Ensuring a vibrant healthy India @ 2047 a daunting task but achievable

Healthy citizens are an asset for any nation. They form the foundation of productivity and vibrancy, and contribute significantly to its economic, social, and cultural development. Beyond the obvious benefits of a reduced burden on healthcare systems, healthy people are more likely to engage actively in the workforce, leading to higher output and innovation. They are also better equipped to pursue education and participate in community life, creating a more informed and socially connected society.

The well-being of citizens also has a profound impact on national security given that a healthy population is more resilient in the face of public health challenges and epidemics. A robust nation is capable of addressing complexities of the modern world in a more decisive manner.

Since Independence, the healthcare sector in India has expanded massively across all fronts. In 2022, there were 1,56,000 Ayushman Bharat Centres, providing primary health care services to communities closer to their homes. The vast network of nearly 13.97 lakh Anganwadi centres covers almost 10 crore children with early childhood care and education. Various health indicators like Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), and percentage of underweight children have fallen dramatically. Over 10 crore women and children are covered under the Poshan Mission launched in 2018. Full immunisation coverage rose from 62 per cent to 81 per cent thanks to strengthened immunisation programmes under Mission Indradhanush. No doubt, these are encouraging numbers but we need to raise healthcare to global levels but how to go about it remains the million-dollar question.

Union Minister of State for Health and Family Welfare Dr. Bharati Pravin Pawar said on December 12, 2023 that there has been an increase of 82 per cent in medical colleges from 387 before 2014 to 706 as of now. Further, there is an increase of 112 per cent in MBBS seats from 51,348 before 2014 to 1,08,940 as of now while PG seats have been increased by 127 per cent from 31,185 before 2014 to 70,674. Dr. Pawar reassured an increase in the availability of doctors by way of a centrally sponsored scheme for establishing new medical colleges by upgrading district or referral hospitals under which 108 new medical colleges are already functional out of the 157 that have been approved.

Similarly, under ‘Upgradation of Government Medical Colleges by construction of Super Specialty Blocks’ of Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) scheme, 75 projects have been approved, of which 64 are complete. Approximately, 22 AIIMS have been approved under a Central sector scheme. She further said that as informed by the National Medical Commission (NMC), there are 13,08,009 allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC) as on June, 2022.

Assuming 80 per cent availability of registered allopathic doctors and 5.65 lakh AYUSH doctors, the doctor-population ratio in the country is 1:834. Also, there were 36.14 lakh nursing personnel as on December, 2022. Assuming 80 per cent availability of nursing personnel, the nurse- population ratio is 1:476.

All said and done, quality and affordable health facilities are not evenly spread in the country. For tertiary care, a majority of people have to travel to metros or other bigger cities where affordable healthcare is available in public sector hospitals. The uneven spread of such facilities in a developing country like ours results in a range of serious consequences, affecting the overall well-being and development of the nation. Cities with concentrated high-quality healthcare facilities experience an overwhelming demand, leading to overburdened public health systems. This strain results in longer waiting times, reduced quality of care, and insufficient resources to address the healthcare needs of the population. One can see a harrowing rush in the emergencies of tertiary care government facilities like AIIMS and PGIMER.

A roadmap is required to ensure that minimal patients have to move to state or national capital for higher treatment. It has to be done on a priority as India’s population is projected to be 1.64 billion by 2047, of which nearly 0.82 billion shall be residing in urban areas. So, we are going to add another 40-crore people in the next 24 years.

This means that the pace of expanding our existing healthcare facilities has to be augmented manifold. Already faced with the crunch of doctors and beds, we will need them more. Since prevention is better than cure matters a lot, a comprehensive approach involving targeted investments in healthcare infrastructure, improved training and retention of healthcare professionals in underserved areas should be adopted without any delay. This will not only reduce health disparities but also help in fostering a more equitable society.

Let us have a look at health facilities in some of the advanced nations like Germany, where the health care system is based on four basic principles - compulsory insurance; funding through insurance premiums; principle of solidarity and principle of self-governance. Around 86 per cent of the population is enrolled in statutory health insurance, which provides inpatient, outpatient, mental health, and prescription drug coverage. Health expenditure per capita is projected to be $ 8,011. Government or compulsory health expenditure as a share of GDP-2022 is estimated to be 10.9 per cent and out-of-pocket expenditure at 1.7 per cent. Infant mortality deaths per 1,000 live births is said to be three, while maternal mortality rate deaths per 100,000 live births is 4.4.

So, we need increased spending on upgrading and expanding healthcare infrastructure in the public sector to create world class affordable health facilities for our people. No doubt private healthcare entities contribute to innovation and efficiency but they often prioritize profit margins over universal access to affordable and equitable healthcare.

The profit-driven nature of private healthcare leads to the neglect of preventive and primary care services, focusing instead on lucrative specialized treatments. Such a system results in fragmented and unequal healthcare delivery, undermining the fundamental principle of healthcare as a universal right. Striking a balance between public and private sectors, with a strong emphasis on public healthcare infrastructure, is essential to ensure that healthcare remains accessible, affordable, and inclusive for all members of society in our country.

(The writer is a senior journalist, columnist and author. The views expressed are his personal opinions)