The next decade will see healthcare being a top priority. Let’s look at the facts: India accounts for 17% of maternal deaths; the highest number of tuberculosis mortalities in the world; 62 million people suffering from diabetes; and a burgeoning population of stunted children.
A major factor driving these numbers is the lack of affordability of quality care. India is now home to the world’s largest healthcare scheme, which promises insurance cover to over 500 million people. All eyes are now focused on whether this ‘brahmastra’ can materialise and reduce the economic burden of disease treatment on the common man.
The existing healthcare sector needs a holistic approach that combines the key issues— affordability, accessibility, and quality. However, in the race to reduce rising medical expenditures, it seems like we are missing the quality aspect.
An “affordability-only” model cannot work if quality is side-tracked. India’s overall healthcare expenditure to GDP is around 1%, much below that of Bangladesh, Bhutan and Sri Lanka. Now, Indian primary health centres (PHC) — the roots of preventive care — alone need 1% of GDP to meet their requirements and maintain the necessary quality standards.
For instance, take the case of safe injection practices in India. Only 22.5% of the injections are administered with a sterile syringe and needle in the metropolitan cities of North India.
The unsafe injection practices, such as re-use of syringes, lead to the spread of common infectious agents such as hepatitis (HBV and HCV), and HIV which could potentially be life-threatening diseases leading to a tremendous cost burden on the patient as well as to the healthcare setting. Auto-Disable (AD) syringes are the most efficient option in the market today to prevent instances of re-use of syringes.
Since PHCs are the point of contact for preventive care, it should be mandatory to empanel these centres with auto-disable syringes. AD syringes prevent the re-use of syringes and help in preventing transmission of bloodborne pathogens from one patient to another.
To ensure that quality medical devices like AD syringes become the standard practice in every health centre, the government needs to strike a balance between affordability, accessibility and quality. Although the initial cost of AD syringes might seem high, the decreased incidence of hepatitis and HIV, in the long run, would reduce the financial burden drastically.
Over the last couple of decades, India has rolled out numerous healthcare schemes. But if we look at the current state of healthcare infrastructure, we can imagine that the road to achieving accessible, affordable as well as quality care is full of challenges. To overcome these hurdles, we need to prioritise and abide by the fundamentals.
Get basics right
Let’s understand why there is a need to build the capacity of the medical infrastructure to optimise the delivery of healthcare. In the current scenario, there is only one qualified doctor available for every 11,082 patients — much higher than the World Health Organisation-recommended ratio of 1:1,000. The Indian healthcare system is thus short of about six lakh doctors, in addition to facing a shortage of 20 lakh nurses.
In another startling report on the state of medical infrastructure, this time in Chhattisgarh, the Comptroller and Auditor General (CAG) found that between 2012 and 2017, “The state suffered from shortages of human resources in critical positions of specialist doctors to the extent of 89%, medical officers by 36%, staff nurses by 34% and paramedics by 12% against their sanctioned strengths...”
While we continue to march on expanding the reach of medical services across the length and breadth of this country, we cannot override quality in the name of maximising accessibility. In a 2018 report published in The Lancet, it was stated that “expanded healthcare coverage does not always mean better quality.”
For instance, Janani Suraksha Yojana was initially meant to reduce the maternal mortality rate and infant mortality rate in India. But this Yojana ended up giving aid to pregnant mothers through a cash incentive programme for the birthing facility. Although it did massively increase institutional deliveries, it did not reduce maternal and new-born mortality rates as it was expected to do.
One of its major shortcomings was the lack of addressing crucial components like antenatal and neonatal care. Even today, around 44,000 women in India die annually due to preventable pregnancy-related causes.
The lapses in the Indian healthcare sector keep pushing away the dream of quality healthcare. Since India’s healthcare sector is at a critical juncture, the next few years will be a testimony to India’s commitment to fighting its long-standing healthcare issues.
Noble-minded schemes like Ayushman Bharat are steps in the right direction. However, it is critical to address the problems of quality and efficacy of drugs and medical devices while maintaining cognisance of the affordability aspect of healthcare.
(The writer is Director-Critical Care, Medanta, Gurgaon)