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COVID-19 exposes India’s underinvestment in healthcare

CII in partnership with Ministry of Health and Family Welfare and the Ministry of Ayush, began the India Healthcare Week with the theme Redefining Healthcare Ecosystem on 17 August, which was inaugurated by Dr Harsh Vardhan, Hon’ble Minister of Health and Family Welfare.

The Healthcare Week has brought together experts from the government and industry to help re-strategize the restoration of the nation’s healthcare infrastructure, and research & development facilities.

As the primary health centres are already overwhelmed due to the public health crisis and face severe shortage of resources, the report highlighted that inadequate health services due lack of basic supplies and equipment, shortage of skilled work force medical and para-medical staff who are overburdened with long hour duties has further worsened the situation. The medical and para medical staff includes doctors, nurses, mid-wives, auxiliary nursing midwives, ASHAs and Anganwadi workers.

“The Covid-19 pandemic has exposed gaps in our system and showcased our under investment in our overall public health infrastructure. We need to develop a cohesive strategy to address the issues we are facing,” said Dr Randeep Guleria, Director All India Institute of Medical Sciences (AIIMS), New Delhi and Chairman CII Public Health Council.

“The quality of our rural infrastructure is poor, and our priority need to be focused on the improvement of rural healthcare infrastructure through government facilities and nursing homes, along with improved manpower, while developing our district level capabilities,” Guleria said.

The Indian Public Health system is a tiered structure, where at the bottom of the pyramid are sub-centres, catering to a population of 3,000-5,000 each, roughly five villages. PHCs are the first base, acting as referral units typically for six sub-centres. PHCs function as the core, and flow into community health centres (CHCs), followed by sub-district and district 11 hospitals. At the apex are medical colleges and advanced research institutes such as the All India Institute of Medical Sciences.

CII has also released a vision document on ‘Strengthening Public Health Delivery – Role of Multiple Stakeholders’.

Challenges for upgrading primary healthcare include insufficient resources for equipment, medicine and vaccine supplies, deficient workforce, unmanageable caseload, clean toilets, and overall health facility.

While guidelines and standard operating protocols (SOPs) are in place, the report said, challenges strengthen testing protocols across states with limited manpower persists, which can only be revamped with effective collaborations in Public-Private partnership models. Resilience of the frontline staff has to be built over the years for strengthening response strategies not just for this pandemic but also for future health crisis. The report highlighted that the proportion of the Union health budget allocated for the National Health Mission, for supporting primary and secondary health care, was reduced to 49% in 2020-’21 from 56% in 2018-’19, while the share for health insurance schemes, focussed on higher level hospitalisation care, has more than doubled to 9 % from 4 % in the same period. The declining trend for support to PHC must be revisited urgently and upscale to at least 70% of all health budgets, the report said.

Even in comparison to countries classified as the “poorest” in the world, India’s share of public expenditure on health as percentage of the GDP is far too lower than countries. In the National Health Profile 2019 – a detailed account of socio-economic status, disease burden, health finance, health infrastructure and human resources in the sector – the government admitted that in 2016, its public spending on health was just 1.17% of the GDP. States drive health spending in India; centre’s contribution has stagnated.

Dr Vinod Paul, Member, NITI Aayog expressed three areas that need to be addressed in the medium term and long term: The path-breaking Ayushman Bharat as served the people of India effectively, however, there are several supply side concerns that need to be addressed. The need to augment our healthcare infrastructure and try to reach 2 beds per 1000 people by 2025. The private healthcare sector needs to play a more pivotal role about training specialists, doctors and high-quality nurses to ensure we achieve a robust and cohesive healthcare infrastructure.

Chandrajit Banerjee, Director General, Confederation of Indian Industry emphasized that CII’s public health agenda will be the highest on the list, and we will work together and meet the huge challenge in front of us. It is not appropriate to expect everything to be done by the government, we expect participation and collaboration from other stakeholders, and this is where CII can come in and contribute to the development of the sector.- MB Bureau