By: Arunima Malik
The country has made its decision and as the newly-elected government now stands at the cusp of a new generation of governance and policies, a concerted focus on equitable healthcare delivery should form the crux of the upcoming policies and schemes.
Health encompasses a variety of areas such as sanitation, nutrition and mental well-being to name a few. However, healthcare at its core is formed by the existing hospitals, hospices, nursing homes and front-line workers that have been tasked with bearing the burden of delivering care to the 1.37 billion Indians today.
The Health Survey and Development Committee constituted in 1946 highlighted the lack of an environment conducive to healthy living, adequate nutrition and curative healthcare. The committee outlined the inadequacy of healthcare provisions, personnel and infrastructure in comparison to the population size and the needs of the citizens of India. While in subsequent years, Indian health care progressed gradually, the issue of inadequacy remained at its core. Even more than 70 years after Independence, the Indian healthcare system finds itself unable to provide quality care to citizens in all parts of the country.
Convergence of three challenges
Over the years, the private sector has emerged as a prominent player in the Indian healthcare sphere. The private sector offers better salaries to its employees and provides greater attention to patients through tertiary and quaternary care hospitals and clinics, with state-of-the-art equipment. However, most high-end private centres and hospitals are concentrated in urban areas and thus the rural population either relies on available preventive care centres in the vicinity or incur huge expense in obtaining curative care in the cities.
Thus, through examining the existing healthcare scenario it can be deduced that with the steadily growing population, healthcare faces increased pressure from the convergence of three challenges, namely: rising number of ill-health cases and over stretched facilities, low level of co-ordination between service providers, and unequal distribution of healthcare capabilities.
Health services in general and diagnostic services in particular, are struggling to cope with increased demand. The citizens continuously face the challenges of long wait times, thus hindering the diagnostic process and leading to diseases potentially becoming life threatening. Cancer diagnostics are a classic example of this problem. Early diagnoses in diseases such as cancer, TB, Pneumonia and Dengue, cannot be overstated. However, the health facilities across India, especially in the rural areas are drastically ill-equipped, lacking adequate number of doctors, tools, medication and sometimes even lacking the required healthcare service provider capabilities.
Patients in hard to reach areas are worst hit with scarce access to diagnostic centres, wherein people are required to travel extremely long distances to receive even basic care. This hampers early diagnoses and timely treatment, leading to higher risk of death. The high maternal and child mortality burden in India, is testament to the health services inequity across the nation. Though, the introduction of front-line workers, namely, ASHAs and ANMs have salvaged the situation significantly, a large number of states including Uttar Pradesh, West Bengal and Maharashtra dealing with shortage of front-line care givers in thousands. The abysmal ratio of 17.1 nurses and 7 physicians per 10,000 population across India further exacerbates the situation.
This gap between healthcare requirements and healthcare provisions sometimes almost seems unsurmountable. Building facilities is time consuming and is likely to not keep pace with the population growth and demands. Thus, innovations in healthcare may hold the key to equitable healthcare delivery.
The concept of mobile clinics or diagnostic centres is a simple and easy one, yet not explored to its fullest potential. Mobile clinics in conjunction with services provided by front line workers will address the problem of timely access to medical care. Through early diagnoses and timely treatment, diseases are less likely to become serious, thus, reducing the burden on hospitals by a reduction in number of patients needing hospitalisation. Mobile clinics are also the answer to the difficulty of developing brick and mortal health facilities in hard to reach areas. This allows for flexibility within healthcare delivery. Areas with disease outbreaks would also benefit greatly with such flexibility.
Though, mobile clinics are not the sole solution, but definitely an effective interim answer to enhance healthcare delivery in India. We are far from equitable healthcare delivery, however the goal should to be to reach as many people and as soon as we can. Healthcare services are groaning under pressure, and it is a matter of time when the health system in India faces a crisis. Hence, this is time to harness Indian ingenuity and devise and implement innovative solutions to ensure equitable health delivery in our nation.
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