• The Indian health system has overcome seemingly insurmountable problems, long considered hopeless.
• Estimates said even under the best-case scenario, India would achieve a total fertility rate of 2.1 (replacement level) only by 2041, but India achieved this by 2020.

Health and lifestyle issues in India

1. High maternal and infant mortality

• High maternal and infant mortality seemed destined to persist as late as 2010.
• Ten years later in 2020, even in the BIMARU (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) states, hospital deliveries have soared to 89 %. (NFHS-5)
• At least five interrelated challenges pervading the population.
• Cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs), and diabetes are spiraling and they all share four behavioral risk factors:
• Unhealthy diet,
• Lack of physical activity and
• Use of tobacco and alcohol

2. Deaths due to non-communicable diseases (NCDs):

• Increased from around 38 % in 1990 to 62 % in 2016.

3. Obesity in India:

• Increased from 19 % to 23 % between NFHS-4 and NFHS-5, in both urban and rural areas.
• 38 % of Delhi’s citizens were found to be obese, followed by Tamil Nadu and Kerala.
• People in Punjab, Telangana, Andhra Pradesh, and Karnataka also have large sections of the population that are obese.
• This increases the risk of diabetes, hypertension, and CVD.

Tackling these challenges

• Building awareness and exhorting people to lead healthy lives can result in saving millions from illness and decelerating premature death.
• Governments must keep millions away from ill health — more cost-effective than eventually treating chronic medical conditions in hospitals.

India’s Healthcare Scenario

1. Health and wellness centres

• Centre and states are trying to bolster primary healthcare by establishing health and wellness centers.

As per the report by the Centre for Community Medicine in AIIMS:

• There are huge variations between states.
• Mizoram, Arunachal Pradesh, and Nagaland were found to have better arrangements followed by Gujarat and Chhattisgarh.
• Jharkhand, Karnataka, and Uttar Pradesh (UP) had the lowest proportions of primary health facilities with full institutional capacity.

2. Core health services

• Challenge: To bridge the gap in hospital services between large urban agglomerations and tier II and tier III cities.
• Only 16 % of the district hospitals in Tamil Nadu offered all key services. (Lancet publication 2023)
• In Assam, Punjab, Madhya Pradesh, Mizoram, and UP, it was found to be just 1 %.
• This forces people into the private sector, which owns two-thirds of the country’s hospital beds.

3. Private hospital Beds

• Large private hospital chains account for just 4-5 % of the beds in the private sector.
• Standalone hospitals and nursing homes provide 95 % of private hospital beds.
• They are unable to provide multi-specialty, leave alone tertiary and quaternary care.
• Solution: The gaps between services available in the metros and big cities and in districts must be bridged.
• Making the centrally-run hospitals (where a 40 % vacancy was reported only a few months ago) and the district hospitals fully functional is imperative.

4. Health insurance penetration

• It is very low resulting in a very high personal outgo on healthcare.
• But more than four crore Indians have bought health insurance in the last 3 years.
• Ayushman Bharat insurance scheme: It is for 10 crore poor families and has been undertaken to provide insurance against hospitalization for up to Rs 5 lakh per year per family.
• Nearly 74 % of Indians are either covered or eligible for health insurance coverage under the Employees State Insurance (ESIC), group insurance, and CGHS.
• However, millions remain uninsured.
• Out-of-pocket (OOP) expenditure: This is pegged at 50 % of the total health expenditure.
• Therefore, essential to provide insurance for the unorganized middle class and to include identified out-patient costs.

5. Use of Artificial Intelligence (AI) and Digital Technology

• Surgery assisted by robots, the use of genetic codes, clinical judgments based on AI, and even pandemic forecasting are already widespread.
• Concern: Ethical and regulatory concerns abound, which recently prompted the Indian Council of Medical Research to release guidelines foreseeing the problems of a lack of accountability for machine-made medical decisions.

India has shown how the impossible can be achieved. India can think out of the box in terms of policy-making and implementation. It will result in better infrastructure and might bridge the gap between metropolitan cities and rural healthcare facilities.