INDIA’S ROADMAP: BEYOND PANDEMIC- WITH REFERENCE TO HEALTH PERSPECTIVE
Archana Verma, M.A in Political Science (FINAL YEAR), Calcutta University
INTRODUCTION
A lockdown of society, by itself is not a cure for the Covid-19 epidemic, and it is just a strategy for winning some time for the healthcare system. Epidemiological models suggest that the epidemic would bounce back once the lockdown is lifted. If this were to happen at the end of India’s lockdown, the epidemic would hit a society already under severe economic distress, with potentially devastating consequences. Therefore, proper strategies are required to avoid such consequences.
STRATEGIES FOR IMPROVING THE HEALTHCARE SYSTEM
The key to ensuring that the Covid-19 pandemic does not leave a long shadow on our health depends on the ability to rectify the deficits in care that have emerged during lockdown while reconfiguring our systems to successfully maintain physical-distancing requirements and other proven interventions such as increased testing capacity, targeted isolation and contact-tracing. Therefore, there is a need to focus on 3 components-
MONEY- The pandemic is a clear proof that we do not invest much; which is why we are facing such problems and compared to other developed countries our health infrastructure is very poor (with poor infrastructure in rural areas). According to the annual data released by the government which states that India spent only 1.6% of its GDP in FY20 (estimate a small rise from 1.5% in FY19). In comparison the U.S spends the most on public health- 18% of its GDP. The Narendra Modi government has aimed to raise the expenditure on public health services to 2.5% of the country’s GDP by the year 2025. Thus, it is essential that this is implemented to do away with inequity in access to healthcare service.
CARE DELIVERY INNOVATION- A little known fact about our public health system is that our community and district hospitals are bursting at the seams but our primary health care centers in rural areas spend an average of only 20 to 30 minutes with patients daily, leaving most of the day free. We can “spread the load” by reconfiguring patient pathways optimally and ensuring that more care is delivered at primary health care centers and at home. One option, for instance, is to use mobile vans to deliver vaccines and medicines in villages throughout the country. Telemedicine is being used by doctors to connect with patients to avoid physical visit to hospital or clinics. India could also harness the large number of NGO’s and Community based groups to enhance capacity of grassroots level health care. When we have limited resources and limited supply of skilled caregivers, it is necessary to find ways to use technology to maximize the benefits without sacrificing on quality and outcomes. Technology can play a big part in this, it is the best way to achieve the vision of a connected healthcare ecosystem.
PARTNERSHIPS AND TRAINING- We must make the Private sector a partner in these unprecedented times. Programs that allow private and informal providers to engage in vaccination efforts and the monitoring and management of chronic illnesses along with minor acute conditions with clear referral pathways can help us reconstruct our systems in a way that is consistent with the long-term physical-distancing that Covid-19 will require.
BHORE COMMITTEE
The pandemic has made it clear that the primary healthcare in rural and urban areas in abysmal and requires special focus. The Bhore Committee begins with a comparison of the Indian situation with other countries. The poor state of India’s health in comparison to other countries especially the developed ones is apparent. But what is more tragic is that, even after so many years, India has not reached the level of health which developed countries had achieved before the start of world war. We need to trace our steps back to BHORE COMMITTEE which spoke about the importance of healthcare ‘at the doorstep of the individual irrespective of their ability to pay’. This was mainly because the Bhore Committee felt that a very large section of the people is living below the normal subsistence level and cannot afford yet even the small contribution that an insurance scheme will require.
The Bhore Committee further recognized the vast urban and rural disparities in the existing health services and hence based its plan with specifically in mind. The Bhore Committee set for itself certain objectives, some of which are following-
The services should make adequate provisions for the medical care of the individual in the curative and preventive fields.
These services should be placed as close to the people as possible, in order to ensure maximum use by the community.
Special provisions will be required for certain sections of the population example- mother, children and others.
No individual should fail to secure adequate medical care, curative and preventive because of inability to pay for it.
RELEVANCE OF BHORE COMMITTEE TODAY
Health services today are as inadequate and underdeveloped as they were during the time of the Bhore Committee. The recommendations of the Committee were not rejected outright by the government of independent India. The principles were accepted in the First Five Year Plan, but the contents were very selectively focused.
More than 40 years later, we see that only one target of the Bhore Committee’s recommendation was realized i.e. the production of doctors. But the unfortunate aspect of this development is that these doctors have been produced not for the ‘salaried service’ in the national health plan that the Bhore Committee had envisaged but for adding to the ranks of private medical practitioners. Inadequate resources may appear to be a strong reason for not implementing the Bhore Committee plan bit when resource allocations are studied carefully we clearly see that financial resources were largely committed to areas which helped in the development of capitalism. But given the subsistence or even below subsistence standard of life in India, the demand for national health services assume a great urgency and hence resource constraint cannot be an issue. We must demand that health becomes a right which the state must provide unconditionally from the revenue it collects from citizens. The Bhore Committee report, though nearly half a century old, gives us the basic foundation from which we can build the apparatus of National Health Service.
In the Indian context, the problem should also be acknowledged in the background of social inequities. Already caste and religion-based discrimination have been noticed in the treatment of Covid-19. The future challenge is to ensure that our healthcare practices are not discriminatory in nature.
The rural-urban divide in the condition of healthcare systems in India is visible at the time when migrants are returning to their villages. Preparedness for quarantine facilities and social integrities in the villages is of prime importance. There is a need to strengthen the National and State health system. The focus will be on building a network of Biosafety level, improving a molecular testing for viral diseases in district and sub-district laboratories.
INTEGRATED DISEASE SURVEILLANCE PROGRAMME
The Integrated Disease Surveillance Programme was launched by the Hon’ble Union Minister of Health and Family Welfare in November 2004 for a period up to March 2010. The project was restructured and extended up to March 2012. The objective was- to strengthen and maintain decentralized laboratory-based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase t through trained Rapid Response Team.
This programme is a positive step towards making our health system efficient. This is important because-
It recognizes cases or cluster of cases to trigger intervention, to prevent transmission or reduce morbidity and mortality.
Assess the public health impact of health events or determine and measure trends.
Monitor effectiveness of prevention and control measures and prevent outbreaks.
Identify high risk groups or geographical areas to target interventions.
MEDICAL PROFESSIONAL
The doctor-population ratio in India is 1:1456 against the WHO recommendation of 1:1000. Therefore, there is a need to address the shortage of doctors. Though the government has taken up steps- such as the number of MBBS and PG seats have increased by 27,235 and 15000 respectively. But then it must be implemented to serve the purpose. Unless we have sufficient doctors and medical staff, we cannot upgrade our medical infrastructure. The shortage of manpower leads to skewed distribution of health services.
MEDICAL INFRASTRUCTURE
We need to improve the infrastructure since most hospitals do not even have basic facilities such as water supply, electricity, and not even simply pain killers. Emergency units too, are not well equipped to handle any emergency treatment, and the unavailability of doctors at odd hours is a huge problem that needs to be addressed. Rural India has 75% of the total population but only around 30% of the country’s hospitals, hospital beds and doctors are available. Therefore, this puts sheer burden on rural health facilities and doctors.
To build a robust medical infrastructure for the future, focusing on India’s infrastructure and technology needs, would require emphasizing the triple Helix model of innovation i.e. bringing together government, academia, and industry now more than ever. This could help minimize duplication of efforts and result in more effective use of resources. The government should allocate adequate amount of resources towards boosting the country’s health infrastructure.
With more funding, the government can provide free treatment to the poor through the public health system. In addition to free treatment, the government can provide health insurance to the poor so that they can avail treatment in private hospitals as well.
Access to medicine is also very essential for ensuring a better health care. The time has come for E-PHARMACIES to create a positive environment by making medicines accessible to all. They provide transparency as well as offer lower costs and greater availability for the consumer, especially in rural areas.
Considering the poor performance of healthcare services throughout the country, the role of NGOS need to evolve. NGOS need to partner with technology solution providers to develop innovative ways to ensure delivery of health services to beneficiaries. NGOS can also address the problem of shortage of skilled human resources which India faces. They are capable of enhancing health system at grassroot level.
CONCLUSION
The pandemic requires India to better regulate the private health sector and ensure national needs are met, without expecting the private sectors to do things for free. India needs to strengthen the public health system while simultaneously regulating and engaging with the private health sector to deliver quality affordable care. India needs to leverage both the sectors to meet the surging health needs of over 1.3 billion people. We also need to make the ‘ONE HEALTH’ approach an integral part of our public health strategy. This involves recognizing that our health is connected to the health of animals, plants and the environment that we all share. It therefore emphasizes that efforts to prevent disease should focus not just on human but also on animal, plant and environment health. We really cannot afford to ignore this idea, given that SARS-COV-2 is believed to have animal origins. Today, India is being touted aa ab emerging superpower, and as a formidable global economic power, accessible quality healthcare can be a key competitive strength for the country. It is time to commence the development of our medical facilities and services to keep the country leapfrog into a progressive nation.