India can certainly do a lot to improve public health. Money is not the only constraint, even though we have been crying hoarse that the Government needs to double or triple its spending on health. There are many other things that need to be streamlined.
Improving healthcare delivery systems ought to be the subject of intense policy deliberation and debate because the development of the country hinges on the health of its citizens.
State of our children
Where does good health begin? With children. Unfortunately, statistics in this regard are not too flattering. Almost half of all deaths of children below 5 is due to undernourishment. About 44 per cent of children below 5 are underweight. Some 72 per cent of infants are anaemic.
Inadequate sanitation-safe water triggers the infection-malnutrition cycle. If our children don’t get the right start to life, they will remain undernourished and under-developed compared with children in the rest of the world.
Where does this leave our future workforce? We will remain an unhealthy nation with human resources that function below par. Our physical strength, mental health and overall well-being are and will continue to be compromised. This has far-reaching consequences on the country’s economic and social development.
It’s clear that investing in health is investing in the future. The Government spends about 1.15 per cent of its GDP on healthcare. This needs to increase to at least 2.5 per cent over the next few years to make any appreciable difference.
Bad health hampers performance, productivity and negatively affects human capital development. Health must remain a priority for State governments as well.
The governments need to work collectively to ensure delivery of quality, accessibility, availability and affordability. Quality is driven by market forces, but when supply is limited compared to demand, it takes a back seat. The governments and health regulatory bodies must ensure that quality standards and minimum patient safety protocols are enforced.
The increase in public health spending should be accompanied by changes in where that money is spent. A substantial part of public spending should be channelised into primary health as committed in the health policy of 2017.
Offering better primary care will help reduce the number of cases where diseases or complications progress to a point where they require expensive and aggressive treatment at tertiary healthcare centres and cannot be cured.
To make it work
For a national health system that works, we need more medical and nursing schools and thousands of health workers, particularly in rural areas. What is urgently required is a multi-layered, qualified, trained and committed workforce. We need a large number of health management professionals to run facilities and programmes efficiently. Healthcare is one of the largest sectors both in terms of employment and revenue generation. It has grown at a compounded annual growth rate of 16.5 per cent and is likely to be worth $280 billion by 2020.
But NSS figures over the last two decades show a decline in the share of public hospitals in treating patients. This could give monopoly to private players to hike prices of diagnostics and medical treatment.
High healthcare costs and lack of insurance coverage penetration often result in greater out-of-pocket expenditure for diagnosis, consultation and treatment.
Still, people today prefer private healthcare despite its whopping cost because of the dismal quality and lack of accessibility and accountability of public healthcare in both rural and urban India.
Clearly, a lot needs to change. The doctor-to-patient, patient-to-bed, and equipment availability-to-utilisation ratios need to improve. The unbridled rise in the cost of secondary and tertiary care treatment in urban areas need to be checked. Communication and coordination skills among hospital staff and doctors, soft skills and time management, emergency health management, crisis management, and supply chain management need to improve drastically. A multi-prolonged approach is necessary, and its implementation needs to start immediately on fast-track basis.
Public intervention in healthcare delivery needs to include monitoring of both public and private delivery systems; ensuring authentic diagnostic facilities at affordable cost; supplementing healthcare with better municipal services —clean air and water, pest control, good sanitation and sewage systems, proper treatment of waste and; including healthcare awareness and physical fitness in the school curriculum.
A robust public healthcare system is essential for transforming the socio-economic trajectory of India. Many problems arise because healthcare systems in hospitals and clinics are not managed well.
We need people who are qualified and trained as hospital managers and who can take care of management-related issues so that doctors can focus on providing the clinical care they are trained for.
Dr Sumesh Kumar is an assistant professor at the International Institute of Health Management Research, Delhi, where Dr Sanjiv Kumar is the director
The state of public health