Dr Sarveshwar Narendra Bhure, Mission Director, National Health Mission, Government of Chhattisgarh

Healthcare is India’s biggest sector in terms of service, revenue, and employment. The industry is growing at a tremendous pace owing to its strengthening coverage, services, and increasing expenditure by public as well as private players. Indian healthcare delivery system is categorized into two major components – public and private. The government, that is, public healthcare system comprises secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centers (PHCs) in rural areas. The private sector provides majority of secondary, tertiary, and quaternary care institutions with a major concentration in metros, Tier I, and Tier II cities. Also, a large part of private sector work in rural areas in the primary sector is undertaken but is largely unorganized. India’s competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries. The cost of surgery in India is about one-tenth of that in the United States or Western Europe.

Delivering affordable healthcare to India’s billion-plus people presents enormous challenges and opportunities for the medical community, insurers, and other service providers. Innovative technologies, processes, and partnerships brought by the Indian government and private companies have begun bridging the healthcare gap. Health is a priority goal in its own right and a central input for economic development and poverty reduction. Significant achievements have been made in a number of areas, which include health parameters, legislation, research and technology, and disease control. The life expectancy has gone up by 17 percent since 1981. In disease control significant achievements are in sight. Some new programs have been introduced with the changes in disease profile. Significant progress can be seen in leprosy control, blindness control, TB control, and iodine deficiency disorder control. Some legislations were also enacted to protect life and personal liberty as the constitution holds the right to healthcare as a key activity of the government. Immediate medical relief and preventing major outbreak following disasters is another area to fight with. There are some challenges to face with like population stabilization, to reduce infant and maternal mortality, mobilization of funds on health, to increase manpower, to increase female literacy, and so on. Control of some diseases like HIV/AIDS, vector-borne diseases, cancer, cardiovascular diseases, diabetes, trauma related injuries, mental disorders is another point to improve healthcare delivery.

To meet challenges to the health system the way forward has to be multipronged, focusing on finance, manpower, research, and social factors like sanitation, drinking water availability, female literacy, etc. India has made rapid strides in raising economic growth and lifted millions out of poverty; progress in improving health outcomes is also significant but India still continues to face an extraordinarily high disease burden, which saps the productivity of Indian workers and lowers their earnings.

Challenges for Indian Healthcare System

A key reason behind the poor health of people in the country is the low level of investments in preventive health facilities such as sanitation and waste management, as well as in medical care facilities such as comprehensive health centers and health professionals. India has one of the highest disease burdens in the world. Many more die of preventable diseases in India than in other countries. One big reason driving India’s health crisis is the unavailability of doctors and nurses. Another key reason for the poor health of Indians is the high proportion of out-of-pocket expenditure on health because of low insurance coverage and weak health systems in rural areas, which forces even poor people to visit medical practitioners in cities and drives up average health costs. High healthcare costs often lead people to delay treatment, aggravating health problems. Public health expenditure in India has moved up over the past decade, but still remains among the lowest in the world.

Problems of inequality. The effect of social and economic inequality on health is insightful. Poverty, which is a result of social and economic inequality in a society, is detrimental to the health of population. The outcome indicators of health (mortality, morbidity, and life expectancy) are all directly influenced by inequality in a given population. More so, it is not the absolute deprivation of income that matters, but the relative distribution of income. And the distribution of the healthcare resources in India is also unequal.

Socio-economic problems. The state of economy has a direct effect on the state of health in a country. The healthcare infrastructure directly depends on the economic strength. The recent changes in the economic policies will have a definite effect on the healthcare in India. Political will: India is a representative rather than a participatory democracy. As in any reforms, a strong political will is of essence in health policy reforms too. New health policy of 2017 is very promising and we can expect great results in the time to come. And states like Chhattisgarh have shown significant improvement in health parameters because of strong political will and dedicated state policies.

Emergence of private healthcare. Emergence of private medical care in India by private healthcare providers has been prolific in the recent past. The role of the private sector is getting stronger in recent days and in an era of new public management we should not deny it. And the rapidly increasing middle-class prefers private medical care. But we shall have a system in place to regulate this sector without charging on their flexibility. The recent move to regulate the cost of cardiac stents was a welcome move.

Other challenges. Many hospitals and healthcare providers are struggling with outdated information technology in India today. A major challenge for our nation and the healthcare industry would not only be to retain the healthcare workforce but also to develop an environment, which would attract those abroad to return (reverse brain drain). The growing demand for quality healthcare and the absence of a matching delivery mechanism pose a great challenge. There is an acute shortage of faculty of medical teachers all over the country. One of the pivotal factors to sustain the projected growth of the healthcare industry in India would be the availability of a trained workforce, besides cheaper technology, better infrastructure, and other factors. Another challenge will be to find good talent in India to provide the ancillary healthcare services; especially the voice-based ones which require not only good English communication skills but also very good analytical skills.

Every area of trouble gives out a ray of hope; and the one unchangeable certainty is that nothing is certain or unchangeable. These words of John F Kennedy offer a ray of hope when we look at the healthcare system in India. However, there have been significant advances in the healthcare system in India over last few decades. Ways for establishing, strengthening, and sustaining the private–public co-operation are essential for rejuvenating the system. With the increasing population and the growth of the middle income group, the access of medical services has gained prime importance. With several initiatives taken by government to address the infrastructure requirements the need for technology solutions have grown rapidly. In the absence of technology solutions, the healthcare sector cannot achieve its full potential as there would be cases of excess and insufficient capacity of specialized services at various locations. All this can be achieved with the help of integration.

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