<p>India can certainly do a lot to improve public health in the country. Spending a lot more money may seem to be the obvious answer. But money is not the only constraint, although we have been crying ourselves hoarse that the government needs to double or triple its spending on health. There are many other things that need to be streamlined to ensure quality healthcare for our citizens.<br /><br />Improving healthcare delivery systems ought to be the subject of intense policy deliberation and debate because the development of the country hinges on the health of its people.<br /><br />But where does good health begin? It begins with our children. Unfortunately, statistics in this regard are not too flattering. India is far behind the rest of the world in terms of the number of malnourished children, shockingly double that of Sub-Saharan Africa.<br /><br />• Almost half of all deaths of children under the age of five years is due to undernourishment<br /><br />• 44% of children under the age of five are underweight<br /><br />• 72% of our infants are anaemic<br /><br />• Inadequate sanitation, safe water trigger infection-malnutrition cycle.<br /><br />If our children do not get the right start in life, they will remain undernourished and underdeveloped, and worse off than children in the rest of the world. Where does this leave our future workforce? We will remain an unhealthy nation with human resources that function below par. This has far-reaching consequences on the country’s economic and social development.<br /><br />At the moment, the government spends about 1.15% of GDP on healthcare. This needs to increase to at least 2.5% over the next few years to make any appreciable difference. Bad health hampers performance, productivity and negatively affects human capital development. Given our federal structure, we need to ensure that health remains a priority for the central as well as state governments.<br /><br />The central and state governments need to work collectively to ensure the four main prerequisites of a good healthcare system: quality, accessibility, availability and affordability. The government and health regulatory bodies need to ensure that quality standards and minimum patient safety protocols are enforced.<br /><br />The increase in public health spending should be accompanied by changes in where that money is spent. A substantial part of public spending should be channelised into primary health, as committed in the 2017 health policy. Offering better primary care will help reduce the number of cases where diseases or complications progress to a point where they require expensive and aggressive treatment at tertiary healthcare centres or cannot be cured at all.<br /><br />For a national health system that works, we need more medical and nursing schools and thousands of health workers, particularly in rural areas. What is urgently required is a multi-layered, qualified, trained and committed workforce. We need a large number of health management professionals to run facilities and programmes efficiently.<br /><br />Pvt sector monopoly<br /><br />The healthcare sector in India is one of the largest sectors both in terms of employment and revenue generation. It has grown at a compounded annual growth rate of 16.5% and is expected to be worth $280 billion by 2020.<br /><br />But National Sample Survey (NSS) figures over the last two decades show a decline in the share of public hospitals in treating patients. This trend could over time give private players a virtual monopoly, leading to steep hikes in prices of diagnostics and medical treatment.<br /><br />High healthcare costs and lack of insurance coverage penetration often result in greater out-of-pocket expenditures for diagnosis, consultation and treatment. Still, people today prefer private healthcare, despite its whopping costs, because of the dismal quality and lack of accessibility and accountability of the public healthcare system in both rural and urban India.<br /><br />Clearly, a lot needs to change. The doctor-to-patient, patient-to-bed, and equipment availability-to-utilisation ratios need to improve. The unbridled rise in the cost of secondary and tertiary care treatments in urban <br />areas need to be checked. Communication and coordination skills among hospital staff and doctors, soft skills and time management, emergency health, <br />crisis, and supply chain management need to improve drastically. A multi-prolonged approach is necessary, and its implementation needs to start immediately on a fast-track basis.<br /><br />Public intervention in healthcare delivery needs to include:<br /><br />• Monitoring of both public and private delivery systems<br /><br />• Ensuring authentic diagnostic facilities at affordable cost<br /><br />• Supplementing healthcare with better municipal services — clean air and water, pest control, good sanitation and sewage systems, proper treatment of waste — and including healthcare awareness and physical fitness in school curricula to ensure preventive healthcare.<br /><br />A robust public healthcare system is essential for transforming the socio-economic trajectory of India. We need people who are qualified and trained as hospital managers and who can take care of management-related issues so that doctors can focus on providing clinical care, which they are trained for.<br /><br />(Dr Sanjiv Kumar is Director, and Dr Sumesh Kumar, Assistant Professor, IIHMR, Delhi)</p>
<p>India can certainly do a lot to improve public health in the country. Spending a lot more money may seem to be the obvious answer. But money is not the only constraint, although we have been crying ourselves hoarse that the government needs to double or triple its spending on health. There are many other things that need to be streamlined to ensure quality healthcare for our citizens.<br /><br />Improving healthcare delivery systems ought to be the subject of intense policy deliberation and debate because the development of the country hinges on the health of its people.<br /><br />But where does good health begin? It begins with our children. Unfortunately, statistics in this regard are not too flattering. India is far behind the rest of the world in terms of the number of malnourished children, shockingly double that of Sub-Saharan Africa.<br /><br />• Almost half of all deaths of children under the age of five years is due to undernourishment<br /><br />• 44% of children under the age of five are underweight<br /><br />• 72% of our infants are anaemic<br /><br />• Inadequate sanitation, safe water trigger infection-malnutrition cycle.<br /><br />If our children do not get the right start in life, they will remain undernourished and underdeveloped, and worse off than children in the rest of the world. Where does this leave our future workforce? We will remain an unhealthy nation with human resources that function below par. This has far-reaching consequences on the country’s economic and social development.<br /><br />At the moment, the government spends about 1.15% of GDP on healthcare. This needs to increase to at least 2.5% over the next few years to make any appreciable difference. Bad health hampers performance, productivity and negatively affects human capital development. Given our federal structure, we need to ensure that health remains a priority for the central as well as state governments.<br /><br />The central and state governments need to work collectively to ensure the four main prerequisites of a good healthcare system: quality, accessibility, availability and affordability. The government and health regulatory bodies need to ensure that quality standards and minimum patient safety protocols are enforced.<br /><br />The increase in public health spending should be accompanied by changes in where that money is spent. A substantial part of public spending should be channelised into primary health, as committed in the 2017 health policy. Offering better primary care will help reduce the number of cases where diseases or complications progress to a point where they require expensive and aggressive treatment at tertiary healthcare centres or cannot be cured at all.<br /><br />For a national health system that works, we need more medical and nursing schools and thousands of health workers, particularly in rural areas. What is urgently required is a multi-layered, qualified, trained and committed workforce. We need a large number of health management professionals to run facilities and programmes efficiently.<br /><br />Pvt sector monopoly<br /><br />The healthcare sector in India is one of the largest sectors both in terms of employment and revenue generation. It has grown at a compounded annual growth rate of 16.5% and is expected to be worth $280 billion by 2020.<br /><br />But National Sample Survey (NSS) figures over the last two decades show a decline in the share of public hospitals in treating patients. This trend could over time give private players a virtual monopoly, leading to steep hikes in prices of diagnostics and medical treatment.<br /><br />High healthcare costs and lack of insurance coverage penetration often result in greater out-of-pocket expenditures for diagnosis, consultation and treatment. Still, people today prefer private healthcare, despite its whopping costs, because of the dismal quality and lack of accessibility and accountability of the public healthcare system in both rural and urban India.<br /><br />Clearly, a lot needs to change. The doctor-to-patient, patient-to-bed, and equipment availability-to-utilisation ratios need to improve. The unbridled rise in the cost of secondary and tertiary care treatments in urban <br />areas need to be checked. Communication and coordination skills among hospital staff and doctors, soft skills and time management, emergency health, <br />crisis, and supply chain management need to improve drastically. A multi-prolonged approach is necessary, and its implementation needs to start immediately on a fast-track basis.<br /><br />Public intervention in healthcare delivery needs to include:<br /><br />• Monitoring of both public and private delivery systems<br /><br />• Ensuring authentic diagnostic facilities at affordable cost<br /><br />• Supplementing healthcare with better municipal services — clean air and water, pest control, good sanitation and sewage systems, proper treatment of waste — and including healthcare awareness and physical fitness in school curricula to ensure preventive healthcare.<br /><br />A robust public healthcare system is essential for transforming the socio-economic trajectory of India. We need people who are qualified and trained as hospital managers and who can take care of management-related issues so that doctors can focus on providing clinical care, which they are trained for.<br /><br />(Dr Sanjiv Kumar is Director, and Dr Sumesh Kumar, Assistant Professor, IIHMR, Delhi)</p>
