India's Fragmented Healthcare System: Filling The Cracks

India’s healthcare sector has been facing several problems, including the low number of institutions and inadequate human resources for quite a while now.

Actually, a three-tier structure described the Indian medical system — primary, secondary and tertiary care services. The Indian Public Health Standards (IPHS) says that the delivery of primary healthcare is facilitated to the rural regions through sub-centre, primary health centre (PHC) and community health centre (CHC), while secondary care is provided through district and sub-district hospitals. On the other hand, tertiary care is delivered at regional/central level institutions or multi specialty hospitals.

While it is significant to focus on all the three levels of primary, secondary and tertiary healthcare, it is vital that the government looks after improving primary healthcare as a public good.

Dr Sudarshan Ballal, Chairman, Manipal Hospitals, affirms, "The devastating COVID-19 pandemic brought out the glaring fault lines in the Indian healthcare system. Some of the major challenges faced by the sector include low budgetary allocation for healthcare of less than 2 per cent of GDP, inequitable distribution of healthcare services across different regions and absence of universal health coverage for every citizen."

"There is a need for a robust public and primary healthcare system which is the backbone of the health care system in our country," he adds.

Deficient infrastructure

India has been battling with deficient infrastructure in the form of scarcity of well-equipped medical institutions for quite a while now. To add to the meagre, the rate of building such medical training or teaching facilities remains low as compared to the need of the hour.

For a long span of time, the government regulation ordered that private medical colleges must be built on at least five acres of land. Consequently, quite a few private colleges were constructed in rural areas, where it became much difficult to appoint adequately qualified, full-time doctors because of the improper living conditions, besides low salaries.

It is only now that the lately-formed National Medical Commission (NMC) has brought forward the idea to do away with the need of minimum five acres of land for establishing a medical college.

Additionally, the commission has proposed to reduce the minimum number of beds needed as a proportion of the number of seats in the college.

Further, the new regulations have also laid down the necessity for libraries, lecture theatres, laboratories and location of faculty offices and settlement of students.

Dr AK Gadpayle, Senior Consultant - Internal Medicine, Sharda Hospital, underlines, "There are National Health Programmes by the central government to be adopted by the state government for full implementation. Some of the national health programmes are 100 per cent centre sponsored and few aren't. The national health programmes sponsored by the centre are working well like immunization, national tuberculosis control programme etc."

Lack of trained human resources

One of the biggest problems in the Indian healthcare industry is the shortage of trained human resources. This includes nurses, doctors, paramedics and primary healthcare staffs. The situation is worse in rural regions, where about 66 per cent of India’s population inhabits.

"Literacy rate in the rural areas is lower than urban areas, hence health education and convincing about programmes gets difficult," explains Dr Gadpayle.

The doctor-to-patient ratio remains terribly low, that is merely 0.7 doctors per 1,000 person. The World Health Organisation's average is 2.5 doctors per 1,000 person. 

This problem can be suitably tackled by increasing the number of existing training and teaching institutions while adding new ones in the long term.

Extra patient-load

Even before the outbreak of the Coronavirus pandemic, healthcare facilities had been burdening with unmanageable patient-load. Besides, serving a population of 1.4 billion continues to be a Herculean task in itself when it comes to properly handling healthcare facilities.

Dr Sudhir Upadhyay, Senior Physician, diabetes, blood pressure and heart specialist, Aayu, suggests, "The best way to deal with this, is by consulting a doctor online. Where for minor health problems, order medicine from home after take teleconsultation. By doing this, hospitals will also be less burdened and can be used for emergency services and treatment of critical patients."

There is also a need for adoption of technology wherever possible to streamline the clinical and operational processes for medical facilities to manage efficient patient flow.

Gaurav Gupta, Co-Founder, Navia Life Care, highlights, "India has a severe shortage of healthcare workers as 1 doctor for 1404 people as compared to the WHO mandate of 1:1100 doctor to population ratio. With these limited resources and a limited supply of skilled caregivers, technology can be of real help to maximize the output and to achieve the vision of a connected healthcare ecosystem."

High out-of-pocket costs

While government hospitals offer free health services, these facilities are inadequately equipped, understaffed and nestled mainly in urban parts. It is a known fact that feasible and accessible healthcare in the public sector can remarkably curtail the spike in dependence on private institutions. Nevertheless, governmental establishments leave no alternatives but to reach out to private institutions and incurring high out-of-pocket expenses. Most of the medical services are, therefore, provided by private institutions and 65 per cent of medical expenditure in India are paid out of pocket by patients.

Increasing the adoption of health insurance could be a possible solution to tackle the issue. 

In a nutshell, there is a need to make healthcare services and service providers more transparent. This will assist in ensuring that people and processes be made easily accountable to facilitate better medical services. It is then that the healthcare sector will breathe a bit easier.