Des­per­ate

The Hindu Business Line - - FRONT PAGE - SUMESH KU­MAR / SANJIV KU­MAR V SUDERSHAN

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

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