Dr Sanjay Kumar Bhasin
On 15 August 2021 when we celebrate 75th day of independence from the Colonial rule, it is important to review what we have achieved in these 74 years.
Thirty two crore Indians attained freedom 75 years back on 15th August with only 18.33% of the population being literate, women constituting only 8.86% (01 out of 11 being literate) and life expectancy stood at 32 years. Boosting healthcare infrastructure of the country was a daunting task for builders of Modern India, with only 50000 doctors and 725 healthcare centers at their disposal. Healthcare in India is an ancient phenomenon; during Buddha’s time (6th BC) hospitals were constructed to look after the handicapped and the poor. King Ashoka (273-232 BC) constructed outstanding hospitals in India and study of Medicine at its bloom in India as has been mentioned by Arabian and European travelers in their books. Portuguese brought concept of Modern Medicine to India, British and French build approximately 7000 hospitals in India.
How the Healthcare System Progressed:
Immediately after independence Ministry of Health made health as priority in a series of 5-year plans and ultimately National Health Policy was endorsed by Parliament in 1983. India has a ‘universal multi-payer health care model’ paid for by a combination of public and private health insurances along with the element of almost entirely tax-funded public hospitals. Along with Allopathy, the Indian government also accepted Homeopathy, Ayurveda, Naturopathy, Yoga, Unani and Siddha as valid alternative medicine approaches. A three-tier structure defines the Indian healthcare system-primary, secondary and tertiary care services, wherein; the delivery of services is extended right from sub centres to super specialist hospitals. Central Government also ventured to focus on higher education, research and national health programmes. It also launched the CGHS (Central Government Health Scheme) for government sector employees.
India slowly and steadily increased number of Medical Colleges, Hospitals and Dispensaries. India has an estimated 714 thousand hospitals beds spread out over 69 thousand hospitals including around 1.1 million beds in private hospitals, outnumbering the public hospitals. At present India has 43,486 private and 25778 public hospitals in place with 59,264 ICUs, and 29,631 ventilators in private and 35,700 ICUs beds with 17,850 ventilators.With this India ranked 11th with a score of 24 in health services, and 9th under Personalized Technologies indicator with a score of 30. But despite all the progress in India, it is not a global leader as it contributes for a third of the world’s poor; putting India at 131st rank out of 188 countries in United Nations Development Program report of the Human Development Index. The doctor-to-patient ratio remains abysmally low, at 0.7 doctors per 1,000 people against World Health Organization (WHO) average of 2.5 doctors per 1,000 people. But in spite of all odds, India has excellently controlled 06 major killer diseases, eradicated Small Pox and controlled AIDS exponential growth.
Present Health Status of India:
Our major health indicators are disheartening. India contributes to 15% of the global maternal deaths. MMR at 130 (2021) for every 100,000 live births is worst than neighboring countries like Thailand (20), Sri Lanka (36), and China (27). Similarly, our Infant Mortality Rate at 28.86/1000 live births at 50th place out of 222 countries, is much more than Sri Lanka (8), Nepal (25), Bangladesh (23), and Thailand (7), China (8) etc. Around 43% of Indian children are underweight today, in comparison to Pakistan (32%), China (4%), and Brazil (2%). According to the NFHS-4 data, only 62% of our children are fully immunized. Furthermore, India has the global rank 1 for tuberculosis (TB), contributing to 27% of the global notification of TB cases.Other developing Nations are placed much better than India. Non-communicable diseases burden is also much more with over 69 million diabetics in India and more than 1 million smoking-related deaths. Average age of the first heart attack among Indians is 53 years, 5-10 years earlier than in other nations.
India’s share in the global burden of diseases is quite significant (20%). India has only 9% of the global community health workers, 8% of the doctors globally (7.7 lacs in 2017), 8% nurses, 6% of the beds for patient care and only 1% laboratory technicians. India’s health-care access and quality index is even lower than small countries like Sri Lanka, Bangladesh, Bhutan, and Nepal. Our public health financing is amongst lowest in the world, varying from 1.2% to 1% of the GDP.
India’s healthcare system has been battling various issues, including the lack of infrastructure, less-than-adequate human resources, unmanageable patient-load and population explosion. High out-of-pocket expenditure remains stress factor with 65 per cent of medical expenses in India are paid out of pocket by patients (ranked 10th worst out of 185 countries). While public hospitals offer free health services, these facilities are understaffed, poorly equipped, and located mainly in urban areas. Preventive health has taken the back seat. Teaching institutions are fast becoming treatment centres severely affecting quality medical education.
Health, both physical and behavioral, is something that is of utmost importance to any nation if it wants to progress. India at 75 still have a long way to go before we can confidently say that our healthcare system is strong enough and is accessible by each and every citizen, irrespective of their ability to afford the same. On the positive side, Indian healthcare has surely come a long way post-independence. We have been slowly but gradually moving in the direction. Even though the healthcare infrastructure calls for a major overhaul, India has been able to put itself on the world map when it comes to medical tourism. Alternative treatments like Ayurveda, Yoga and Naturopathy have also seen a boom especially in the last decade or so. Accessible and Affordable healthcare in the public sector can considerably reduce the rise in dependence on private institutions. National Health Policy (NHP) 2017 with target of ‘Health for All’ at an affordable cost must focus towards proactive healthcare, not reactive healthcare. For that health and wellness centres (HWCs) component should get equal attention as the Ayushman Bharat scheme, the Pradhan Mantri Jan Arogya Yojana (PM-JAY) and universal health insurance scheme are getting. 75 onwards, India has to constantly keep working in the direction. Government initiatives and schemes, public private partnerships (PPP) in health, private sector hospitals, increasing awareness about health insurance and even start-ups in the space that use technology to reach a wider set of audience, hold the key in creating a robust healthcare ecosystem that will benefit the maximum number of our citizens. Citizens of the country hope that healthcare budgets shall be increased in view of the needs of the Nation for its lasting progress as Progress of the Nation is determined directly by the Health of its Citizens.
(The author is Professor of Surgery Senior Surgeon, Columnist, Honorary Secretary JK Chapter of Association of Surgeons of India)
Dr Sanjay Kumar Bhasin