Low Healthcare Expenditure Blights India

Healthcare is a one of the key sectors in India and the government certainly needs to focus on it. In the wake of the Modi government’s completion of two years, Dr Sanjiv Agarwal, Founder & Managing Director at Diabetacare, offers his views about how India ranks abysmally low in providing health services to people. The country ranks much below other BRICS countries in public expenditure on healthcare in proportion to GDP. He also talks about how diabetes is growing in India, impacting even children, with changing lifestyles.

Excerpts:

The Narendra Modi government has been in office for two years now. What is your take on the government's measures pertaining to health?
The policy intentions of the government have been positive in the fact that it has clearly pronounced the need for dedicating more financial resources to healthcare to improve access and affordability.

Intrastate disparities, lack of access and affordability, and out of pocket expenses are the major challenges people face in India vis a vis healthcare. When it comes to public expenditure of healthcare in proportion to GDP, India ranks low; much below other BRICS countries. In this regard, the objective laid out in the National Health Policy to increase healthcare expenditure from 1.04 per cent of GDP to 2.5 per cent by 2020, with 70 per cent of this being dedicated to primary health care, is a welcome step. The draft policy also lays down plans to provide essential and generic drugs and diagnostics free of cost for all primary health care needs. A few other commendable measures have been with regard to setting up dialysis centres in each district and plans to provide a basic insurance cover to poor people.

But, the devil as they say lies in the detail. Here it lies in implementation. How well these intentions are translated on to the ground will take some time to ascertain.

What are the challenges and opportunities in the healthcare right now? What are the other measures that you would like the government to take to boost healthcare in India?
As mentioned above, access and affordability remain the biggest challenges. A bulk of our population cannot afford private healthcare while the public healthcare infrastructure is crumbling under the weight of overload. Shortage of doctors and primary health centres in rural areas is another problem. In fact our medical services are so heavily skewed in favor of urban areas that almost 70 per cent of the doctors in India are concentrated in urban centres. Addressing malnutrition and communicable diseases is another major public healthcare challenge which if addressed can cause a huge reduction in burden on healthcare in India. Challenges also include a shift in the pattern of diseases towards an increased burden of lifestyle diseases. Such that we are a nation that faces the scourge of deaths due to under-nutrition while at the same time we have an increasing burden of morbidity and mortality due to lifestyle diseases (ostensibly cause by excessive consumption). Opportunities are with respect to huge growth potential for the private sector. Our low cost of healthcare (as compared to western countries) is a huge advantage that has in recent years driven major increase in medical tourism.

Improving the state of public hospitals and health centres and increasing their reach is the most important task at hand. As much as it needs increases in public spending, it also needs close monitoring and policy measures to ensure the increased allocation translates into facilities.

Apart from increasing public spending, the government would also do well to partner the private sector in its endeavor to ensure universal healthcare. Such partnerships may include subsidizing facilities for a section of people in private hospitals to increase access; incentivizing private hospitals to set shop in rural areas; using technology widely to improve penetration of healthcare such as through telemedicine.

On health, the government is seen shifting its responsibility more on the states. This is even as the Centre is managing a large chunk of finances. Your views on this.

Healthcare is a state subject. Moreover, the 14th Finance Commission increased the allocation of states from 32 per cent to 42 per cent of divisible funds. In this context is it appropriate that more responsibility is shifted on to the state governments and they are equipped to use their quota of funds effectively. To be fair, state governments being closer to the ground conditions are better equipped to use healthcare funds. The Centre should set up mechanisms to ensure transparency and accountability to ascertain if the allocated quotas have been used appropriately.

Talking about diabetes, India's numbers are alarming - it is higher than that of population of other nations like the UK. How do you think that can be tackled?
Approximately 65-70 million Indians live with Diabetes and half of them are ignorant of their condition. The number is expected to touch the figure of 100 million by 2030. Rapid urbanization, lifestyle, poor diet choices, increasing sedentary lifestyle patterns are some of the contributing factors. Diabetes is one of the leading health challenges of our time.

Addressing this challenge requires major work on the twin scales of prevention and management. We need the government to launch major awareness campaigns, on lines of the sanitation and vaccination campaigns that have been run, to reach millions of people and inform them about the lurking threat of diabetes. Having worked in the healthcare industry for more than two decades, I have realized that intelligent use of technology could make a huge difference to disease management especially in diabetes. We should enter in the segment where we can first focus on awareness about diabetes and its complications and then ensure adherence of people towards diabetes management. 360 degree monitoring & advanced care is crucial in diabetes management. With the 24/7 comprehensive technological support, doctors & patients are assured of constant monitoring and review.

Diabetes is growing in children too? What are you prevention and cure tips? What is the ratio between children, men and women?
Incidence of type 2 diabetes in children is a worrying trend. It shows major problems in our collective lifestyles. Rise of obesity – driven by inactivity and fast food consumption -- is a major driver of this trend today. Parents should help children to be active every day and push them for outdoor activities. They need to be out on the grounds. Avoiding junk food is another major necessity. Schools should implement a no junk food policy in their premises and canteens. Limit sitting in front of laptops, television or tablets to less than 1.5 hour. Enroll your children into physical activities such as swimming, gymnastics, sports etc. Smoking is not cool is the message that needs to be driven among teens. Smokers are twice as likely to develop diabetes as non-smokers.

What are the risks of other diseases from diabetes? What do you think about the awareness of the disease in India?

Diabetes has major associated health repercussions and complications.

High blood glucose levels can lead to loss of vision, kidney damage, feet diseases even lower limb amputation. Diabetics are much more prone to cardiovascular disease than non-diabetics.

Unfortunately, knowledge and awareness regarding diabetes is very poor in India. Most people do not consider it a life-threatening disease, when actually it is one. This emphasizes the need for carrying the right messages regarding diabetes right down to the masses and also extending diabetes education activities to rural areas as well where the prevalence rates of diabetes have already begun to rise.

Technology seems to have changed the contours of India. Do you think with technology and its aspects like telemedicine etc, it will be easier to tap the rural areas?
Modern technology has great potential to increase access of healthcare services in rural communities, especially the ones where there is serious shortage of doctors. Tele-health provides basic consultation facilities where there are one, increases quality of care and reduces costs by reducing readmissions and unnecessary emergency department visits for rural communities. Tele-health allows small rural hospitals to continue providing quality care at low costs. Also, rural patients receiving care via telehealth can avoid driving long distances to access specialty care. Telehealth allows specialists to visit rural patients virtually, shortlist the emergency patients and reduce actual hospital visits and admissions.