Boosting Health Infra

Governance Issues Health

As the pandemic continues to wage on, people have started prioritising their health over most things.
This pandemic, especially during the Delta wave, exposed several gaps in the healthcare system and infrastructure.
Current health infrastructure in India paints a dismal picture of the healthcare delivery system in the country.
Public health experts believe that India is ill-equipped to handle such emergencies.
It is not prepared to tackle health epidemics, particularly given its urban congestion.

The Indian Constitution has incorporated the responsibility of the state in ensuring basic nutrition, basic standard of living, public health, protection of workers, special provisions for disabled persons, and other health standards, which were described under Articles 39, 41, 42, and 47 in the DPSP.
Article 21 of the Constitution of India provides for the right to life and personal liberty and is a fundamental right.
Public Health comes under the state list.
India’s expenditure on healthcare has shot up substantially in the past few years; it is still very low in comparison to the peer nations (at approx. 1.28% of GDP).

(1) 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.
The expenditure on healthcare is one of the lowest in the world, lower than nations with similar economic growth rates.
Though our economy has grown robustly post-liberalization, investment in healthcare has consistently hovered around 1% of the GDP.

(2) Sector attracts investments, but delivery remains contentious

India’s healthcare sector has attracted a steady stream of investments, albeit at the higher end of the value chain — the secondary & tertiary care.
Lack of penetration, inflated billing, opaqueness in diagnosis, and poor quality of service has ensured that most Indians get treated below the standards prescribed by the WHO.

(3) Among the cheapest in the world, yet unaffordable for most locally:

Healthcare in India is cheap. For example: Compared to India, the cost of a knee replacement treatment is over twenty times more in the US and double in Malaysia.
Yet India has one of the world’s highest rates of out-of-pocket spending in healthcare.
There are millions in India who cannot afford these procedures in their own country.

(4) Less than one doctor for 1,000 patients, but medical tourism booms:

India treated 3.6 lakh foreign patients in 2016 and the country’s medical tourism market is expected to grow to $7-8 billion by 2020.
The doctor-patient ratio in India is less than the WHO-prescribed limit of 1:1000.
There is a dearth of medical schools and clinicians.
Most hospitals in India are overburdened, understaffed, and ill-equipped.

(5) Stark divergence in healthcare outcomes within the country

Healthcare being a state subject, the healthcare outcomes have remained divergent based on the quality of the state administration.
While North India is the most populated part of India, it has one of the most undeserved healthcare infrastructures in the country.

These are some issues that surfaced during this pandemic

Poor Infrastructure: This is well revealed through indicators like hospital beds per 1,000 people.
Fewer doctors per thousand: The WHO mandates that the doctor to population ratio should be 1:1,000, while India had a 1:1,404 ratio as of February 2020.
Denial of healthcare: Private hospitals are reportedly denying treatments to the poor. Cases of overcharging patients are also being reported in private hospitals.
Underutilization: Despite private hospitals accounting for 62 percent of the total hospital beds as well as ICU beds and almost 56 percent of the ventilators, they are handling only around 10 percent of the workload.
Negligence for mental healthcare: Mental health problems are already a major contributor to the burden of illness in India which usually gets unnoticed.

Universal health coverage: Access to healthcare in India is not equitable—the rich and the middle class would survive the COVID-19 or any other crisis but not the poor.
Increasing healthcare professionals in numbers: India has handled the COVID-19 pandemic exceptionally well. However, India is in dire need of more medical staff and amenities.
Revamping medical education: If the government wants to stay successful in fighting the COVID-19 pandemic, it needs to rapidly build medical institutions and increase the number of doctors.
Cross-subsidization of health-care: How the poor managed without, or even with, any government insurance scheme is a big question. They can make up for the loss by cross-subsidizing treatments of patients with premium insurance policies.
Looping-in private players: For too long, India has allowed the private health sector to grow, with little regulation. Time is ripe to loop in private players and promote the industrialization of health-sector.

PLI scheme: In view of these challenges, the government announced various policies like PLI scheme for domestic manufacturing of active pharmaceutical ingredients (APIs).
National Digital Health Mission: It also announced the National Digital Health Mission.
Budgetary allocation: In the Union Budget for the financial year 2021-22, an amount of Rs. 2,23,846 Crore was allocated This comes to about 6.43% of total Budget provision.

India’s healthcare system is too small for such a large population.
There seems to be a long battle ahead. The public healthcare system cannot be improved overnight.
The country needs all hands on deck during and after this crisis—both public and private sectors must work together and deliver universal health coverage for all citizens.
Ultimately, the onus of governance always rests with the government, which needs to set standards, invest resources, ensure quality, and strategically purchase services from the private sector, as needed.