Health

8 Ways in Which India's Public Healthcare Can Change for the Better

As we enter the new year, we reflect on the last, and dream of an India where all people live in good health. Here is one wishlist of items that could take us there.

1. Quantum increase in budget allocations

Despite modest increases in budget outlays over the last year, India continues to spend some of the lowest amounts as a country on health, around 1.1% of its GDP. The National Health Policy recommends increasing the outlay – Centre and state combined – to 2.5%. It further recommends that state budgets increase health allocation 8% of the total budget. At the moment, all states except Delhi a lot less than 8%. The Union budget also received a modest increase of 19% after near-constant allocations for two years.

We wish that the national and state budget allocations increase by at least 25% in the next year, i.e. the national health budget would receive Rs 80,000 crore (even if not accounting for purchasing power parity). However, this wouldn’t be sufficient because it contributes only to about a third of total government spending on health. A quantum increase on state government allocations to health is necessary: states increasing their allocation by 1% every year will help reach the recommended goal of 8% in four years.

We also wish that bulk of this increased spending will the fund national health mission as well as health and wellness centres that then help improve access to and quality of primary healthcare. And finally, we dream of adequate allocations to fund the Centre’s strategic plan to control tuberculosis, which remains the biggest threat to India’s public health.

2. Rebuilding trust between doctors and patients

Among other things, 2019 will be remembered for the low level of trust between doctors and the people, leading to several incidents of violence against doctors, and doctors taking to the streets in protest. This state of affairs is a result of an overextended healthcare setup with perverse incentives, making room for unethical practices and an increasing cost of care.

On the bright side, the trust deficit is so bad that it can only improve. We wish 2020 marks the beginning of an era of more compassion by doctors and better communication between doctors and patients.

3. Reclaiming peace and harmony

Conflicts produce ill-health in the societies. The Ottawa Charter for health promotion, released in 1986, lists peace as the first prerequisite for health. In 2019 in India, prolonged curfews, internet shutdowns and restricted communication in Kashmir, as well as in other parts the country, have adversely affected the mental and physical health of the country’s peoples.

We wish for a year of peace, harmony and stability, helping people lead healthier lives.

4. Introducing eggs in anganwadi centres

The Government of India released its first Comprehensive National Nutrition Survey in 2019. Its findings confirmed the high and persistent malnutrition among children across states. One problem here is the preferred source of proteins. For example, anganwadi centres in many states introduced eggs in their meals. Eggs can meet the protein needs of young children at an affordable price. However, many political leaders, activists and religious personalities resisted this move on religious and ideological grounds.

It is against the interests of children to deny them a good, sustainable and cheap source of proteins. We wish that in 2020, policymakers will stick to their original decision to supply eggs in anganwadi meals, and contribute to nourishing India’s underprivileged children.

5. Making workplaces safe

Recently, a factory fire in Delhi took the lives of 43 labourers, and the absurdity of it all will be hard to forget. A report released last year by Safe in India revealed how thousands of workers in the automobile sector lose their hands and fingers working in factories in Gurgaon. In 2020, we wish that India’s workers across sectors have access to safe working environments and hope that factory owners and administrators become more sensitive to their employees’ safety and illnesses.

6. A stronger push against tuberculosis

Apart from its lethal and/or debilitating effects – on individual people as well as their friends, families and communities – tuberculosis also continues to push people into poverty even after it has been treated. We have found through our research that patients in southern Rajasthan incur a debt of Rs 22,000 on average before presenting themselves to outpatient clinics, and most of them had to stop working thanks to the disease’s ill effects. Indeed, even after treatment resumed, many of them couldn’t resume full employment either.

There is a significant delay in the diagnosis of tuberculosis, especially among poorer people who don’t visit a doctor until the symptoms have become severe. While the Government of India has committed to administering people-centred care, the care remains both impersonal and erratic. Poor nutrition also affects the continuation and outcomes of treatment.

In the new year, we wish more patients of tuberculosis are provided the trifecta of humane healthcare, nutritious food and income opportunities they desperately need to be rid of this disease.

7. Primary healthcare centres regain their primacy

Two spate of infant deaths – in Muzaffarpur in Uttar Pradesh and then Kota in Rajasthan – in hospitals rocked the nation in 2019. The tragedy was only symptomatic of the extent to which government hospitals, where the children had been admitted for care, continue to be overstretched, understaffed and of poor quality, especially in North India. Reports like these only cover the tip of the healthcare iceberg. At the same time, these hospitals are the only ones available to a large section of the population, for whom private healthcare is just too expensive and often even geographically inaccessible.

The need for primary healthcare centres to provide humane care closer home, focusing on prevention and early detection, has never been so acute in India. Instituting more of them will significantly improve the population’s health outcomes even as they reduce the overall need for hospital care, in turn reducing the load on doctors, nurses, lab-workers, technicians and other hospital staff.

Of course, India already has a large number of primary healthcare centres and subcenters, but they remain far from adequate. A report the Centre for Policy Research, New Delhi, released last year showed that in 15 states, not a single one of these facilities meets the national public health standards set by the Ministry of Health and Family Welfare.

Since then, the Centre has claimed it has improves the quality of care in 40,000 centres and subcenters, and converted them to ‘health and wellness’ centres.

There are two components of the government’s Ayushman Bharat scheme. Of them, the Pradhan Mantri Jan Arogya Yojana, the universal health insurance scheme, has received more attention and resources than the the health and wellness centres component. This asymmetry does not augur well for the future of Indian healthcare.

Our organisation runs a primary healthcare centre in partnership with the Rajasthan government in the tribal district of Dungarpur. The centre deals with medical emergencies, provides outpatient care to about 100 people per day, conducts a coupe score safe childbirths a month, manages communicable and non- communicable diseases and provides preventive care to women and children in a catchment of about 25,000 people. All of this costs about Rs 50 lakh a year.

We wish that all primary healthcare centres in the country provide similar care with dignity, especially to the most marginalised.

8. Women and girls are able to access care whenever they need

Gender discrimination in India begins when a girl is born. The biological advantage reflected in the lower infant mortality rates among female babies relative to the males is offset by social and cultural preferences for male children, and many more girls die in infancy than boys as a result. This longstanding trend continued unabated in 2018-19 as well.

One way such discrimination manifests is when parents or other guardians take fewer girls and women to a healthcare facility for medical assistance when they need it. At the All India Institute of Medical Sciences in New Delhi, many more men seek care than women. Even in specialised newborn-care units in the country, and especially in Uttar Pradesh, more boys than girls are admitted, confirming an unsettling truth: discrimination begins at birth.

We have also witnessed distressing incidents of discrimination in care for women in southern Rajasthan, where many families often deny women and girls hospital care even in life-threatening situations.

In 2020, we wish that fewer babies die, and more women and girls seek – and receive – healthcare when they need it, irrespective of whether they are accompanied by others. We also wish that both the state and central governments are more proactive on this front.

Dr Pavitra Mohan is the founder and Dr Sanjana Brahmawar is the director of nutrition, both at Basic Healthcare Services.