Even before the pandemic exposed the faultlines of India’s health infrastructure—even in big cities like Delhi and Mumbai—it was always clear it was bursting at the seams. With just 0.6 doctors per 1,000 population and 2.2 nurses, as compared to the WHO’s norm of 1 and 3, respectively, India simply cannot cope with the demands made by its citizens even in non-pandemic situations. Indeed, unless the level of Covid-19 infections are milder than those seen in some countries, India will be hard-pressed to deal with the situation considering the infection is rapidly spreading to semi-urban and rural areas.
Fixing this requires large investments in doctors and nurses and even physical infrastructure like hospital beds; according to a number put out by Tata Group chairman N Chandrasekaran, India needs 600,000 more doctors and 2.5 million nurses; around two-thirds of doctors, he says, operate out of urban areas where just a third of Indians live. Getting so many doctors and nurses, especially in rural areas, is going to cost a lot; money that India simply does not have.
Fortunately, as we saw in the pandemic, several innovative solutions are being tried. Apart from greater use of telemedicine, we even saw the authorities in Mumbai coming up with less-contact healthcare that required fewer doctors and nurses, with remote monitoring being used. With the increasing use of AI, machines can deliver a lot more and even help in diagnostics; a CT scanner with information on lakhs of patients may be able to offer better diagnostics than a trained radiologist. Doctors sitting in cities can remotely look after more patients with relatively less experienced medical personnel helping out at the ground level; indeed, with greater care being offered in primary care facilities, there will be less pressure on secondary and tertiary facilities.
Even before the pandemic, India was moving in this direction, albeit hesitatingly. While the government first talked about the creation of health records in 2013—it had also envisaged setting up of a National e-health authority in 2015—there has been little progress on this front. Kerala has been the only state to embark on digitisation of health records, whereas others have put the plan on the back-burner. But, it now appears, the prime minister is expected to announce it on the Independence Day. The programme shall entail digitisation of health records, creation of a registry for doctors, patients and medical facilities. The government also plans to introduce telemedicine and e-pharmacy, but at a later stage. And, while there are some existing programmes already—5C in Karnataka is working with some district hospitals to provide teleradiology services, and Janitri is helping provide neo-natal care in Rajasthan—these need to be brought under a single umbrella and, in fact, linked to Aadhaar and DigiLocker; so, a person getting radiology or blood report can receive it in their locker and then can share it with the doctor or hospital. A digitisation exercise, Chandrasekaran said in a recent lecture, had helped get 55% more patients getting treated in primary care centres, a 50% increase in doctor availability, etc. On the Independence Day, freedom from poor healthcare is something to look forward to.