Governance

Issues relating to development and management of Health

The "Right to Life" is considered essential by the Constitution, and the government is required to protect everyone's "right to health." The federal system of India, as well as the responsibilities and funding splits between the Centre and the states, have affected the health sector to a large extent. The states are in charge of planning and delivering health care to their citizens. Healthcare has become more focused on innovation and technology over the past two years and 80% of healthcare systems are aiming to increase their investment in digital healthcare tools in the coming five years.

According to some estimations, the Indian healthcare sector will be worth $774 billion by 2030. Hospitals, medical tourism, health insurance, medical equipment, telemedicine, outsourcing, clinical trials, and medical gadgets are all part of India's healthcare industry.

Problems pertaining to Healthcare sector

Insufficient Medical personnel:

• • There is a massive shortage of medical staff, infrastructure and last mile connectivity in rural areas. g.: Doctor: Population 1:1800 and 78% doctors cater to urban India (population of 30%).
  • Massive shortages in the supply of services (human resources, hospitals and diagnostic centres in the private/public sector) which are made worse by grossly inequitable availability between and within States.
  • For example, even a well-placed State such as Tamil Nadu has an over 30% shortage of medical and non-medical professionals in government facilities.
  • 61% PHCs have just one doctor, while nearly 7% are functioning without any
  • 33% of PHCs do not have a lab technician, and 20% don’t have a pharmacist.
  • In states like Odisha, more than 3,000 government posts for doctors or about 50% of all government medical doctor posts are lying vacant.

Health budget:

• • India’s expenditure on the health sector has risen meagerly from 1.2 per cent of the GDP in 2013-14 to 4 per cent in 2017-18. The National Health Policy 2017 had aimed for this to be 2.5% of GDP.
  • The health budget has neither increased in real terms nor is there any policy to strengthen the public/private sector in deficit areas. While the Ayushmaan Bharat provides portability, one must not forget that it will take time for hospitals to be established in deficit areas.
  • This in turn could cause patients to gravitate toward the southern States that have a comparatively better health infrastructure than the rest of India.

Infrastructure constraints:

• • There are doubts on the capacity of India’s infrastructure to take on the additional load of patients during pandemics like Covid-19 as seen recently.
  • There is a growing medical tourism (foreign tourists/patients) as a policy being promoted by the government, and also domestic patients, both insured and uninsured.

Crumbling public health infrastructure:

• • Given the country’s crumbling public healthcare infrastructure, most patients are forced to go to private clinics and hospitals.
  • There is a shortage of PHCs (22%) and sub-health centres (20%), while only 7% sub-health centres and 12% primary health centres meet Indian Public Health Standards (IPHS) norms.
  • In the northern States there are hardly any sub-centres and primary health centres are practically non-existent. First mile connectivity to a primary healthcare centre is broken. For eg, in Uttar Pradesh there is one PHC for every 28 villages.

Strong role of Private players:

• • Approximately 70 per cent of the healthcare services in India are provided by private players. If private healthcare crumbles due to economic constraints or other factors, India’s entire healthcare system can crumble.
  • Over 70 per cent of the total healthcare expenditure is accounted for by the private sector.
  • However, Private hospitals don’t have adequate presence in Tier-2 and Tier-3 cities and there is a trend towards super specialisation in Tier-1 cities.
  • lack of transparency and unethical practices in the private sector.
  • Lack of level playing field between the public and private hospitals has been a major concern as public hospitals would continue receiving budgetary support. This would dissuade the private players from actively participating in Governmental scheme.

High Out of pocket expenditure:

• • According to the latest National Health Accounts (NHA) estimates released in March 2021, patients bear a big chunk of health expenses, as high as 61 per cent of the total health expenditure, by themselves.
  • Even the poor are forced to opt for private healthcare, and, hence, pay from their own pockets. As a result, an estimated 63 million people fall into poverty due to health expenditure, annually.
  • Inequities in the health sector exist due to many factors like geography, socio-economic status and income groups among others. Compared with countries like Sri Lanka, Thailand and China, which started at almost similar levels, India lags behind peers on healthcare outcomes.

Poor insurance penetration:

• • India has one of the lowest per capita healthcare expenditures in the world. Government contribution to insurance stands at roughly 32 percent, as opposed to 83.5 percent in the UK.
  • The high out-of-pocket expenses in India stem from the fact that 76 percent of Indians do not have health insurance.

Fake doctors:

• • Rural medical practitioners (RMPs), who provide 80% of outpatient care, have no formal qualifications for it.
  • People fall prey for quacks, often leading to grave disabilities and loss of life.

Numerous Schemes and its limitations:

• • The Government has launched many policies and health programmes but success has been partial at best.
  • The National Health Policy(NHP) 2002 proposed to increase Government spending on health by two to three per cent of the gross domestic product (GDP) by 2010 which has not happened yet.
  • Now, the National Health Policy 2017, has proposed to take it to 2.5 per cent of the GDP by 2025.
  • The overall situation with the National Health Mission, India’s flagship programme in primary health care, continues to be dismal.
  • The NHM’s share in the health budget fell from 73% in 2006 to 50% in 2019 in the absence of uniform and substantial increases in health spending by States.

Healthcare without holistic approach:

• • There are a lot of determinants for better health like improved drinking water supply and sanitation; better nutritional outcomes, health and education for women and girls; improved air quality and safer roads which are outside the purview of the Health Ministry.

Issues in particular with Urban healthcare

• Rural-urban disparity: Until recently, Union government mostly focused on rural healthcare. Ex: expenditure on urban areas was ₹850 crore in 2019-20, compared to nearly ₹30,000 crore for rural.
• Lack of government primary and preventive health infrastructure: Against a norm-based target of 9,072 urban primary health centres (UPHCs), only 5,190 are operational.
• Most states do not have urban sub-centres (SCs), people’s first point of access for healthcare services. There are only 3,000 urban SCs compared to over 150,000 in rural areas.
• Urban areas also suffer from ‘over-hospitalization’ of basic care, ideally done in clinics.
• Lack of devolution of functions by state government and inadequate role clarity among various health-related agencies
• Poor financial condition of ULBs, and low priority accorded to health.

Issues in particular with Rural healthcare

• Only 11% sub-centres, 13% Primary Health Centres (PHCs) and 16% Community Health Centres (CHCs) in rural India meet the Indian Public Health Standards (IPHS).
• Only one allopathic doctor is available for every 10,000 people and one state run hospital is available for 90,000 people.
• Innocent and illiterate patients or their relatives are exploited, and they are allowed to know their rights.
• Most of the centres are run by unskilled or semi-skilled paramedics and doctor in the rural setup is rarely available.
• Patients when in emergency sent to the tertiary care hospital where they get more confused and get easily cheated by a group of health workers and middlemen.
• Non-availability of basic drugs is a persistent problem of India’s rural healthcare.
• In many rural hospitals, the number of nurses is much less than required.

Central Government Schemes for Healthcare Sector in India

Health is a state subject, the Central Government supplements the efforts of the State Governments in delivery of health services through various schemes for primary, secondary, and tertiary care.

• By 2025, the Government of India is planning to increase the expenditure on Health care to 2.5% of the GDP.
• In the Union Budget 2020-21, the Ministry of Health and Family Welfare was allocated a budget of more than Rs 65,000 crores.
• In Budget 2020-21, Government of India has approved the extension of National Health Mission with an allocated budget of around Rs 34,000 crores.
• Under the National Health Mission (NHM), financial support is provided in the following areas: ASHAs workers, ambulances, mobile medical units (MMUs), drugs and equipments, support for Reproductive, Maternal, New-born, Child & Adolescent Health (RMNCH+A).
• The National Nutrition Mission has set an objective of reducing the under nutrition, problems of stunting by 2%
• The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) – This is the largest health care program funded by the Government.
• In the Union Budget 2020-21, PMJAY was allocated a budget of more than Rs 6400 crores.
• As of Nov 2019, more than 63 lakh people have received free treatment under Ayushman Bharat – PMJAY.
• In the Union Budget 2020-21, Government of India allocated Rs 3,000 crores for Pradhan Mantri Swasthya Suraksha Yojana (PMSSY).

Potential of the Indian Health Sector?

• India's competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe.
• India has all the essential ingredients for the exponential growth in this sector, including a large population, a robust pharma and medical supply chain, 750 million plus smartphone users, 3^rd largest start-up pool globally with easy access to VC (Venture Capital Fund) funding and innovative tech entrepreneurs looking to solve global healthcare problems.
• India will have about 50 clusters for faster clinical testing of medical devices to boost product development and innovation.
• The sector will be driven by life expectancy, shift in disease burden, changes in preferences, growing middle class, increase in health insurance, medical support, infrastructure development and policy support and incentives.
• As of 2021, the Indian healthcare sector is one of India’s largest employers as it employs a total of 4.7 million people. The sector has generated 2.7 million additional jobs in India between 2017-22 -- over 500,000 new jobs per year

Opportunities in Health Care Sector

• By 2030, the Indian healthcare sector is estimated to reach US$ 744 billion according to a report by Aspire circle.
• Data Analytics: The National Digital Health Mission (NDHM) will bring with it the digital Health ID, which will save patient data. It would aid in effective policymaking, and private firms would gain an advantage in the market introduction of innovative technology.
• Investing privately: It would be simple for private players to spend strategically with the arrival of information technology and big data. As we all know, the Indian healthcare sector is in urgent need of workers, and there is room for thousands of people.
• Start-ups: A climate conducive to start-ups and entrepreneurship can be formed in this field with the support of the government and private stakeholders.
• Medical Tourism: India is already one of the most popular medical tourism destinations in the world, and this industry can be effectively tapped in the next years.

Measures required in Health Sector

• Improving infrastructure: There is an urgent need to improve the infrastructure of public hospitals, which are overburdened as a result of India's large population.
• Focus on private hospitals: The government should encourage private hospitals because they make a significant contribution. Because the difficulties are severe and cannot be tackled just by the government, the private sector must also engage.
• Increased efficiency: To improve the sector's capabilities and efficiency, more medical personnel must be hired.
• Utilization of technology: In order to connect the dots in the health system, technology must be used. Medical gadgets in hospitals and clinics, mobile health apps, wearables, and sensors are only a few examples of technology that should be included in this area.
• Awareness: People should be made aware of the importance of early detection and prevention. It would also assist them in reducing their out-of-pocket expenses.

There is an urgent need to improve the infrastructure of public hospitals, which are overburdened as a result of India's large population. The government should encourage private hospitals because they make a significant contribution. Because the difficulties are severe and cannot be tackled just by the government, the private sector must also engage. To improve the sector's capabilities and efficiency, more medical personnel must be inducted. In order to connect the dots in the health system, technology must be used. Medical gadgets in hospitals and clinics, mobile health apps, wearables, and sensors are only a few examples of technology that should be included in this area.