The vicious onslaught of the second wave of the Covid–19 pandemic has left the entire country gasping for breath, quite literally. It has also brought in the open the woefully inadequate healthcare infrastructure in the country. That the pandemic in the last 12 months has caused unprecedented financial as well as health related distress to almost every household would be an understatement now.
Healthcare in India is—and for a very long time for excellent reasons must remain—a significant domain as well as responsibility of the State, primarily due to the capital intensive investments and high costs of private sector health care.
However, that public healthcare facilities are inequitable in availability, accessibility and standards with a crunch of both financial as well as qualified human resources is already a well known fact.
Therefore, it is required to look at certain facts to ascertain short and long term solutions for this problem.
Why India’s Health Infrastructure is Falling Short
The basic tenets of healthcare are accessibility, availability, affordability and quality, for which it is essential to increase Medical Colleges/PG institutions as these are compulsorily attached to minimum 300 bedded Hospitals with continuous training and research. They are the bedrock of all of the above including availability of present as well as long term manpower and healthcare providers.
As of early 2021, India has 739 districts but only 542 Medical Colleges and 64 PG Institutions (public and private), which is less than one per district with a highly uneven spread.
For example, in North East with 08 States—made up of 120 districts—for a population of almost 80 million, there are just 15 medical colleges and two PG institutions.
Third largest state of Bihar with 38 districts has only 16 medical colleges and no PG institutions. Punjab with 22 districts has only two PG institutions and 10 medical colleges.
Large scale private and corporate health care set ups, being cost intensive, are also similarly concentrated in metropolitan and tier I/II cities, with often emergency healthcare services also being patchy and poor in Tier III cities and below.
In terms of Doctors, India has barely 1 million for a population of 1.3 billion.
We Must Recognise the Urgency of Action
To fix this abysmal scenario, it is necessary to undertake certain measures, which will likely be highly capital intensive. In view of the unprecedented onslaught of the second wave, it is also important to provide certain measures of immediate relief to the public.
However, the national budget allocation for healthcare in 2020 was just Rs 69,000 crores which is approximately only 01% of the GDP, which was then increased to 2,83,000 crores in the 2021 budget.
Though healthcare being on the concurrent list, each state also allocates further resources from its own budget, but it is certainly not game changing immediately.
Immediate and Short Term Measures
Health Insurance Signing up for healthcare insurance must be made into a national movement. School books must include awareness about the same. PM Modi addressing this through his flagship “Mann Ki Baat”, or other such initiatives by esteemed citizens are likely to increase the much needed awareness. This will not only make private healthcare more affordable for citizens but also incentivise large private healthcare providers to expand quickly into Tier III areas.
Blood/Plasma Donation Drives These must be encouraged not only by doctors but by political and religious leaders, sports icons, celebrities etc. Governments must look at ways of ensuring regular donation drives and ramping up related infrastructure such as through NCC, SCC etc.
Participation of Pharma industry The participation of a robust pharma industry as well as those involved in manufacturing life saving equipments such as oxygen cylinders, ventilators etc are critical. Hence, policy as well as pecuniary benefits/incentives must be extended to them. Care must be taken to ensure that such industries remain running even during emergency measures such as lockdowns.
Measures to Shore Up Finance
Direct Tax Rebates The ceiling for tax rebate on insurance premiums, medications and OPD as well as in-patient treatments must be increased to levels commensurate with prevalent escalating healthcare expenditure rates and must include monthly medications for chronic ailments.
Corporate Tax Rebates They must also be extending to the healthcare and pharma industries as well as those involved in the manufacturing of any life-saving equipment.
Loans for Private Healthcare Since the healthcare burden cannot be borne by governments alone, therefore, private healthcare set ups with transparent, hassle free quality control must be encouraged by special loan schemes at minimal interest rates. For example, a medical college and hospital requires minimum of Rs 100 crore investment to start. Hence, affordable, hassle free finance is crucial.
CSR All CSR initiatives must compulsorily consist of a significant and defined portion dedicated towards healthcare infrastructure enhancement.
Incentives to Healthcare Workers
Chikitsak Puraskar Given the tough service conditions and personal risks in situations such as Covid-19 etc GOI/MoHFW must formulate a policy of service recognition for HCW`s by way of service ribbons, awards etc akin to other national civilian awards.
Higher Education Rural Service Benefits There must be a nationally uniform policy of quota in PG seats for doctors in lieu of minimum period of service in designated rural/hilly/backward/remote/sensitive areas and this benefit should also be applicable in higher education for their children/family members. That is likely to incentivise senior doctors as well to undertake service in these areas. This will make a huge qualitative difference as well in healthcare in these areas and not just quantitative.
Monetary Rural Service Benefits Monetary benefits must also be provided to all healthcare workers rendering service in rural/hilly/backward/remote/sensitive areas by way of non taxable special monetary allowances.
How Legislators Can Play Their Part to Improve Healthcare in India
Saansad Adarsh Aspataal Yojana PM Narendra Modi had launched a scheme known as Saansad Adarsh Gram Yojana for rural development by way of all MPs were to adopt a village in their constituency to be transformed into a Model Village. This scheme must be supplemented or reconstituted with all MPs adopting a public medical college/PG institution/district hospital in their constituency to help develop into Aadarsh Aspataal. States may launch similar schemes for the MLAs to adopt.
Screenings/AMEs Healthcare is better served by prevention than by cure, and therefore health check up camps, screenings and annual medical examinations must be made far more rigorous and compulsory as far as possible such as in all educational institutions, all Govt servants etc to aid in early detection and thus lesser in-patient load.
Visits Last but not the least, every Health Minister must ensure to visit every medical college, PG institution and district hospital under his jurisdiction at least once in six months. Those visits are likely to reveal and improve a lot.
Despite having the best, most abundant natural resource of all, i.e. Human Resource, a major reason of why we continue to lag the developed world is the burden of diseases and lack of good health.
Therefore, if India is to realise her true and worthy place in the world, it is imperative that her citizens have good health. With the measures suggested above, and with consistent efforts, we might move a few steps closer to that, bringing much needed relief to our people.
(Dr Saurabh Sachchar is a Consultant Radiologist. Till recently, he was working at Safdarjung Hospital, New Delhi. He tweets at @dr_sachar. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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