Rural healthcare: of access, affordability

For all the gratified talk about India’s health sector and the medical tourism hub it has turned India into, the truth remains that our healthcare system is highly inequitable. Even today, a large section of our population has to travel more than 100 km to access basic healthcare.

Data collected by the NSSO in 2010 found that 86% of all trips taken for medical purposes were by rural Indians. According to estimates, urban centres are home to almost 70% of the doctors and almost 65% of the country’s hospital beds despite having less than 30% of the total population.

Government estimates suggested that as on March 31, 2017, only 4,156 posts for specialists were filled in Community Health Centres as against a requirement of 22,496. From lack of access to high cost of services, rural patients face several hurdles to healthcare that limit their ability to avail the care they need.

Pradhan Mantri Jan Arogya Yojana or Ayushman Bharat has raised much hopes. However, establishing an affordable and accessible healthcare ecosystem requires a wider approach that includes creating the required human resource and raising awareness among rural Indians.

Barriers to access

Low health literacy: Poor health literacy disables a patient’s ability to comprehend health information and instructions from healthcare providers. Sometimes, rural residents feel reluctant to visit a healthcare facility as they are not confident of communicating with a healthcare professional. At the same time, it also translates into low awareness about chronic diseases and symptoms that must be taken seriously. It is important, therefore, to have a functioning primary healthcare service closer to the doors of rural people.

Long distance commutation: According to a NATHEALTH-PwC report released in 2017, 50% of beneficiaries travel more than 100 km to access quality medical care as about 70% of India’s healthcare infrastructure is concentrated in the top 20 cities. The requirement of long distance commutation increases costs and inconvenience and often results in discontinuation of treatment. For people with chronic diseases such as hypertension diabetes, heart disease etc, this can have serious consequences on health.

Workforce shortage: Rural India faces a glaring shortage of doctors and allied healthcare professionals, severely limiting access to healthcare and negatively impacting health outcomes. Poor medical infrastructure in rural India also acts as an impediment to attracting qualified and trained health professionals. The government’s ambitious Ayushman Bharat scheme which envisages establishing of 1,50,000 health and wellness centres cannot succeed without addressing the human resource gap in rural areas.

The way forward

Human resource creation: Trained human resource to offer healthcare services can be generated by commissioning new medical colleges in rural areas, providing monetary and non-monetary incentives to doctors to work in rural areas, improving working conditions for healthcare professionals and providing them with ancillary infrastructure to carry out basic duties. Equipping trained AYUSH practitioners with the ability to diagnose and refer conditions at primary level can also temporarily fill the gap.

Re-skilling primary healthcare doctors: Doctors in rural areas should also be constantly reskilled and upgraded to keep them abreast with the latest developments in medical field. The doctors in primary healthcare setup must be updated and able to cope with evolving disease patterns and epidemics and make right diagnosis and provide quality treatment. It is important, therefore, to make CMEs mandatory for them.

Innovative approaches to healthcare: To bypass the problems of human resource and infrastructure shortage, we need to create innovative and low-cost solutions and technologies that can enable us to bring healthcare closer to the homes of rural populations. Rural ambulances, mobile check-up vans, healthcare kiosks and use of telemedicine are some ways.

Gramin Healthcare has opened more than 100 operational kiosks across six states that provide basic healthcare services at subsidised rates to villagers every day. These kiosks are digitised healthcare clinics that use telemedicine. They have a nurse who conducts a physical examination and connects with the online doctor by live audio or video feed through a technology backed platform.

We need many more such disruptive initiatives and platforms to further the goal of universal healthcare.

(The writer is Founder, Gramin Healthcare)