Healthcare In India needs deep Introspection; innovations and technology will be key drivers

India doesn’t have enough hospitals, doctors, nurses and health workers, and since health is a state subject, disparities and inequities in the quality of care and access to health varies widely not just between states but also between urban and rural areas.

What happens when your fundamental rights of healthcare are denied?

What happens when politicians make empty promises?

What happens when your entire savings are given to meet with your immediate medical needs?

Ironically In India, there is one government allopathic doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. You don’t need an epidemic, however predictable, for the public health system to collapse. It is a matter of routine that patients share beds and doctors are overworked.

Satya Brahma, the chairman of the Pharma Leaders Group feels that most of the ambitious healthcare reforms carried out by the successive governments have not reached the one billion plus population & need a through introspection.

A surge of external forces, new partnerships and a collective public outcry to fundamentally change healthcare’s status quo aim to force the relatively stagnant healthcare industry to adapt, I believe by definition, the disruptors in healthcare are probably little known to most of us today because we remain engrossed in headline management & fail to understand how healthcare delivery mechanism can be bettered. We are in an exciting phase of healthcare innovators' belief that India needs disruptive innovators creating a new market, disrupting the status quo and displacing established incumbents and the rules of the realm. Mere cosmetic changes won't help, we need actions, bold reforms & sustained campaign to deliver healthcare to rural India. Everybody can give lectures, but how do we do that?

Healthcare in India has been in deep shambles & need deep introspection. People say that healthcare is a fundamental right, but it is not fundamentally right in India. The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution. However, historical public spending of just over a percent of GDP on healthcare has ensured that the country’s healthcare remains unnourished and has left for the private sector to service. The fundamental aspect of healthcare, primary healthcare, is in shambles. There is only one primary healthcare centre (often manned by one doctor) for more than 51,000 people in the country. The World Bank estimates that 90% of all health needs can be met at the primary healthcare level. India has grossly under-invested in the area that should matter the most.

My perception of healthcare innovations points to the poor state of healthcare conditions in the country. India is at the crossroads with the government rolling out the biggest publicly funded healthcare plan in the world In healthcare. But at a time when Universal Health Coverage has become the new buzzword of healthcare in India since Ayushman Bharat, the National Health Profile 2019 throws up sobering figures. Let's look at the numbers.

Between 2009-10 and 2018-19, India’s public health spending as a percentage of GDP went up by just 0.16 percentage points from 1.12% to 1.28% of GDP and remains a far cry from the 2.5% GDP health spending that has been India’s target for some years now. The cost of treatment has been on the rise in India and it has led to inequity in access to health care services. India spends only 1.28% of its GDP (2017-18 BE) as public expenditure on health. Per capita public expenditure on health in nominal terms has gone up from Rs 621 in 2009-10 to Rs 1,657 in 2017-18. Compare this with the average total medical expenditure per childbirth in a public hospital: Rs 1,587 in a rural area and Rs 2,117 in an urban area. Based on Health Survey (71st round) conducted by NSSO, average medical expenses incurred during hospital stay during January 2013-June 2014 was Rs 14,935 for rural and Rs 24,436 in urban India.

We seem to be comfortable with innovation but we push hard against disruptors who dare to disturb our status quo. Innovations in the form of new drugs, devices, algorithms, processes and payment schemes are our standard fare. What we know for sure is the disruptors are busy building new businesses based on value propositions that many incumbents think are impractical or implausible. They are attracting investment from private equity, strategic investors, angel investors, venture capital and go-fund-me campaigns.

Its time to make a fresh beginning. We can't afford to be silent spectators. In new India, there is a dire need to reverse this trend in every aspect of life, particularly in the healthcare sector. Medical negligence and apathy, poor quality of healthcare services, lack of hospitals and the shortage of doctors and nurses, low hospital bed density, doctor-to-patient ratios are greater issues that need to be addressed.

Let's build a strong India & a healthier India

India has a little over one million modern medicine (allopathy) doctors to treat its population of 1.3 billion people. Of these, only around 10% work in the public health sector, shows data from the National Health Profile 2017. The shortage of health providers and infrastructure is the most acute in rural areas, where catastrophic health expenses push populations the size of the United Kingdom into poverty each year.

Add apathy and you have bodies of the dead being mutilated by dogs in hospital morgues, people carrying home their dead children because the hospital refused them a hearse, and tragedies like the hundreds of infant deaths in Gorakhpur’s Baba Raghav Das (BRD) Medical College every year. BRD Medical College Hospital’s failure to save lives points to a systemic rot in public healthcare delivery, which is saddled with problems of mismanagement and inadequate resources — infrastructure and human.

Despite being routinely flagged, these shortages are seldom corrected. Learning from failure is rare, and course correction after mistakes is rarer. This brings us to critical questions: Can such deaths be prevented? How can India’s public health system deliver quality care? Will public hospitals just end up being places where the sick go to die?

Where are the doctors?

India doesn’t have enough hospitals, doctors, nurses, and health workers, and since health is a state subject, disparities and inequities in the quality of care and access to health vary widely not just between states but also between urban and rural areas.

In India, self-styled doctors without formal training provide up to 75% of primary care visits. Strengthening primary healthcare hasn’t got the priority it needs and the sick reach hospitals after faith-healers, quacks and other unqualified practitioners fail to cure them. With early diagnosis and timely referrals, many lives can be saved. There are 462 medical colleges that teach 56,748 doctors and 3,123 institutions that prepare 1,25,764 nurses each year, but with India’s population increasing annually by 26 million, the numbers are too little. India keeps announcing new AIIMS-like institutes in states, but where is the faculty to train these doctors? Setting up a building and buying equipment is not enough, you need trained doctors to provide care.

Time for introspection, debates & corrective measures!

(Disclaimer: Satya Brahma is the Chairman of the Pharma Leaders Group. The opinions expressed are the personal views of the author. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)