Going out of reach

By Lekshmi Parmeswaran
In Health
December 11, 2015

In a country where 22 per cent of population lives under BPL, the public healthcare system is facing shortage of funds & doctors


According to World Health Organization, India has only 0.7 physicians per 1000 patients, which are well below the requirement of 1:1000

Another front and this time the Mahatma Gandhi was once quoted saying “It is health that is real wealth and not pieces of gold and silver”. The current situation of healthcare in India is anathema to the Gandhian ideals and the country has only been seeing an increasing commercialization of this sector. Probably no issue has stratified Indian society to the extent that healthcare care has. The division of the citizens into haves and have-nots is striking whichever way one looks.

With the government spending just 1.4 per cent of its GDP on public health for a country where 21.9 per cent of its population live below the poverty line, it comes as no surprise that healthcare has become the single biggest concern when one tries to get a glimpse into the future. Also the contrasting realities of this sector have given rise to more questions than answers regarding the sharp disparities that is visible even when one takes a cursory glance at the larger picture.

Some of the private hospitals in urban India are known for their high end facilities and have become the biggest hubs for medical tourism. These hospitals are housed with the most modern equipments and offer facilities that are on par with the international standards. But, in spite of the giant steps taken by what can be called the ‘creamy layer’ of healthcare, none of these benefits have trickled down to those who cannot afford the expensive treatment that is provided in such hospitals. For the rural India and the urban poor, the dawn of a serious illness on a family member still means a complete drain of the finances and a future that is often destroyed forever.

Why does India that boasts of institutions like the All India Institute of Medical Sciences and has some well formulated pro-poor health schemes, still lack in the delivery of essential services to those in need? There are no easy answers to this question as the challenges before the country are myriad. But the perception that only the private sector is capable of providing good quality treatment to the ailing is where the crux of the matter lies.

The very mention of government hospitals evokes in people images of disarray. They are seen as places with no order; where patients are huddled together and where the treatment given is substandard. While that is indeed the case often, the reasons attributed for the incompetence of these establishments might be very different from all that has been believed to be true so far.

A lot many facts about government hospitals are often overlooked while making an analysis of the prevalent conditions. When nearly 30 per cent of the country’s population lives below the poverty line, it also means that they have recourse only to low cost treatment. With such a large number of people visiting these hospitals, everyday a new challenge is thrown at the doctors working in such establishments. They handle more number of cases than any private hospitals and in the grueling situations with no proper support system. The real problem then becomes the lack of enough number of doctors to treat the less fortunate, and the lack of facilities at government hospitals.

According to World Health Statistics released by the World Health Organization (WHO), India has only 0.7 physicians per 1000 patients, which are well below the WHO requirement of 1:1000. The Medical Council of India has accorded full recognition to a total number of 302 medical colleges which will train 42,175 medical professionals while the total number of colleges in the country stands at 412. A further breakdown of these figures will reveal the real issue hindering the progress of the public health care delivery system in India.

Among the 412, only 200 are government run institutions and the rest 212 are in the private sector. The high capitation fees charged by the latter establishments with little focus on real merit make many of the students graduating from these colleges incompetent to face the real world challenges. And the select few who are capable enough to treat patients prefer to work in the private hospitals as that is where the monetary benefits are the maximum.

Related to this, is the problem of support staff. The government hospitals are woefully short of support staff. The nurses who are expected to manage more patients than it is humanly possible, naturally develop an attitude of resignation and often are not able to attend to the needs of each and every patient. The lack of sufficient numbers of lab technicians implies that the tests are never done on time and diagnosis come a little too late in some of the cases. Most of the hospitals do not even have sufficient number of beds to accommodate all the cases that come because of which many are forced to turn to private hospitals. But not all can afford private healthcare.

“The condition inside the government hospitals is mostly pathetic. The toilets are unclean and there have been occasions when I was left with no option other than using the soiled bed sheets. The used syringes and cotton swabs with blood stains on it which have become a common sight in the general wards and are a constant source of infections”, opines Omana, a domestic worker whose only recourse to get treated are the government hospitals.

There is also a clear lack of structure in the government hospitals. Often patients are made to wait in long queues which sometimes becomes fatal for those suffering from serious illness. In cases of emergencies there is no system of checks and balances in place that would make it mandatory for the doctors in to attend to such cases with a sense of urgency. The only remedy available to ordinary citizens for medical negligence is to take the route of long drawn legal battles through civil courts.

Besides, the sad reality is that a good number of the doctors enrolled in the government service prefer to work in hospitals abroad as those are equipped with the most advanced technologies and they also get a chance to earn more. Money also becomes important in the prescription of medicines and tests. Many doctors in the public sector sensing an opportunity to reap in benefits enter into a tacit understanding with the pharmaceutical companies and testing labs and subject patients to procedures that were never needed in the first place.

Time for action

Correcting all that is wrong with the public healthcare delivery system might not be possible in one go. But there can be efforts put in every day to improve the present situation. For that what is primarily needed is an understanding that only a healthy population can take the country forward. Also the cut of 5.7 per cent in total allocation to the health sector in the budget is in no way justified. Coming after the tabling of the National Draft Health Policy which has provisions of increasing the expenditure on health to 2.5 per cent of the GDP, it casts a veil of suspicion on the intentions of the government.

Here many have argued that the announcement of setting up of ten more All Indian Medial Sciences (AIMS) institutions could be a panacea for all the ills affecting this sector. Needless to say, this argument is based on false premises. What India needs at present are good hospitals within a radius of 5km of every residential area, be it rural or urban. More money needs to be spent on creating the infrastructure which includes diagonistic equipments that can give accurate results.

Perhaps, the most important of all is to bring in accountability and hold every stakeholder responsible for the timely delivery of services. A separate tribunal should be created and doctors should be brought under the Consumer Protection Act in order to curb any kind of negligence. Legal provisions should also be made to bring the BPL families under insurance cover. The biggest irony here is that India does not need to look outside to revolutionize its healthcare system. Three states in the country have forged ahead in ensuring an egalitarian society. The first case is that of Rajasthan which has reduced its poverty level by 10 per cent with a simple step of providing drugs free and basic diagnostics free of cost to the general public. The next is Tamil Nadu, which provides 400 medicines free of cost in its government dispensaries even as the centre is still debating this issue. The third and the most important one is that of Kerala which has become the first state in the country to provide cancer treatment free of cost and provide all the BPL families with an insurance of Rs 2 lakhs. It is also a known fact that the WHO prescribed treatment for Tuberculosis which is available in all government hospitals for free, is still the best cure for the disease.

In the end, for a country like India where all advanced technologies are available in the medical field, all it will take to revamp the system is a strong political will. Even when one thinks about the economic implications, the best possible solution is to invest more in the healthcare sector to give the coming generations a healthy and wealthy future.