Low spending, paucity of healthcare workers and abysmal infrastructure are some critical concerns bedeviling our healthcare sector. In the Union Budget presented by Finance Minister Nirmala Sitharaman, the allocation for the National Urban Health Mission went up from Rs 875 crore to Rs 950 crore, confirming that tertiary care continues to be at the centre of policymaking, though primary care needs it the most.
A dysfunctional primary healthcare system translates into lack of accessibility, delay in diagnosis and referrals, and a number of preventable deaths especially in rural areas where private healthcare facilities remain limited and unaffordable. Along with an increase in public spending on health, we need a multi-pronged approach to make primary healthcare functional at the grassroots.
The lack of trained doctors and other paramedical staff is one of the biggest hurdles to improving the state of healthcare services in the country, especially in rural and underserved areas. There is just one government doctor for every 10,189 people, a figure that is woefully short of the WHO recommended doctor-patient ratio of 1:1000. The nurse patient ratio is 1:483, compared to the ideal ratio of 1:4. As it stands, we have a shortage of 6,00,000 doctors and 2 million nurses.
Mammoth vacancies bedeviling primary healthcare in rural areas imply that there are villages where health centres are running without doctors and specialists. According to a recent survey, close to 6% of the primary healthcare centers have only one doctor, while 5% have none. The government urgently needs to open more medical colleges, and increase the number of MBBS and PG seats in medicine to meet the demand for doctors.
Lack of skill and knowledge upgradation is another problem bogging down primary healthcare in India. According to the Medical Council of India, primary physicians are mandated to complete 30 hours of Continuing Medical Education (CME) once every five years for re-licensure. However, only 20% of physicians in India follow this as it’s not legally binding.
In the recent past, cases of doctors still prescribing single or double anti-retrovirals for HIV/AIDS patients instead of triple combinations which are standard now have been reported. This knowledge gap leads to problems like anti microbial resistance (AMR) and even deaths. Making CMEs mandatory and promoting provision and pursuing of online CME courses is important to enable primary healthcare providers to upgrade their skills and knowledge in the field.
As healthcare becomes more value-based and patient-centric, digital technology is going to play a key role in preventive healthcare. Primary healthcare can reap dividends by adopting digital technology to minimise errors in records and improve the delivery of curative services. Telemedicine centres can be an alternative to improving access to rural populations. Currently, a number of private organisations and NGOs are experimenting by introducing novel telemedicine technology in rural areas. We need to scale this up to bring real-time benefits to rural populations who have to travel long distances to even access a physician.
A lot of the private organisations in India have state-of-the-art infrastructure and world class treatment facilities. Unfortunately, most private hospitals are concentrated in urban areas where presence of high income population makes the venture profitable. Understandably, private hospitals would struggle to earn profits in rural areas and need major incentives to start operations there.
The government must make private healthcare a partner in our collective endeavour to scale up accessibility. Incentives to private sector for starting hospitals in rural areas can include tax breaks till the hospitals break even, help in land procurement and reducing GST on medical equipment. It will help quality and affordable healthcare trickle down to the grassroots.
(The writer is Senior Advisor, Innovations & Public Health)
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