Millennium Post

India’s health care system lies in tatters

It was a ghastly sight at a government referral hospital at Jabalpur. At its entrance, a big mound of hospital waste—blood-soaked cotton, gauze, bandages and syringes, and empty vials--greeted us as we went looking for a doctor in search of an investigative story for a television channel. Inside, a lone nurse was on duty. That was 25 years ago.

Cut to the present. During a recent visit to a vaccine storage facility, located alongside a health centre at Raipur, I found the premises chaotic and filthy. The same scenario unfolds in every state—forlorn and pathetic. The country’s healthcare system remains neglected, inefficient, under-served and grossly inadequate. Governments continue to promise adequate measures but changes are hardly visible on the ground.

India’s mission is to provide Universal Health Coverage (UHC) for all. But political will remains buried in wonky policy documents. Implementation is largely ignored or tardy at best, be it Central schemes, Centre-sponsored schemes or State schemes. Health being a state subject, the less said about most states and their healthcare systems, the better. The present government is more concerned and preoccupied with pursuing economic growth. It overlooks the critical point that societal consequences and sustainability of growth largely depend on the health of its people. A healthy economy is directly proportional to citizens’ health.

The healthcare budget for 2015-16 of Rs 297 billion is very little considering the challenges before our healthcare system. The Centre wants states to contribute more funds for running the country’s flagship health programmes. At the same time-ironically the Central government spends an abysmal one percent of India’s GDP on healthcare, less than China, Afghanistan and Sierra Leone. For a humongous population of 1.25 billion, disbursement of medical care is extremely mismatched. On the flip side, an insufficient number of doctors and a poor network of public hospitals, coupled with bureaucratic bungling, results in India often struggling to spend its allocated budgets.

According to the UN, one-third of the world’s poorest are in India. And most of them live in rural settings, where patients are forced to seek poor medical advice for nascent ailments. They receive no treatment or proper diagnosis and care due to the absence/insufficient number of qualified doctors and a poor presence of public hospitals. Many patients avoid consultation till complications arise. Lack of experts forces them to rush to cities and seek expensive treatment.

Primary Health Care (PHC) is grossly ill-equipped: It is plagued by poor infrastructure, lack of specialists, inadequate availability of qualified para-medical staff, a sore lack of equipment, diagnostic kits, medical devices and medicines. No wonder one comes across horror stories galore. Last month, a sweeper in a government-run hospital at Kujang in Odisha’s Jagatsinghpur district sutured the incision after the doctor performed a caesarean section on a woman, and left the operation theatre to attend to another patient.

WHO norms require at least 23 health workers (doctors, nurses, auxiliary nurse midwives) per 10,000. These are never followed. Public Health Centres must be located close to villages. At the minimum, a qualified physician and adequate numbers of trained staff must be deputed at these centres to attend to a population of exceeding 5,000 in number. Also, these centres must be well equipped with diagnostic kits, devices, medical supplies and medicines.

However, the revised (2012) guidelines document on PHCs, issued by the Ministry of Health and Family Welfare, says, “A typical Primary Health Centre covers a population of 20,000 in hilly, tribal, or difficult areas and 30,000 populations in plain areas with 6 indoor/observation beds. It acts as a referral unit for 6 sub-centres and refers out cases to Community Health Centre (CHC—a 30-bedded Hospital/Referral Unit for 4 PHCs with specialised services). This translates to 30 beds for up to 1.2 lakh patients per every CHC. One’s imagination balks at the availability of medical equipment, devices and supply in such inadequate CHCs.

The government has announced that more AIIMS are being established in B or C class towns. This implies that the poor from villages will still have to travel long distances for tertiary health care. The need is for small hospitals to be set up close to rural regions with adequate facilities, and competent doctors and specialists should be posted there to provide quality health care. With PPP being the buzz word in every sphere, private hospitals, nursing and medical colleges should be built around rural clusters, and graduating students should be encouraged to intern in the countryside serving the poor. They would be thus be exposed to difficult conditions in which the underprivileged survive and gain valuable experience and empathy.

In most states, execution of the National Health Mission (NHM) programmes has considerably slowed down following a policy decision to route many payments through states. Badly-run bureaucracy and corruption in states have led to transfer of funds to other sectors leaving the health sector in disorder and chaos. Resultantly, it has left a stark impact on the NHM and AIDS prevention.

The country has successfully eradicated multiple diseases, including smallpox, polio and guinea worm disease. HIV infections and AIDS-related deaths have dropped significantly. All these were due to strenuous efforts and utmost zeal of anonymous healthcare providers spread out across the country. Is it not possible to develop the healthcare system along similar lines?

India dreams of becoming a global superpower. Can it, without an efficient healthcare system. Unless health is prioritised, goals set for universal health coverage will remain unachieved. Given the present scenario, it will have to struggle for at least 10-15 years to bring the UHC programme under its ambit.

The author is an independent journalist
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