is booming, it is too expensive for the majority of India’s population to access at viable costs. This reflects poorly on the future of the domestic healthcare industry. If the rate of increase in medical expenses outperforms the rate of growth of income, then consumers are driven off the service. The fact that medical needs cannot be compromised with seems to give the market an indication that the demand for healthcare services is not very responsive to price increases. However, this inelasticity could also lead to people turning to substitutes for conventional allopathic medicine, which is scientifically proven and sound, towards non-evidence based medicine, which is a comparatively unregulated space, and give room for quacks and superstition to mislead and defraud millions of desperate consumers.

Ayushman Bharat and the way forward: The rise in the number of non-communicable diseases has been noted and responded to in various new initiatives by the government including the Ayushman Bharat scheme, which aims at providing healthcare via state-sponsored insurance cover to 50 crore of India’s poorest. This scheme, is meant to deliver secondary and tertiary care only, and the initial costs of screening and diagnostics, are supposed to be delivered by the second element of the program, i.e. the 150,000 new health and wellness centers that to come up in the coming months. All essential diagnostics and medicines can be availed free of cost here.

Apart from these policy initiatives, the country needs greater numbers of supporting medical personnel such as nurses, auxiliary nursing midwives, accredited social health sctivists, health visitors, laboratory technicians, pathologists, computer operators, healthcare managers and other ancillary staff to complete the overall healthcare experience.

Leveraging local participation for last mile healthcare experience: India’s vast geography and cultural diversity prevents a top-down approach from functioning in the manner that it should. One cannot have a central cadre of medical staff and expect them to be posted in remote locations far from their homes and loved ones and remain committed to selfless service. Behavioural economics tells us that people need the right incentives to be motivated and give their best. To overcome the challenges of serving healthcare in remote regions, one needs the assistance of local agents of change. These could range from village sarpanchs and elders to voluntary agencies working in the area. This approach also ties in with the need to create a market driven ecosystem of demand for health services that are

*Nominally priced

*Easy to access, possibly via the use of supplementary but regularly held camps and portable tissue sample collection centres

*Leverage the use of technology, in particular ICT and assisted telemedicine for expert consultations and to provide a complete range of health solutions that is perceptibly effective and precise

*Create consumer demand for itself, is supported by a working supply chain of medicine suppliers, equipment and clinical service suppliers and provides local employment generation to spread the good word and become self-marketing

*Establish the family doctor in the ethos of rural households, the doctor becoming their guide and advisor, hence preventing them from taking aggressive medicines and ridding them of the superstition, fear and uncertainty of disease and its management. This will also help in family planning and improve health indicators such as MMR and IMR, utilise women, the primary modes of communication for health related issues and treatments to the most ailing, or other female, members of the household.

For India’s healthcare model to succeed, it is essential that all stakeholders are asked and seen to participate and partake of the entire ‘gramin’ experience.

(The writer is the founder of Gramin Healthcare)