The big question today
With its massive population, India must prioritise both Universal Health Coverage and preventive healthcare
Yet again, another World Health Day has dawned upon us and we are left confronting several rather uncomfortable questions: "When will we have adequate health coverage for all the citizens of the country? What would it take to make it happen?"
Even after 70 years of Independence, Indians still lack sufficient access to health coverage. The coverage, as anyone would understand, has two aspects: first, the financial means to access health facilities; and, second, the medical and hospital infrastructure itself. The recently announced National Health Protection Scheme (NHPS), which encompasses an allowance of up to Rs Five lakh on health per family per annum, may solve the problem of financial difficulty in accessing medical and healthcare services for the masses. The second and equally important aspect of providing healthcare services to the populace is the existence and functioning of an adequate and robust healthcare infrastructure system in the country where there is no paucity of manpower or physical structure to render the services.
If we look at the current availability of doctors, nurses and medical officers in comparison to the actual requirement, the sheer enormity of the task of providing healthcare facilities to the population looks quite daunting. There is a shortage of about 20 lakh nurses in the country. The current doctor to population ratio is about 1:1674 as compared to the desired 1:1000 that is recommended by the World Health Organisation. And these are just the statistics; they don't even begin to reflect upon the shortcomings of the healthcare system. It is not a hidden truth that the Indian healthcare system is fraught with large-scale deficiencies, and even if we do have the adequate number of doctors, nurses and paramedical staff as per the rulebook, there will still be a severe shortage of manpower.
Indians, right now, are suffering from a host of medical problems owing to the age-old peril of poverty as well as the lifestyle changes accompanying modernisation. There is an entire gamut of diseases and ailments that are increasingly becoming epidemics. More than 10 lakh Indians are diagnosed with cancer yearly and the number is only rising. According to a reputed medical journal, The Lancet, about six to seven lakh people lost their lives in our country in 2012, after fighting a failed war with cancer.
India is infamous for being the world capital of the deadly cardiovascular diseases. The Global Burden of Disease reports that heart disease claimed the lives of 1.7 million Indians in 2016. Overall, more than 60 lakh people lost their lives to non-communicable diseases (NCDs) in 2016 in the country. These numbers clearly indicate the dire need for universal health coverage for all Indians.
Now, let's look at the newly announced NHPS. It is a step in the right direction but there are a lot many questions that need to be addressed before it can have any meaningful impact on the health coverage and delivery in the country. It is not yet clear as to how the government will fund the scheme. The government may have many options; but, it is still to be seen how well the institutions of our country deploy those options to provide the much-needed monetary assistance to the needy who are desperate for quality secondary and tertiary medical care.
The lack of awareness and knowledge among the masses for tapping into the database and availing the requisite financial help is another challenge for the government. Planned and organised educative campaigns need to be rolled out in order to educate people sufficiently about the methods of availing benefits under the scheme. Another challenge would be to avoid procedural complexities for the poor and illiterate patient who has as much right to healthcare as any other affluent citizen. The government has to ensure that the patients and their family members receive their due under the scheme. Further, another important point to consider is the method that could be adopted when engaging with those families that genuinely require more than Rs Five lakh in a year to avail emergency medical services.
All these scenarios have to be approximated, deliberated upon and overcome with adequate solutions before we lose any more innocent lives and drain the country of its young and healthy workforce—a most important resource for the making of a scientific, military and economic superpower.
While we look at the accessibility to health coverage as one way to counter the many healthcare challenges that India faces today, it is also important to emphasise upon the policies and awareness that encourage preventive healthcare. It is better to mend the roof before the monsoon arrives; similarly, it is better to be on our toes before the bout of disease strikes.
With changing lifestyles and the growing incidence of infectious diseases, diagnostic tools are gaining a whole new relevance. From non-communicable diseases to infectious diseases, diagnostics is playing an essential role in the procedures of treatment and aftercare. Another critical aspect of diagnostics that does not get enough attention is preventive healthcare.
Today, we have ample avenues to getting tested early and identify the parameters which may be indicative of lurking metabolic disorders and/or healthcare conditions. These may range from simple blood cell counts and cervical pap smears to genetic tests that detect inherited conditions such as metabolic disorders and even heritable cancers. Although an allied support to healthcare services, these are growing faster than healthcare facilities in the country. We are also making gradual inroads in the interiors of India. In fact, the early diagnosis of a disease is nearly as good as preventing the disease because there exists a world of difference on what can be done to prevent the disease from spreading further and what can be done at the most advanced stages.
The prevention of non-communicable diseases can be brought about by proper education regarding proper nutrition, healthy lifestyle changes and the recognition of early symptoms by either mass communication methods or through health campaigns that can reach out to people living even in the most remote areas of the country. In the spectrum of infectious diseases such as those of the lower respiratory tract and gastrointestinal tract, prevention entails some intervention by public health authorities in providing clean air and environment, easy access to clean drinking water and proper sanitation.
Unfortunately, in India, health is the most compromised aspect – whether in the ambit of the social, the professional or, even, the personal.
Investment in health receives minimum attention, whether through medical insurance or through periodic medical assessment by availing various diagnostic services. Only when one falls ill does the bell begin to ring, and people begin exploring both, timely tests and health coverage. However, with the growing focus on preventive healthcare, India is moving towards a stronger and a healthier nation. Yes, we do have challenges, but days like the World Health Day help us to reflect upon our shortcomings and inspire us to keep walking, quite literally.
(Dr Lata Kini is Senior Pathologist, CORE Diagnostics. The views expressed are strictly personal)