The disastrous consequences of the second wave of COVID-19 earlier this year underscores the urgent need to address the inadequacies of India’s healthcare system and ensure health systems strengthening to combat similar situations in the future.
This effort requires accelerating investments in the health sector for improved infrastructure and well-equipped health care facilities, a trained health workforce and reliable data for monitoring health outcomes, as well as for formulating evidence-based policies and programmes.
India's Investment in the Healthcare
The National Health Policy 2017 envisaged investments in public health that would account for 2.5 percent of GDP by 2025. However, public spending on healthcare in India continues to be very low compared to other BRICS countries that are comparable to India in terms of income and economic growth.
While the Indian government spends only 1.2 percent of its GDP for health, the corresponding figures for Brazil (4.1 percent), China (3.6 percent), Russia (3.6 percent), and South Africa (4.1 percent) are much higher.
With the government allocating just 1.2 percent of the GDP for public healthcare, as opposed to the global average of 8.8 percent, Indians continue to incur heavy out-of-pocket expenses for medical expenses in the private sector.
According to the National Health Accounts Estimates for India for 2016-17, government health expenditure constitutes only 32 percent of the total health expenditures in India, while 68 percent of households’ medical expenses is accounted for by out-of-pocket expenditures, placing an enormous financial burden on households and resulting in many families getting pushed into poverty.
Why Is There Shortage Of Healthcare Professionals?
The limited budgetary allocations for health in India have also resulted in a substantial shortage of medical training institutions and a resultant shortfall of medical professionals catering to the health needs of the country’s population.
A recent study by the WHO and the Public Health Foundation of India reiterates the severe shortage of health professionals in India across all levels. This study reports that we may need at least 1.8 million doctors, nurses and midwives to achieve the minimum threshold of 44.5 professional health workers per 10,000 population.
The repercussions of insufficient human resources and inadequate investments in public health are bound to have its impact on the marginalised, poor and vulnerable communities.
Further, shortages of healthcare staff in the public sector also reflect the unwillingness of newly qualified health professionals to join government-run health facilities, especially in rural areas, because of the high costs of private medical education, comparatively low government salaries, irregular payments in government hospitals and the lack of opportunity for career progression.
These issues can only be mitigated if doctors and other healthcare workers are adequately compensated and learning opportunities, e-learning platforms, are available to upgrade their skills, particularly on COVID-19 management and post COVID-19 care.
It is equally necessary to ensure that the health and safety of health providers themselves is given due priority, both in context of the pandemic and in routine practice.
Reimagining India's Healthcare System
The COVID-19 pandemic has provided a unique opportunity to reimagine India’s health system, with distinct and equally important roles for both the government and private players.
Though, we need greater regulations for the private sector as thus far it is largely unregulated. The challenge now is to build on the momentum to deliver better care for the future.
First and foremost, there is a need to improve health outcomes through the provision of adequate healthcare services and financial protection for their health care needs.
The Prime Minister’s Jan Arogya Yojana (PM-JAY) under the Ayushman Bharat is a step towards providing Universal Health Coverage by identifying the vulnerable population groups so that they have access to quality health services without incurring financial hardship. While the PM-JAY provides hospitalisation cover for secondary and tertiary care, comprehensive primary care is provided through Health and Wellness Centres.
Second, newer models of care need to be implemented which cater to the distinct challenges created by the pandemic. We are already witnessing an increased focus on telemedicine services and the government has issued new guidelines to make telemedicine a legal practice in India.
The Ministry of Health and Family Welfare, along with NITI Aayog, has rolled out the new guidelines that will allow registered medical practitioners to provide healthcare services using telemedicine services. Furthermore, the government has also launched the National Digital Health Mission which encompasses telemedicine, health IDs, health records, along with e-pharmacy and digi-doctor services.
While these initiatives have been initiated, a robust digital health strategy is required to enable an integrated, functional and efficient tele-health network throughout the country.
Greater focus should be placed on boosting the uptake and adoption of digital technologies by patients. There needs to be equal emphasis on strategies which promote health literacy the concept of self-care among people to enable them to address their health needs adequately.
Third, there is a need to strengthen data collection and reporting systems. We need to collect and make available disaggregate data widely by age, gender, comorbidities etc.
This is not only applicable in a pandemic situation but even during normal times to track health status of the population, disease surveillance and response, and for research. This will also empower policy makers and healthcare workers to devise data-driven policy decisions.
India Needs to Prioritise Healthcare
Health system strengthening is key to responding to the population's needs for care and services. The prioritisation of the emergency response to COVID-19 at the expense of other health services will have a long-term impact on overall health outcomes globally.
An effective, accessible, integrated and overarching health system, with a strong emphasis on primary care is the need of the hour. Strengthening surveillance, early detection and efficient reporting mechanisms can help prevent large out-breaks.
Building an emergency response system will enable our health system to not only combat future disease outbreaks but will also be the key to offset the ill-effects of pandemics.
Going forward, the message is loud and clear. We need to respond early and decisively, with focused, comprehensive strategies to mitigate health crises in the future. Building institutional capacity, investing resources and harnessing innovations through partnerships would be key for accelerating effective response now and in the future.
(Poonam Muttreja is the Executive Director of Population Foundation of India. J Pratheeba is a Health Economist at the Population Foundation of India. This is an opinion piece, and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)
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