Health sector needs funds and manpower

A strong healthcare system has a direct and positive correlation with the economic growth of a country. The unprecedented disruption caused due Covid-19 has made us cherish the crucial services rendered by doctors and paramedical staff in nation building. Every year, India celebrates July 1 as National Doctors’ Day, honouring Bharath Ratna Dr Bidhan Chandra Roy, who played an important role in establishing many centres of excellence in the health sector including the Indian Institute of Mental Health, the Infectious Disease Hospital and Kolkata's first-ever Postgraduate medical college. The visionary had helped India strengthen its primary health care services in the early 1950’s and 60s. Although, there have been key initiatives by the incumbent governments, there persists issues related to human resources and health finances in the medical sector.

The 2030 Sustainable Development Agenda (SDA) emphasises on Health and Well-being in its Goal number 3. The National Health Policy (NHP) 2017 had set a target of government expenditure on health at 2.5 % of the GDP by 2025 and had asked the states to spend at least 8% of their Budget on the health sector by 2020. There is a long way ahead. But there have been efforts. The Union Department of Health and Family Welfare was allocated Rs 38,343 crore in the FY (Revised Estimates) 2016-17. With a more than 105% CAGR growth rate, in FY 2020-21 (RE) Rs 78,866 crore was allocated— the government had understood the importance of a strong health sector even before pandemic hit the nation. In order to achieve the NHP target, state governments have come forward to provide an adequate budget for healthcare to strengthen the delivery system and reduce the Out of Pocket Expenditure of households.

The World Health Organization (WHO) has promulgated a desirable doctor–population ratio as 1:1,000. According to official figures, as on June 30, 2020, there are 12,55,786 allopathic doctors registered in the country; besides the 7.88 lakh Ayurveda, Unani and Homeopathy (AUH) practitioners. Assuming 80% availability, the doctor-population ratio in India is 1:825. But this ratio alone does not signify a strong health care system, which is influenced by many factors including adequate financial resources for the sector, strong pharmaceutical industry with a favourable R&D ecosystem and sufficient production of medical devices.

The Rural Health Statistics 2019-20 highlights the shortfall of specialist doctors in Community Health Centres (CHC). There is a marked shortfall of 78.9% of surgeons, 69.7% of obstetricians and gynecologists, 78.2% of physicians and 78.2% of pediatricians compared to the requirement in the CHCs. At Primary Health Centres (PHC) 24% of the sanctioned posts of doctors were vacant in 2020. These high vacancies underscore the challenges faced in deploying and retaining personnel at PHCs and CHCs. Reduced doctor availability can cause patients to wait for hours for a consultation, leading to delays in treatment— this adds to higher mortality and morbidity issues. Also, given the size of India, ensuring easy and hassle-free medical services can be a big challenge. Increasing the number of medical seats at undergraduate (UG) and postgraduate (PG) levels is a right step in this direction. The number of MBBS seats have been increased by 48% between 2014 and 2020. The numbers of PG seats have also increased by 79% over the same period.

Way forward

There is a clear requirement to strengthen the health infrastructure. States have to confirm to NHP 2017 goals to build state-of-the-art infrastructure, which optimise the delivery of health services. Also, preventive healthcare should be promoted and programmes to create awareness about healthier lifestyle and wellbeing should be encouraged. The vacancies in PHCs, CHCs and District Health Centres (DHCs) must be systematically filled to ensure that medical graduates are provided an opportunity to work there. A rotational mechanism will not only enhance the expertise of professionals but also provide job opportunities to fresh recruits. Effective utilisation of health professionals can further strengthen the health system. Specialisation of health professionals should be mapped to the demands and requirements of a region and this should be the basis for allocation of resources in different health facilities. Further, health professionals should be incentivised to work in their allocated posts. Apart from financial incentives, professional incentives such as work credits and relocation benefits can be provided to doctors and nurses working in PHCs, CHCs and DHCs. The authorities should also explore the option to deploy digital tools such as Clinical Decision Support Systems to provide better consultation and diagnostic services.

These measures will reinforce our efforts to achieve the SDG 3 targets and increase health worker density and distribution across the country.

(Kalal is Deputy Secretary (Health) and Kaur is Associate (Health) at the Niti Aayog)