A view from inside India’s crumbling health infrastructure
The three-tiered basic health infrastructure topped by district hospitals for tertiary care has been in place for years but it has completely failed to come to the rescue of the hapless rural population during the second wave of coronavirus pandemic.
Why India’s Healthcare infrastructure is crumbling?
- Increase in population density: The three tiers I.e. sub-centres, primary health centres (PHCs) and community health centres (CHCs) have increasingly become incapable of handling patients.
- As per the latest Human Development Report 2020, India has eight hospital beds for 10,000 people in comparison to China which has more than four for just 1,000.
- Healthcare centres disobeying government norms: The high proportion of healthcare infrastructure are not even conforming to the government’s own minimum standards for healthcare facilities, including such basics as water supply, electricity, operation theatres or labour rooms, and X-ray machines.
- Only 4% of sub- centres, 13% PHCs and 9% CHCs conform to Indian Public Health Standards (IPHS) which lay down detailed norms for what facilities should be provided at each level.
- Uneven distribution of healthcare staff: There is equally chilling the chaos in health personnel placements with some states having excessive staff while others are grossly deficient, but all show major shortfalls in specialists and technicians.
- Neglect and gross underfunding from the government: The funds for the National Health Mission under which this whole rural health system runs are shared between the Central government and the state governments on 60:40 basis.
- The Central government is much better placed financially to support the system than the state governments but over the years, there has not been much effort to provide funding for this system.
- Insurance based models: The emphasis has shifted to the insurance-based model which effectively puts the private hospitals centre stage, at the cost of the publicly funded lower tiers of primary healthcare.
- Large population is not getting basic healthcare facilities: The increasing role of private sector has not only pushed millions into poverty and debt during the pandemic, but it has also brutally deprived the poorer sections of any healthcare in this time of crisis.
Opportunity of developed health infrastructure
- Increased budget allocations: India's spending on healthcare i.e. less than 1.5 per cent of the GDP, has been among the lowest in the world while in developed countries, it is somewhere between 10-18 per cent.
- The money is being used to strengthen public health facilities and infrastructure for testing, treatment and development of ICU beds.
- The money is also being used for installation of oxygen generators, cryogenic oxygen tanks and medical gas pipelines in public health facilities and procurement of bed side oxygen concentrator.
- Infrastructure development: The Indian healthcare sector, which grappled with the lack of basic infrastructure, was not equipped to address a colossal crisis like the COVID-19.
- The country has become self-reliant in the manufacture of medical devices, personal protective equipment (PPE) and ventilators.
- Adoption of new technologies: The pandemic has prompted tech startups across the globe to explore leading-edge innovations to assist the administrations and healthcare workers to tackle the virus spread.
- The digital health technology can facilitate pandemic strategy and response in ways that are difficult to achieve manually.
- Role of public health sector: India’s scanty expenditure on the public health sector has forced millions of people to seek medical services from the private sector which remains largely unregulated.
- The pandemic has underscored the need to revamp the public health system, by augmenting the health infrastructure and human resources.
- Role and regulation of private sector: The private sector brings 3.3 per of the GDP to healthcare in India and during the pandemic, it was found that the sector filling several gaps in the public healthcare delivery.
- The pandemic has provided the government a better opportunity to rework on the strategies to strengthen the public-private partnership and assist the private sector in realising public health goals.
Measures to be adopted to address crumbling health infrastructure
- Strengthening and refurbishing the local public health centres (PHCs): These should be equipped and manned to deal with all emergency medical care, except for rare occurrences.
- The objective should be that no patient has to travel beyond 10 to 15 km in urban areas, and 20 to 25 km in rural regions for healthcare.
- Coordination and facilitation of decentralised programme: A managing group can be created, comprising representatives from various related departments and organisations at the district level.
- The managing group should be headed by the district magistrate or his senior nominee who can work out an action plan, and enumerate the responsibilities for different ground level officers and departments.
- Development of district managing group: It can be formally notified, and bestowed with special administrative and financial powers to deliver prompt and uninterrupted services as may be defined by the state government.
- Notify and commandeer all or listed medical care centres within the district territory, public or private, to provide notified medical services during the public health emergency;
- Make all logistics arrangements well in advance by engaging public and private assets;
- Develop medical centres with required specialisation services and the capacity in anticipation of the demand;
- Maintain and upgrade existing (PHCs), ensuring, particularly in rural areas, replacements for missing medical officers, engaging additional medical and technical staff through innovative sources;
- Upgrading and using the healthcare apparatus of institutions like municipal bodies, and panchayats, and drawing on the support of anganwadi workers, and specially hired volunteers;
- Declare containment zones, and to also ensure that citizens meticulously abide by the precautionary advisories and instructions;
- Tackle cases of leakage, black-marketing of essential medical supplies;
- Fix priorities and place special focus on rural areas in terms of speedy testing, tracing and vaccinating; and
- Keep the general populace informed daily of the medical and other facilities available. And to meet daily to ensure clearing of bottlenecks and to course-correct if needed.
- Constitution of public health emergency cell: It should be created by state/ UT comprising senior officials from all related departments, to be the focal point of decision making.
- The state governments should also share information and progress through dashboards and other technology tools, and invite suggestions.
- Public health emergency requires perfect administration: Each state should see that such a capable implementing machine is driven by passionate team leaders and no bureaucratic rules should be allowed to obstruct the missionary spirit required here.
Road ahead
- It is a truism that without proper implementation a policy is merely a good-intentioned statement as the Indian bureaucracy can help plug the gaps and swiftly create healthcare structures, accessible in any grave eventuality as well as normal times.
- The development of the existing PHCs, which generally have plenty of open space and ramshackle structures, through public-private partnerships can be a win-win situation.
- A bottom-up approach will not only help blunt any possible surge in the Covid wave but will also build the much-needed health infrastructure.
- The government needs to develop a comprehensive healthcare policy, keeping in mind that the small clinics and nursing homes are the backbone of the country’s primary and secondary healthcare.
- The pandemic has emphasized the increased demand to bring regulatory reforms in the private health sector which should be made accountable to both the government and the public.
Next
previous
Latest News
General Studies