Dr Chetan Mehta
Consultant Critical Care
BAPS Pramukh Swamy Hospital, Surat

Healthcare delivery in India – Fixation required?

Well whenever and wherever you talk about the market, India is and will always be a big market. Although we have a gross deficit of healthcare professionals and equipment, we are far behind in either maintaining them or getting them in the first place. Going forward in the next 10 years, if I see post-pandemic era, it would be very crucial for the Indian government on how they shape our healthcare delivery to root level in India. Bottom line is that India is a huge market for skills and instruments but policies need to be framed in a way that we become a global leader in that too.

On budgetary allocation in healthcare
If you see the population and healthcare delivery system we are in, current budget allocation of approximately `69,000 crore is quite low. But I think with COVID-19 pandemic, the government will reconsider its budget allocation by next year. Investing money on healthcare services and development will be as essential as procuring high-end defense equipment because I think wars will not be fought on battlegrounds in future. India needs more and more budgetary allocation on medical research, primary healthcare delivery, and development of PPP if we want to achieve the goals of healthcare to all. government may consider investing more on insurance sector too by making it more affordable for middle class to get basic medical insurance so healthcare becomes within the reach of the average Indian family.

On your planned budgetary allocation for the fiscal year 2019-20
I am no expert in this area, but India is in gross deficit of having quality equipment and devices in primary healthcare delivery areas. A huge allotment of funds would be required. We can reduce the financial burden by manufacturing them locally and with support from private authorities. Most of the quality healthcare equipment is manufactured in either China or European Union, so by encouraging local manufacturing we can get them at a cheaper price.

On your vision for health and family welfare
Healthcare delivery in India is broken at various levels and it is not reaching upto the level it should reach. There are major differences we observe between health services in metro cities and even in Tier-II cities. Major differences are there between government and private set-ups too. Although we are developing larger healthcare facilities in urban areas with private funding, maximum population of India is taking services in rural India and that too in government setup only. So, the biggest challenge in India for implementing health services according to me is to fix this broken government system. India has one of the finest government primary and secondary healthcare delivery systems on paper, but how much it is practically helping is a big question. So, for me the biggest challenge for the Indian government is to provide quality healthcare workers and equipment in government healthcare facilities. We may need to work on a war-footing to manufacture and supply quality medical instruments and equipment e.g. multipara monitors, ventilators/respirators in government facilities only because they are the one in maximum shortage. Another big concern is for providing quality and  trained workforce in government sector, some policy decisions need to be taken to allow private practitioners to work in government sector with a decent payout. PPP at all levels may help straighten some creases in the system.

On monitoring the quality of private healthcare
India is a huge country and to reach out to our 1.4 billion population, 20 brands with approximately 5–7 hospitals per brand are not enough to deliver services. The Indian population needs an efficient private healthcare delivery system. In the private healthcare delivery segment, things are not regularized or monitored; it has too many loopholes. NABH and NABL standards should be implemented from grass root level so that healthcare delivery becomes streamlined. I would not say that those should be absolutely compulsory right away, but there should be a plan to apply these standards to the entire sector in the next few years so that healthcare delivery is monitored at all levels.

On public-private partnership
I think it’s the most important thing required for Indian healthcare system. We are not a country with huge financial backup from the government side to deliver similar healthcare to all levels. Indian healthcare delivery, is divided in three segments. One, the healthcare framework managed by various government authorities, either center or state. Second, the total private structure, where corporate hospitals and nursing homes run the show. Third, public-private partnership institutions, where both government and private authorities join hands to deliver quality health services. The government system is huge but inefficient in various areas while private sector is efficient but costly so not affordable by all; I feel public private partnership will be the game changer in Indian scenario. I strongly support public-private partnership in India for healthcare delivery at grass root level. It should be streamlined, professionally setup, non-expensive and doctor-friendly so as to make it a win-win situation for all. The government should come up with a definitive plan with timeline to make more and more public-private partnership institutions in Tier-II and Tier-III cities throughout the country.

On areas where government should invest to make healthcare available to everyone
Primary healthcare at rural level should be the key for India as we have a strong network of primary health centers in India. To make use of this network, the government should invest in providing quality healthcare workers and equipment to support them,and in urban areas, PPP to establish tertiary care centers to provide quality care. With infectious diseases making inroads in the world, the government should invest in setting up ID hospitals at district level to manage any such infections at a very early stage and in a professional manner. Indian government should also invest in research to effectively create a shield against local infection and their prevention.

On policy interventions that the healthcare sector in the state aligns with the healthcare objectives at the national level
Since independence we have not given enough importance to preventive care and our healthcare is more or less aimed at therapeutic targets only. State and centre should align with each other in providing preventive care. Another area is to provide medical professionals working for the government, where states can develop local bodies that develop and regulate medical educational institutions.

Anything else you may like to add
Having in the healthcare industry for almost 23 years now, I have seen Indian healthcare system from root level to top most healthcare facilities. With 1.4 billion people, and with a very poor doctor-patient ratio, it is a very big task for the Indian government to provide quality healthcare services at grass root level. India needs more and more qualified doctors to provide services, and for that India needs to increase medical educational institutions and major policy changes too.

  • I recommend a few steps:
  • Increase number of educational institutions and increase numbers of UG/PG seats in existing institutions.
  • Improve medical education by taking services from private practicing doctors.
  • Post-graduation training should be extended with one-year compulsory service in rural set-up, not after completing MD/MS but after completion of second year.
  • PPP in developing institutions in Tier-II and Tier-III cities.
  • Infectious diseases block hospitals must be there at district level to tackle local infections and endemics.
  • More funding and support is required for research in India in healthcare delivery improvement (as we are hugely dependent on the western world for that).
  • Aggressive efforts are required by the government to stop brain drain to the western world. We are losing quality talent.
  • Budget allocation must be increased.
  • Manufacturing of essential drugs and instruments in healthcare should be in India to reduce the cost to the patient, and eventually reducing the overall cost of healthcare.
  • One more area where we are far behind is in number of medically insured families. Although awareness is increasing, huge attention is required to make basic medical insurance cheaper for Indian families. We may come up with public private partnership  hospitals in next few years but till then either direct government insurance schemes or making private insurance cheaper by reducing taxes would help Indian families on immediate basis.

Indian healthcare delivery system is broken at certain levels and in some areas we need urgent attention. Primery and preventive health, workforce to provide health delivery, shortage of quality equipment, and a way of providing cheaper as well as efficient health services are the areas which require fixation on immediate basis.

This pandemic situation has shown us where we stand in the world to tackle this kind of situation. We need to rethink our strategies and come up with future plan of action. 

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