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India needs a renewed health-care system

Context:

  • India has a new Union Health Minister after the recent cabinet reshuffle. So, what does the new Health Minister need to learn from previous experience, and what unfinished tasks need to be taken forward?

Relevance:

  • GS-II: Social Justice (Health and associated issues)

Mains Questions:

  1. A need for strengthening public health systems; regulating private health care, and preventing further privatisation of the health sector. Discuss the statement in context of Covid-19. 15 Marks

Dimensions of the Article:

  • Health for All
  • Status of Health in India:
  • Major healthcare issues highlighted during COVID 19:
  • Way Forward

Health for All

  • A healthy productive population is an enabler for sustainable development and hence it is critical that the Government remains committed to improve public health delivery, reduce health inequities and ensure affordable health care for all.
  • Though India has made substantial progress, there are areas which require policy interventions to attain the goals of accessible, affordable and quality health care.

Status of Health in India:

  • Health expenditure:
    • General Government expenditure on health as percentage of GDP in 2019-20 was 1.6% (up from 1.5% in 2018-19.
    • Out-of-Pocket Expenditure (OOPE) as a percentage of Current Health Expenditure fell down to 58.7% in 2016-17 from 60.6% in 2015-16.
    • Population with health insurance coverage: About 14% of the rural population and 19% of the urban population had health expenditure coverage.
    • Source of hospitalisation expenditure: Rural households primarily depended on their ‘household income/savings’ (80%) and on ‘borrowings’ (13%) for financing expenditure on hospitalisation. The figure is 84% and 9% respectively for Urban households.
  • Life Expectancy: As per the 2019 Human Development Report released by United Nations Development Programme (UNDP), between 1990 and 2018, life expectancy at birth increased by 11.6 years in India.
  • Child Health: As per estimates developed by the UN Inter-agency Group for Child Mortality Estimation:
    • Under-five mortality rate (U5MR) (deaths of children less than 5 years per 1,000 live births) has declined from 126 in 1990 to 34 in 2019, with a Annual rate of reduction (ARR) of 4.5 per cent in the time period 1990-2019.
    • Infant mortality rate (deaths of children less than 1 year per 1,000 live births) has declined from 89 in 1990 to 28 in 2019. o Neonatal mortality rate (deaths of children within a month per 1,000 live births) has declined from 57 in 1990 to 22 in 2019.
  • Status of Immunisation among children aged 0-5 years:
    • About 97% of children across the country received at least one vaccination — mostly BCG and/or the first dose of Oral Polio Vaccine at birth, but two out of five children (40%) do not complete their immunisation programme.
    • Among States, Manipur (75%), Andhra Pradesh (73.6%) and Mizoram (73.4%) recorded the highest rates of full immunisation.
    • In Nagaland, only 12% of children received all vaccinations, followed by Puducherry (34%) and Tripura (39.6%).
  • Maternal Health:
    • Institutional deliveries: In rural areas, about 90% childbirths were institutional (in Government/private hospitals) and in urban areas it was about 96%.
    • Pre and Post Natal Care: Among women in the age-group 15-49 years, about 97% of women took pre-natal care and about 88% of women took post-natal care.
    • Maternal Mortality Rate (proportion of maternal deaths per 1,00,000 live births reported) of India has declined from 130 in 2014-2016 to 122 in 2015-17.
  • Profile of ailments: About 31% of the hospitalised cases had infectious diseases followed by injuries (around 11%), cardio-vascular (around 10%) and gastro-intestinal (around 9%).

Major healthcare issues highlighted during COVID 19:

  • Availability of basic infrastructure:
    • India has 8.5 hospital beds per 10,000 citizens, one doctor for every 1,456 citizens (WHO’s prescribed norm is 1:1000) and 1.7 nurses per 1,000 people (WHO’s prescribed norm is 3:1000).
    • Lack of adequate number of ventilators in hospitals needed for patients with severe COVID-19 infection.
    • Availability of limited accredited diagnostic labs delays testing and consequent understanding of disease progression.
  • Uneven distribution of healthcare workforce: Most of the workforce practice in metropolitan or tier I or tier II cities, creating personnel deficiencies in small towns and villages.
  • Denial of healthcare: Private hospitals are reportedly denying treatments to the poor along with the cases of overcharging patients despite accounting for about 62 percent of the total hospital beds as well as ICU beds and almost 56 percent of the ventilators.
    • This has been seen in Bihar, which has witnessed an almost complete withdrawal of the private health sector which has nearly twice the bed capacity of public sector.
  • Negative perception of medical career: The stories of shortages of PPE leading to health workers getting infected, and health workers getting attacked by infuriated patients and relatives etc. may create a negative perception towards medical career in India in long run.
  • Gaps in urban health services and urban planning: The coronavirus epidemic has disproportionately affected the urban areas and has highlighted that many large urban conglomerations lack public health services, especially the sub-urban regions.
  • Dysfunctional state of Integrated Disease Surveillance Programme (ISDP): It was launched in 2004 to strengthen decentralized laboratory-based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs). But it continues to struggle for manpower and resources and has failed to create a robust and decentralized data collection system involving the district health system across states.
  • Gaps in Care of Non-COVID-19 patients: Extreme focus on containment of COVID-19 infection is likely to result in missed opportunities for timely diagnosis and treatment of other chronic diseases.
  • Other issues:
    • India’s dependence on imports for pharmaceutical products like Active Pharmaceutical Ingredients (APIs).
    • Disbelief in alternative/traditional medicines for treatment due to lack of research in AYUSH treatments, lack of precise standards for herbal formulations etc.
    • Lack of focus on preventive healthcare: Of all healthcare spending, only 7% was spent on preventive healthcare, while more than 80% was spent on treatment and cure as of FY17.

Way Forward

Short and medium-term measures

  • Reducing the chances of hospital-acquired (nosocomial) infections.
  • Ensuring that COVID-19 does not cause denial of hospital services for non-COVID patients.
  • Disruption of immunisation as well as other programmes should be addressed at the earliest, to avoid preventable deaths in the future.
  • Ensuring supply of affordable medicines: PMBJP (Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana) outlets can to be leveraged.
  • Use of technology: For instance, Aarogya Setu app helps in contact tracing.
  • Union Ministry of Health is currently working with partners to establish an “Interfaith Corona Coalition” to engage religious communities in action against COVID-19.

Long-term measures

  • Upgradation of Public health services: by enhancing health budgets and adequate recruitment in public health systems.
  • Primary healthcare must be given importance: All public health activities required for epidemic control – including testing, early detection of cases and various other preventive measures are being carried out by Primary Healthcare Centres.
    • However, the proportion of the Union health budget allocated for the National Health Mission, which is focused on supporting primary and secondary health care, was reduced to 49% in 2020-’21 from 56% in 2018-’19. The declining trend for support to PHC must be reversed.
  • Improving robustness of Pharma Supply Chain: India needs to diversify its sources of raw materials as well as destinations for products.
  • Revamping urban health services: There is an urgent need to launch a massive programme for revamping of urban health services focussed on primary healthcare, along with major upgradation of urban living conditions, especially in “non-notified” slums which must be recognised as integral to the city.
  • Innovative approaches: such as converting train coaches into isolation wards, mobile hospitals etc.
  • Creation of Central Bed Bureau: as recommended by SC in 1997 to ease the pressure for emergency beds. The Bureau should be equipped with wireless or other communication facilities to find out where an emergency patient can be accommodated.
  • Promoting preventive healthcare: The huge and expanding network of Health and Wellness Centres (HWCs) within the Ayushmaan Bharat programme could become centres of health promotion as well as disease prevention. These could also act as for hub of community level monitoring.
  • Boosting private sector investment in social sector infrastructure through public-private partnership mode.
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October 2022
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