Relevance: GS-2: Issues relating to the development and management of Social Sector/Services relating to Health, Education, Human Resources.

Key phrases: Health care, PHCs, SHCs, tertiary care, urban- rural devide, out of pocket expenditure.

Why in News?

• Apollo Hospitals MD Suneeta Reddy said on Friday the healthcare sector should not only be the focus of the Budget, but must also remain at the centre of the economy as the country aspired to become a $5-trillion economy.

Healthcare service in India:

• In 2020-21, India spent 1.8% of its gross domestic product (GDP) on healthcare. With ‘health and well-being’ one of the six pillars of the Union Budget 2021-22, the government has committed approximately 2.5-3% of GDP now.
• Data shows that India has 1.4 beds per 1,000 people, 1 doctor per 1,445 people, and 1.7 nurses per 1,000 people. According to the World Health Organization (WHO), India ranks 184 out of 191 countries in health spending. The US spends over 16% of its total GDP on healthcare, while Japan, Canada, Germany etc. spend over 10% of their GDP on healthcare.
• Healthcare deserves that position now more so because we are a nation where 70% of healthcare spending is out of pocket. It is time to look at healthcare differently,

Problems with Health Care Infrastructure of India:

• Health care infrastructure is heavily skewed in favour of urban areas The evidence show that private health care market occupies a large share of hospitals (75%), hospital beds (50.7%) and medical institutions (54.3%) largely located in urban areas. The growth of private sector has been urban and metro centric.
• Shortage of Staff and Equipment’s: Though Indian Government both central and state have created a vast network of health care infrastructure in India but it is insufficient to provide proper health care to common people in a cost-effective manner. The government Rural Health Survey reveal that only 55.6% of CHCs have functional X-ray machine while only 18% of specialists required (surgeon, physician, gynaecologist and paediatrician) are in place.
• Inter-State and Intra-state variations: There is high variation in the availability of health care facilities across the states and within the state. In a few states such as Kerala, Tamil Nadu and Delhi public health facilities play their intended role of being the first point of care and proactively delivering essential services while in some states like Uttar Pradesh, Bihar, Jharkhand primary health care is not available to masses and they are highly dependent on private sector with their own expenditure. These states also suffer from lack of doctors and nurse.
• No proper regulatory mechanism and monitoring- Not only there is shortage of doctors but there are many practitioners in the private sector who are actually not qualified doctors or Jholachapp in local language. According to WHO report published in 2016 only one in five doctors in rural India is qualified to practice medicine. The report said that 31.4% of those calling themselves allopathic doctors were educated only up to class 12 and 57.3% doctors did not have a medical qualification.

Measures needs to build a better Healthcare ecosystem in India:

• Primary health Centres needs to be strengthened as 80-90% health needs of a person in a life time can be provided by primary health care centres that ranges from maternity to child care, disease prevention through immunisation, management of seasonal and life style diseases like flu, cold, fever, hypertension, diabetes etc. supporting care to aging people who have multiple diseases. Ex. For this in urban areas Mohalla clinics can be a good alternative while in villages SCs and PHCs should be strengthened.
• Increase the expenditure on health from current 1.4% to 2.5% as envisaged NHP 2017 to improve infrastructure in health centres. In health there is a problem of underfunding and not inefficiency. If government can ensure a perfect combination of physical and human infrastructure by spending adequate amount of money on health, the results will be different.
• To meet shortage and availability of trained staff at PHCs and CHCs preference should be given to local people. To solve problem of abstaining from leaves or resistance to live in rural areas, local people should be trained and posted in SCs, PHCs and CHCs of difficult/ tribal and hilly areas.
• Skills of good performing ASHA, ANM workers and nurses should be upgraded and they should be posted in their own rural and remote areas of PHCs and CHCs.
• To remove misallocation of medical colleges maximum in urban areas new medical colleges whether it is private or public should be opened strictly only in rural and remote areas. Special focus should be on large populous northern states or backward states.
• There should be proper regulation and monitoring against all the malpractices prevalent in health area. Stringent laws and punishment should be there for all those who do unethical practices in this field as health is a service not business to fulfil the greed of the people.
• Use of technology can help a lot to reduce the cost as well as improving facilities in health area. On line monitoring of all the facilities of a health centre as well as use of tele-conferencing, tele-medicine and tele-radiology, mobile hospital and mobile ambulance in remote, rural, hilly and tribal areas can help a lot to bring down the cost of establishing health centres over there.
• Overall help of community people should be sought for providing health care to all because no programme can be successful without active involvement of community. Kerala is a good example for it that took help of educated youth and Panchayati Raj Institutions for implementing her health programmes.

Way Forward:

• Healthcare could be made more affordable through thoughtful changes in the GST regime. GST makes healthcare expensive. We do not have a set-off against the input tax, so the healthcare industry is observing all these taxes and in certain cases tax rates are as high as 18%. If the government can give us either zero or 5% GST, it would benefit the sector immensely.
• Pandemic had shown the importance of preventive healthcare, and the government, by rationalising GST rates, could make insurance and healthcare spending more affordable. “Currently, India provides the best quality healthcare in the world at one-tenth of the cost.
• India had been emerging stronger despite several waves of the pandemic and had now learnt to meet the challenges. The national budget must focus on three priorities namely unemployment, up skilling of workforce and signalling support to ideas or sectors that would drive growth in the next century.
• Clean energy, manufacturing hubs to serve the Indian industry, logistics, fintechs, e-commerce and digitally enabled services are some of the sectors that will drive growth.
• The government has done so much in the past two years and sure it will continue to support these.

Source: The Hindu

Mains Question:

Q. As the country aspires to become a $5-trillion economy, there is a need to provide more focus the healthcare service in India. Critically analyse with suitable example.