Making Health Accessible
Making Health Accessible
The common public discourse on the wealth of nations often eclipses the much-needed talk on the health of nations. India spends one of the lowest amounts ($75 or Rs. 4875) in terms of per capita health expenditure (compared to a global average of $1059/Rs. 68,835, according to the World Bank. As a share of its GDP, India’s public health expenditure is a meagre 1.4%, against a global average of 5.9%. Health forms the backbone of any society and no government should ignore its people’s legitimate demand and aspiration for quality health services, that they both desire and deserve.
Mr. Scindia remains committed to universal health coverage, strengthening the primary healthcare system, linking new medical colleges, provision of free drugs and diagnostics at public health facilities. He has envisioned a 6-point plan to overhaul the healthcare system:
- Primary health care: There is an urgent need to provide accessible and affordable primary-care services covering at least minor ailments, along with risk screening for early disease detection, good-quality medicines, and appropriate referral linkages to secondary and tertiary health in case of serious ailments. Currently, primary health care facilities in India suffer from a severe shortage in beds, basic equipment, healthcare providers like doctors and nurses, and medicines. Our current primary health system needs to be completely overhauled so as to go beyond basic treatment and provide immunisation, maternal and child health services, free essential medicines and diagnostics. However, a well-functioning comprehensive health care system also requires adequate fund allocation, along with a robust monitoring system to regularly track patient outcomes.
- Health infrastructure: The state of healthcare in India does not paint a pretty picture – a shortfall of 20% in primary health centres, 30% in community health centres and 20% in sub-centres. Those that exist are also poorly equipped, with crumbling medical infrastructure, often in single rooms. With 0.9 beds per 1000, India ranks far below the global average of 2.9 beds. There is also a need to upgrade and create good healthcare infrastructure – clinic and hospitals, which must be adequately staffed with doctors, nurses, and equipped with quality medicines and equipment.
- Human resource for health: A crucial element of our healthcare system is the availability of quality medical professionals. Currently our primary health system struggles with a below-par national physician-patient ratio of 0.76 per 1,000 population, among the lowest in the world, due to a paucity of MBBS-trained physicians, and more worryingly, the unwillingness of existing physicians to serve in remote and rural areas. Madhya Pradesh, for instance, faces a shortfall of 51% of specialist doctors, while primary healthcare centres too languish in neglect, with 58% of Medical Officers at PHCs posts lying vacant. Capacity-building efforts must also include other non-MBBS personnel such as nurses, auxiliary nurse midwives and rural medical assistants.
- Strengthening the grassroots system: At the local level, India’s healthcare system is equipped with ASHA workers, Auxiliary Nurse Midwives and Anganwadi workers. As primary health care givers, they are supposed to reach every individual in their locality to provide basic facilities. However, even this, fundamentally sound system, is collapsing on itself due to poor compensation, heavy workload and lack of security of tenure. Mr. Scindia recognizes that these healthcare providers play a crucial role at the grassroots level and considers it extremely important to strengthen them by taking into account and resolving their issues and demands.
- Health insurance: Health insurance in India suffers from lack of scale, covering only 29% of households. The out-of-pocket expenditure in India accounts for nearly 62% of the country’s total healthcare expenditure, so it is not enough to simply enhance access and coverage, a health policy must also aim to reduce out-of-pocket expenditure, by covering outpatient care, which accounts for the largest part of OOPE.
- Health Research & Outcomes: A robust institutional framework that tracks patient outcomes like disease, death, infection must be regularly reported and monitored. For a country like India with a burgeoning population that is now also witnessing a swift uptick in non-communicable, lifestyle-related diseases, it is crucial to invest funds to research development activities in diagnostics, vaccines, new drugs, in addition to the control and management of communicable diseases, fertility control, maternal and child health, and control of nutritional disorders.
Work So Far
Towards achieving this goal of affordable, quality healthcare for all, Mr. Scindia has made a number of interventions in his constituency:
- Shivpuri Medical College (built at a cost of Rs. 190 cr) will transform the state and quality of medical education and produce doctors who can help lift healthcare in the underserved parts of the state.
- Lifeline Express: The world’s first hospital on a train, stops in his constituency of Guna (covering a district each every year), where it provides quality healthcare to rural patients, whether it is eyesight, hearing, mobility restoration, cleft lip correction, dental or neurological treatment, or life-saving cancer surgery. Started in 2003, the Madhavrao Scindia Health Mission-sponsored Lifeline Express has treated over 1.7 lakh patients in and around Guna, Shivpuri and Ashoknagar.
- Trauma Centresin Guna, Shivpuri and Ashoknagar at a total cost of Rs. 15 cr.
- Smile on Wheelsmobile hospital van in Chanderi that treated over 80,000 patients over 4 years.