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Healthcare In India: A Fundamental Right, But Fundamentally Not Right!
Lucknow, December 11 || Healthcare is a Fundamental Right, but it is not fundamentally Right. Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution but due to differential distributions of services, power, and resources, it has resulted in inequalities in healthcare access.
Access and entry into hospitals depend on gender, socioeconomic status, education, wealth, caste, and location of residence. Large numbers of tribes and ex-untouchable that live in isolated and dispersed areas often have low numbers of professionals. Those with the greatest need often do not have access to healthcare.
The World Bank estimates that 90% of all health needs can be met at the primary healthcare level. India has grossly under-invested in the area that should matter the most. You don't need a Corona epidemic, for the public health system to collapse. Today when I am writing this article coronavirus has taken approximately 0.15 million Indian lives.
But as all the resources are diverted for combating Covid-19, around 10 million have lost their lives due to Non-Covid diseases.
Corona pandemic has pushed fragile India's public health system which was already overstretched, overburdened on the verge of collapse. Healthcare in India has been in deep shambles & need deep introspection.
After the BRD oxygen tragedy, I started touring all over India conducting 100s free medical camp and realised that the BRD oxygen tragedy was just a brutal face of our broken health system.
I started collecting data from National Family Health Survey (NFHS), different government health agencies, World Bank, WHO, UNICEF, UN, and those data were so staggering that it shocked me to the core. Here are a few points which highlight the Shocking status of our Health System
1-Public spending stagnated to 1.2% of total GDP to the world average of 6-8%,
India ranks 170 out of 188 countries in domestic general government health
expenditure as a percentage of GDP.
2-India ranks 145th among 195 countries in terms of quality and accessibility of
healthcare — Lancet.
3-India ranks 94th out of the 107 countries in the Global Hunger Index (GHI).
4-India ranks 144 out of the 156 countries in the world happiness Index.
5-India ranks 129 among 189 countries human development index (HDI)-UN.
6-India ranks 150th in female health and survival among 153 countries — Gender Gap Index.
7-The fundamental aspect of healthcare — primary healthcare is in shambles. There is only one primary healthcare center (often manned by one doctor) for more than51,000 people in the country.
8-40% of people (around 63 million) that are hospitalised are pushed either into lifelong debt or below the poverty — Medical debt is a major cause of poverty in India.
9-50% of children are malnourished and only 62% are immunised. Malnutrition caused 69% of deaths of children below the age of five in India, according to UNICEF
One in two women of reproductive age is anaemic.
10-India reported 8.82 lakhs under 5 years of child deaths, the highest in the world. UNICEF 2018.
11- 4.5 lakhs of people die of tuberculosis every year.
12-India had the third-largest number of people living with HIV in the world.
13-India is the diabetes capital of the world—India is home to 77 million diabetics.
14-Doctors without formal training provide up to 75% of primary care visits.
15-According to the State of Global Air (SOGA) Report, 2020, long-term exposure to outdoor and household air pollution—contributed to 16,67,000 deaths in India in 2019.
16-There is a stark divergence in healthcare-74% of doctors are in urban areas that serve 28% of the population.
20. Private sector consists of 58% of the hospitals in the country, and 81% of doctors.
21. Post-Covid mental health crisis is looming.
22. India faces oxygen scarcity, PPE kits, ICU equipment, Medicine, Sanitizer as cases surge.
23. About 10.5% of medicines sold are substandard and falsified-WHO.
24.At present, there are 541 medical colleges (280 governments and 261 private-total 80,312 undergraduate seats) but only 64 PG Institutes (36,192 seats).
25-Most hospitals in India are overburdened, understaffed, and ill-equipped-but medical tourism is booming which is expected to reach 372 billion $ by 2022.
We can't afford to remain silent spectators. In a time when India is struggling with the dual burden of corona pandemic and economic slowdown. It's time to make a fresh beginning for Healthcare. Healthcare reforms need thorough introspection, debates & corrective measures. Mere cosmetic changes won't help, we need immediate actions, bold reforms & a sustained campaign to deliver healthcare to rural India.
What are the Solutions and what should be the Approach?
1-Universal access to good quality health care services without anyone having to
face financial hardship - for all at all ages irrespective of caste /religion /region /gender /disability /economic status- free consultation/drugs/diagnostics and free emergency care services in all public hospitals.
2-Make the "Right to Healthcare" a justifiable right through the enactment of appropriate legislation.
3-Increase public health expenditure to 5% of the GDP.
4-Uninterrupted supply of Oxygen, PPE kits, ICU equipment, Medicine, Sanitiser.
5-Training of Doctors/Paramedics in Intensive care.
6-Immediate & legible Compensation in case of death of corona warriors.
7-Increase free testing capacity to 1 lakh/million population, Immediate Sero-Survey of Covid-19 Antibodies to all over India to know the real extent of the disease.
8-Curb on rumours, unscientific views.
9-Re-distribution of all resources taking care of Non-Covid diseases.
10-Fill all the existing vacancies and create new jobs every year.
11-Post Covid Care Clinic at each PHCs.
12-Universal Immunisation - including MMR, Pneumococcal, Typhoid, Hepatitis-A, HPV, Chickenpox, Rota Virus, JE, Influenza, COVID-19 vaccine
13-Universalise and expand the ICDS program to effectively cover under-5 children and universalize community-owned CMAM (community-based management of malnutrition) programs and daycare services as important interventions in malnutrition.
14-Decentralisation- 60% of the expenditure being borne by the Centre and 40% by states.
15-To have at least 5 beds per thousand population distributed in such a way that it is accessible within the golden hour rule.
16-Regularise all contractual health workers (e.g.-NHM employees) including ASHA, Anganwadi, and helpers involved in the delivery of public health services.
17-Universalise Maternity Benefits.
18-GST exemption for OPD/IPD Products and drugs for serious ailments.
19- Strengthening of Health Management Information system.
20- Strengthening Medical Disasters & Health epidemics system.
21-Population Stabilisation should be on the priority list.
22-Control of Tuberculosis, HIV/AIDS, Vector-Borne Disease, Non-Communicable Diseases.
23-Clinical Psychologist/Psychiatrist/Counsellor at each PHCs.
24- Measures-Formulate long-term plans to reduce Air pollution.
25- Enhancing the validation, evidence & research of the different health care systems as a part of the common pool of knowledge. Formulate and implement a comprehensive policy on
occupational health and Adolescent/ sexual health.
Let's demand "Right to Healthcare"
Let's build a strong India & a healthier India
-- Dr Kafeel Khan
(The author was formerly with the Department of Paediatrics, BRD Medical College, Gorakhpur, U.P. Views Expressed are his personal)