Primary Health Centre india healthcare
Where do you think India stand globally in the healthcare sector? I had no clue until I stumbled upon this page in the World Health Organization (WHO) website. India is ranked 112th  in the world out of 191. I will try to explain why we are in that position even after 67 years of Independence. Lets take a look at the various choices an Indian citizen has regarding health services in the country.

Pathetic condition of Public Hospitals

India spends just about 1.3% of the GDP for healthcare and this is one of the lowest rates by any country in the world. That single fact shows how much the Government cares about the nation’s healthcare system. The lack of investment in the healthcare system is most evident in the higher level hospitals like the District hospitals and the Government medical colleges. One would think twice before seeking health care from such hospitals. I will tell you why. Most of these public hospitals in rural areas of India don’t even have the most basic facilities available. Those hospitals in the urban areas are no different. Being the highest level of referral institution in the area, the Out Patient Department (OPD) will be overcrowded. Long queues  can be found extending beyond the gates even before the OPD hours begin. The wards are not for those who are conscious about their personal hygiene. If you get a bed in the General Ward, you are one lucky fellow. Others need to find their space in between the beds and often the verandahs. Insects and even rats (not exaggerating!) can be easily found if you have good eyes. Even if you are willing to suffer all this, there will be shortage of Doctors and other staff at the hospital and so the quality of the healthcare hangs under a huge question mark in these hospitals.

The poorest in the rural areas will get only basic primary healthcare from a Primary Health Centre (PHC). If his/her malady persists, the poor patient is referred to a higher centre for further treatment/management. The hospital which the poor man chooses is obviously the public hospital (Taluk/District/even medical college) because he cannot afford to the treatment expenses for care from a private hospital. And no wonder, India being the second most populous county in the world, the number of persons seeking public healthcare services is not going to decrease. The public hospitals as a general rule has thus become the poor man’s hospital.

Shining Private Hospitals

If you have never known or been to India, you would be surprised when you learn about the Medical Tourism prevalent in the country. Not far away from the above mentioned public hospitals, there are countless number of private hospitals and speciality clinics. Air conditioned lobbies and rooms, well dressed attenders, elevators and not to forget, the mere number of doctors and other nursing staff will lure the wealthiest in the community to these hospitals. The middle class also makes use of these hospitals and often end up in huge debts. I had once read about the millions of Indians who were pushed into poverty every year because of the medical expenses alone.

These private hospitals provide diagnostic tests and surgical procedures at rates which might be unaffordable for the lower economic class Indians, but not so for the ‘foreign’ patients. In their countries the same tests and procedures might be costing ‘x’ times than in India. This is one of the main reasons for the  growing industry of ‘medical tourism’ in the country.

Rising Demand for Doctors

Just ask any doctor who has recently resigned from Government Health Service department why they did so and you will get only one answer – financial reasons! Health workers are dropping out from pubic healthcare system very rapidly. Most of the doctors want to get a speciality post-graduation and work in a private hospital. Others, prefer to go abroad  for work or for higher studies. The situation is getting more evident in the rural areas of the country. The Government keeps on ignoring this fact and is doing nothing to prevent this shortage.

Health Insurance in India

According to The Hindu, based on fresh stats, only 17% of the total population of India were covered under health insurances. There are some Government sponsored Insurances prevalent in the country, the benefits of which most people in rural areas are still unaware of. There are numerous private companies too playing their cards in this business. Most of the patients covered under insurance scheme have to meet their medical expenses from their own pockets. This pushes them deeper into poverty. Our Prime Minister has plans to implement big insurance schemes based on the ‘American model’. But is it really enough?

Comparing with Western countries

Our country has the diverse spectrum of healthcare facilities, ranging from mere basic ones to modern superspeciality clinics. But why is there such gross inequality in the services that the common man can avail? One major fact is the investment in healthcare. United States of America for example spends about 18% of its GDP just for healthcare (one of the highest). I am not saying that USA has the best healthcare system in the whole world. One of the major drawbacks of the American healthcare system is that it is purely based on ‘health insurance’. Only the insured people get health care. others just don’t. Vast majority of health services in the USA is provided by the Private companies (with access to the Government) and the cost of these services is decided by these companies, which is the reason why medical or surgical care in America is one of the most expensive in the world. India had always tried to imitate the American healthcare system without laying the proper foundations.

The National Health Service (NHS) is one of the best healthcare system in the world that every country should cry out for. The system is owned and run smoothly by the Government giving equal health care facilities to all its citizens. The family doctors are given more importance in their system. A patient can consult a specialist doctor only if the family doctor refers him/her.

How to Improve our Healthcare System

“The needs of the many must prevail over those of the few”.
Health, as you all know has been declares a fundamental human right which implies that the Government has a responsibility for the health of its people. The current hurdles in front of every Government is to make the healthcare services accessible to all its citizens in urban and rural areas equally. Another important thing to keep in mind for the policy makers and medical experts is to give more emphasis on ‘Preventive Medicine’ rather than just offering curative services of all sorts (a topic for another day perhaps). Keeping this in mind, the long proposed “Health for All” can only be achieved by strengthening the Primary Health Care system in the country.

 There is no meaning in just investing more money in building new hospitals and speciality clinics. We have to start building from the ground level. Here are some of my suggestions :-
Health doesn’t imply medical care alone. Health has many pillars which includes Housing, Sanitation, Healthy life style, and many more. The Government should start with these pillars by providing proper drinking water, housing and proper sanitation facilities for the whole population. Sounds impossible in a country like India, isn’t it? The UK government has been doing this for decades and still continues to do so. My cousin who works in the UK has told me that one can sue the Government there if he/she gets a disease after consuming the potable drinking water provided by the State. We have the manpower, the money and all the other resources, but we haven’t even thought about this concept.
Spending more money on the healthcare system  has already been mentioned. This must be done in such a way that the rural areas gets more benefits. More PHCs needs to be setup. PHCs should be made the first portal of entry for every individual. Along with this, setting up an efficient referral system is very much needed for the proper delivery of health services. Everyone irrespective of their wealth should have an easy access to public hospitals. Capital should also be utilised to provide health insurance schemes to all the economically backward people in the country. Expenditure for providing preventive, curative and rehabilitative health services should be made an unavoidable part of every Budget.
MUST READ : The concept of “Health for All
Haven’t you heard about NRIs complaining of the healthcare services in India compared to the other countries? They put the blame only on the Government and keeps on doing their  things. They abide to the sanitation rules in the foreign countries where they work and forget it when they reach their homeland. Not only the governing body, but us, the community has duties and responsibilities to improve the system. We should implement proper waste management methods in our household, we should keep our environment clean.
Instead of asking for more speciality hospitals and more infrastructure in the secondary healthcare level, every individual in the country should ask their respective political representatives to provide them with good quality drinking water, good sanitation facilities  and good primary healthcare facilities for a change in the right direction.
Jobs of Health Workers including doctors should be made more attractive to reduce the number of dropouts and to encourage the young generation to think about building a career in the Health Department.
An effective mechanism to make the whole country’s healthcare system centralised, for proper regulation and maintenance should be implemented as early as possible. The costs of health services even in Private hospitals should be regulated by this mechanism.

Wrapping it Up

India has all the potential to become one of the best countries in the world in every sector and that can be achieved only if we start with the healthcare system. Our new Government can make all the necessary changes that are required to make the healthcare system of India one of the best in the world. We the people of India also have our roles to play in shaping up the best healthcare system of the future. This might take several years, sometimes even decades, but for all that to happen, we must start moving in the right direction from today. Let’s do it.
Image Credit – CDC Global
Dr Prasoon

Dr Prasoon

Author at BeingTheDoctor
Dr Prasoon, founder of BeingTheDoctor is a qualified medical practitioner who finds time to write articles on "health" and his "clinical experiences". He is currently engaged in providing primary health care services in rural India. Learn more in the "about" page.
Dr Prasoon

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