Health For All Demands Integrated Planning And Prioritisation

Despite rapid strides in the arena of healthcare over the past two decades, the majority of Indians still lack access to doctors and medical treatments. Health for all remains an unrealized vision. A huge, 70 million people in the country suffer from rare diseases, and non-communicable diseases (NCDs) such as heart disease, cancer and diabetes contribute to 53 per cent of the overall disease burden in the country.

According to a 2010 World Bank report, premature deaths and preventable illnesses lead India to lose 6 per cent of its gross domestic product (GDP) annually. In Addition, tropical and vaccine preventable diseases (VCDs) continue to claim a disproportionate number of lives. According to industry estimates, 315 million of the 1 billion people impacted by tropical diseases worldwide are found in India alone. Tuberculosis and Malaria roughly cost India about $24 billion and $1.5 billion annually, which is compounded by the cost of other more rare tropical diseases like rabies and leprosy.

Several factors have led to this dire situation of public health: India’s public health expenditure stands at a miniscule 1.4 per cent of the GDP, which is much lower than countries like China (3.1 per cent), Brazil (3.8 per cent), Russia (3.7 per cent) and South Africa (4.2 per cent). This low spend has spawned an inadequately public health system, that fail to cater to the medical needs of the majority. Lack of basic infrastructure equipment and specialist doctors, shortages of essential drugs and the absence of a strong referral network can be blamed for the high mortality associated with many illnesses. Most hospitals don’t even have enough beds for patients: the total hospital bed density in 2010 was 1.3 per 1,000 people, against the WHO guideline of 3.5 hospital beds per 1,000 people.

Dismal public health facilities lead most people to seek private medical care, which depletes their financial resources and puts them into debt. Over 70 per cent of the population is in the lower socio-economic bracket, with no provision for medical insurance or organised healthcare. Expensive private healthcare is beyond the means of most economically disadvantaged people who need medical treatment, leading to delays and aggravating health problems.

According to WHO, up to 65 per cent of the Indians cannot afford even the most essential and generic medications. A 2011 research paper by Soumitra Ghosh of the Tata Institute of Social Sciences, states that out-of-pocket health expenditure accounts for nearly one-sixth of India’s poverty burden.

Aside from the shortage of equipment and life saving drugs, the lack of doctors and nurses in rural areas that harbour 70 per cent of India’s population, remains a major, unsolved problem. In 2012, India had a ratio of 0.7 doctors and 1.5 nurses per 1,000 people, a far cry from the recommended average of 2.5 doctors and nurses per 1,000 people in developing countries, says the World Health Organisation. The shortage of properly trained paramedical and nursing professionals worsens matters. The inability of health personnel to perform basic procedures, operate equipment and extract blood properly is a huge problem, since it leads to delayed and inaccurate diagnosis of diseases.

In its recent assessment of the Indian economy, the Organization for Economic Co-operation and Development (OECD) identified India’s poor health outcomes as one of our major developmental challenges. Policy makers can’t afford to sit back and ignore this problem, since the need for a serious evaluation and the generation of far reaching solutions will only worsen matters. Health must be regarded as a significant contributor to the social and economic climate of the country. There’s no escaping the reality that we need to implement appropriate policy interventions in several areas, to improve the quality and accessibility of healthcare.

The first is the issue of funding. Policy makers and the public must hold the government accountable to its commitment to doubling public expenditure on healthcare over the next 2-3 years. Evolution of new mechanisms of healthcare financing must be accorded priority, to increase affordability and access. For instance, the additional cess on tobacco and alcohol that was announced in the last budget should be diverted to support sustainable healthcare financing. Ensuring availability and access to rationally priced drugs is also crucial.

Placing emphasis on early diagnosis and preventive health will go a long way in curbing the rise of many non-communicable diseases, and mechanisms for early detection must be included in as many programmes as possible.

Health for all must become an economic, social and cultural right. Integrated planning and prioritisation; the mandatory adoption of guidelines and improved standards for care; and government leadership in ensuring adherence are important components of a strong health system. A robust governance patient centric healthcare system with several stakeholders must be created by state and union governments. We must nurture innovative public-private partnerships in healthcare, since the future rests on such collaborations.

Primary and secondary care centres must be strengthened through the provision of trained healthcare personnel; functional equipment, critical drugs and a proper referral chain from primary to secondary to tertiary care levels. We also need an additional 1.54 million doctors and 2.4 million nurses to match the global average. New solutions must be found for our current healthcare crisis, because an investment in the health of all is ultimately the only way to ensure a safe and productive future.