Tag: Challenges Facing the Health Sector

World Health Day 2024

Why in news: Every year on April 7, World Health Day brings people together to focus on health equity, a crucial issue central to global health and fairness. The World Health Organization (WHO) recognizes health as a fundamental human right. The theme for this year is “My Health, My Rights,” emphasizing the importance of individual rights in health and wellbeing.

Introduction  

India’s healthcare system is characterized by significant reliance on private healthcare providers, which account for the majority of healthcare services in the country. According to a World Bank report, as of 2021, about 80% of outpatient care and 60% of inpatient care was managed by the private sector. This dominance has been attributed to various factors, including perceived better quality of care, shorter waiting times, and more advanced facilities in private hospitals compared to public hospitals.

Impact of COVID-19 on healthcare

• Major issues in India include inadequate emergency preparedness, shortage of health workers and insufficient medical supplies such as PPE, ventilators and oxygen.
• Hospitals were overcrowded during the peak of the pandemic, resulting in a severe shortage of beds and critical care facilities, especially in densely populated cities and rural areas.
• A WHO survey showed that 90% of countries reported disruption to health services, underscoring the global impact on routine health care.
• The pandemic highlighted the urgent need for investment in public health infrastructure, increased health care workforce, and assurance of equitable access to health services for the entire population.

Healthcare Sector in India

The healthcare sector in India encompasses a broad spectrum of services, including hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. The system of healthcare delivery in the country is bifurcated into two principal components: the public and the private sectors.

The public healthcare system, managed by the government, primarily focuses on offering basic healthcare facilities through Primary Healthcare Centres (PHCs) in rural areas, alongside a limited number of secondary and tertiary care institutions situated in major cities.

In contrast, the private sector plays a pivotal role in providing advanced secondary, tertiary, and quaternary care, with a significant presence in metros, as well as tier-I and tier-II cities.

Market Dynamics and Growth

The Indian healthcare sector has shown robust growth and is anticipated to experience a significant expansion. From 2016 to 2022, the sector grow at a Compound Annual Growth Rate (CAGR) of 22%, escalating its value from USD 110 billion in 2016 to an estimated USD 372 billion in 2022. This growth trajectory highlights the increasing demand and investment within the healthcare domain in India.

Government Spending on Healthcare

The economic commitment of the Indian government to healthcare has seen a gradual increase over recent years. According to the Economic Survey of 2023, public expenditure on healthcare ascended to 2.1% of the Gross Domestic Product (GDP) in the fiscal year 2021-22, marking a rise from 1.8% in 2020-21 and 1.3% in 2019-20. This increment underscores a focused effort to enhance healthcare infrastructure and accessibility across the nation.

Health Insurance and Medical Tourism: The health insurance sector witnessed a growth of 13.3% Year-on-Year (YoY), with the gross direct premium income underwritten by health insurance companies reaching Rs. 58,572.46 crore (approximately USD 7.9 billion) in FY21. This growth reflects an increasing awareness and uptake of health insurance products among the Indian population.

Medical tourism in India is another area that has demonstrated significant potential and growth. Valued at USD 2.89 billion in 2020, the medical tourism market is anticipated to expand to USD 13.42 billion by 2026. India’s cost-effectiveness, advanced medical technologies, and skilled healthcare professionals have made it a preferred destination for medical tourists from across the globe.

Telemedicine: The telemedicine sector in India is on an upward trajectory, expected to reach USD 5.5 billion by 2025. The adoption of telemedicine services has been accelerated by the COVID-19 pandemic, demonstrating the sector’s potential to bridge healthcare access disparities, especially in remote and underserved areas.

Health in the Indian Constitution

Directive Principles of State Policy, particularly Articles 39(e), 41, and 47, provide a strong foundation for the right to health. Article 47 directs the State to regard as its primary duties the raising of the nutritional level and standard of living of its people and the improvement of public health.

Supreme Court of India’s Stand on the Right to Health

The Supreme Court of India has, through various judgments, implicitly recognized the right to health as part of the right to life under Article 21 of the Constitution.

In landmark cases like Paschim Banga Khet Mazdoor Samity vs. State of West Bengal (1996), the Court held that the government has a constitutional obligation to provide adequate medical services to the people.

The Court has consistently maintained that access to healthcare is integral to the right to life, and the State must ensure that medical services are available to all, particularly the vulnerable and marginalized sections of society.

Challenges Facing the Health Sector

Limited health care access: shortage of health care providers, lack of standards for quality care, inadequate health financing, and, especially, limited funding for research.

Limited budget: According to the Economic Survey 2022-23, the budget expenditure of the central and state governments on the health sector is expected to reach 2.1 percent of GDP in FY23 and 2.2 percent in FY22.

This is in stark contrast to countries like Japan, Canada, and France, which allocate around 10% of their GDP to public healthcare. Even India’s neighbors, Bangladesh and Pakistan, invest more than 3% of their GDP in their public healthcare systems.

Insufficient Medical Research: The country pays little attention to research and development (R&D) and the adoption of new, technology-driven initiatives in healthcare.

Ineffective Policymaking: Effective and efficient healthcare service delivery hinges on sound policymaking. In India, the challenge is more about supply than demand, underscoring the need for improved health policies.

Healthcare Professional Shortage:

India faces a significant deficit in healthcare workers, including doctors, nurses, and other medical staff. A report to Parliament by a minister highlighted a shortfall of 600,000 doctors. According to the Indian Journal of Public Health, India needs 20 lakh doctors by 2030.

However, currently, one doctor in a government hospital sees ~11000 patients, which is more than the WHO recommendation of 1:1000.

Resource Shortages:

Healthcare professionals in India often operate under challenging conditions, dealing with overcrowded departments, insufficient staffing, and a lack of medicines and infrastructure. According to the National Health Profile, India has only 0.9 beds per 1000 population of which only 30% are in rural areas.

Role of Digital Innovation

• Emerged as critical for maintaining care continuity.
• Telemedicine, remote monitoring, and digital health records usage surged.
• According to McKinsey & Company, telehealth use in the US increased from 11% (2019) to 46% (early 2020).

Ayushman Bharat Digital Mission (ABDM)

• Launched in 2021 to support integrated digital health infrastructure.
• Aims to bridge gaps among healthcare ecosystem stakeholders.

Key Features and Benefits of ABDM

Health ID for Every Citizen: Unique ID for storing health information, and improving access to medical records.

Digital Doctor and Health Facility Registry: Enhances discoverability and facilitates resource allocation.

Interoperability and Data Privacy: Ensures seamless communication across health information systems with strict privacy protocols.

Uniting Stakeholders through ABDM

• Provides a common platform for healthcare providers, payers, and consumers.
• Integrates various digital health services under one umbrella, encouraging collaboration.
• Significant milestones achieved within a year: creation of millions of Health IDs and registration of thousands of doctors and healthcare facilities.

Steps required to strengthen the existing state of Health infrastructure in India

1. Increase Public Health Spending

Objective: To reach the goal of spending at least 2.5% of GDP on health by 2025, as outlined in the National Health Policy 2017.

Actions: Allocate more funds for healthcare infrastructure development, including the construction and upgradation of PHCs, CHCs, and tertiary care institutions.

2. Upgrade Primary Healthcare Centers (PHCs)

Objective: To ensure that all PHCs are equipped with essential facilities, medical supplies, and manpower.

Actions: Invest in infrastructure upgrades, such as improving building conditions, ensuring regular electricity and water supply, and providing essential medical equipment and drugs.

3. Strengthen Human Resources for Health

Objective: To address the shortage of healthcare professionals across the country, particularly in rural and underserved areas.

Actions: Increase the number of seats in medical and nursing schools, offer incentives for healthcare professionals to work in rural areas, and implement continuous professional development programs.

4. Promote Public-Private Partnerships (PPPs)

Objective: To leverage private sector expertise and investment to improve healthcare infrastructure and service delivery.

Actions: Encourage PPP models in areas such as hospital management, diagnostic services, and telemedicine services, ensuring proper regulatory frameworks to monitor quality and equity.

5. Implement Telemedicine and Digital Health Solutions

Objective: To enhance access to healthcare services, particularly in remote areas, and improve healthcare delivery efficiency.

Actions: Scale up telemedicine services under initiatives like the Ayushman Bharat Digital Mission, and integrate digital health records to facilitate seamless patient care across different levels of the healthcare system.

6. Focus on Preventive and Promotive Health

Objective: To reduce the disease burden by promoting healthier lifestyles and preventing diseases.

Actions: Implement wide-reaching public health campaigns on nutrition, sanitation, vaccination, and disease prevention, and integrate preventive healthcare services at all levels of healthcare delivery.

7. Enhance Accessibility to Affordable Medicines

Objective: To ensure that essential medicines are available and affordable to all segments of the population.

Actions: Expand the network of Jan Aushadhi stores (generic medicine stores) and ensure adequate supply and distribution of essential drugs in healthcare facilities.

8. Strengthen Healthcare Data Management

Objective: To improve healthcare planning, monitoring, and decision-making through better data management.

Actions: Develop and implement comprehensive healthcare information systems that collect, analyze, and utilize health data effectively, ensuring data privacy and security.

9. Address Social Determinants of Health

Objective: To tackle the broader determinants of health, such as education, employment, and environment, that impact health outcomes.

Actions: Foster intersectoral collaboration between the health sector and other sectors to address the root causes of health disparities and promote health equity.

10. Enhance Emergency Medical Services

Objective: To improve the responsiveness and effectiveness of emergency medical services (EMS) across the country.

Actions: Develop a robust EMS infrastructure, including ambulance services, emergency departments, and trauma care centers, particularly along highways and in rural areas.

Government Initiatives Related to Healthcare

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): Launched in 2018, it’s the world’s largest health insurance/assurance scheme fully financed by the government. It provides a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families.

National Health Mission (NHM): NHM consists of National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM). It aims to provide universal access to equitable, affordable, and quality health services, especially to the poor and vulnerable sections of the population.

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): This scheme was launched to correct regional imbalances in the availability of affordable and reliable tertiary healthcare services and to augment facilities for quality medical education in the country.

Janani Suraksha Yojana (JSY): A safe motherhood intervention under the NHM, JSY aims to reduce maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.

Integrated Child Development Services (ICDS) Scheme: This program offers a package of services such as supplementary nutrition, pre-school non-formal education, nutrition and health education, immunization, health check-ups, and referral services for children under 6 years of age and pregnant & lactating women.

Mission Indradhanush: Launched to immunize all children under the age of 2 years, as well as all pregnant women, against eight vaccine-preventable diseases.

Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP): This initiative aims to provide quality medicines at affordable prices to the masses through Jan Aushadhi Kendras spread across the country.

National Digital Health Mission (NDHM): Announced to develop the backbone for the digital health ecosystem in India, NDHM aims to provide a unique health ID for every citizen, digitize health records, and establish a national digital health authority.

PM Atmanirbhar Swasth Bharat Yojana: Introduced to strengthen the healthcare infrastructure across the country to prevent, detect, and respond to future pandemics. The scheme focuses on developing capacities of primary, secondary, and tertiary healthcare systems.

Rashtriya Bal Swasthya Karyakram (RBSK): Aims at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability.