Why India Needs an ethical and affordable healthcare system?

It will be grossly unfair not to take pride in our existing health system, which takes care of nearly 140 crore people of different age groups, living in 28 States and nine Union Territories. Braving odds, challenges and inadequacies, our health facilities are ever prepared to serve us under any circumstances. They bore the brunt of Covid-19 pandemic's first and second waves and are now ready to deal with its impending third wave. Doctors and paramedical personnel in public and private health sectors did a fantastic job and will ever be appreciated by a grateful nation. However, laurels and resilience don't cover up critical gaps in a sector as vital as health. Majority of our people being poor and from low income groups, the need for a robust, ethical and affordable health facility is being felt like anything when we are celebrating 75 years of Independence, which means nothing but the fact that we need to work harder to align our health system to the ground realities and emerging challenges.

Ailments caused by poverty, non-communicable diseases spreading their tentacles in rural areas, income disparities and multiple roadblocks in accessing affordable and quality healthcare pose serious questions our policy makers and other stakeholders need to ponder over and be future ready accordingly. Data, which are in the public domain, point to shortage of beds, doctors, super specialists, para medical staff, technicians, family physicians, quality medicines and infrastructure in terms of primary health centres, community health centres and so on. Notwithstanding rapid strides we have made in the medical sciences and health sector in the past 75 years, a fine-tuned health system from primary to tertiary level, evenly spread across the country, remains elusive. It may appear to be a tall order to many of us but the urgency for a wholesome health facility for all can't be ignored. Since health along with education is the first victim of poverty, we have to be quite proactive in combating malnutrition driven diseases.

Simultaneously, one needs to see if there is a need to revisit existing policies, guidelines and enabling measures aimed at making the health system more vibrant. Health and education are the state responsibilities. Still, there is a role for the private sector in responding to people's health needs. However, there has to be some fundamental clarity about their role in the health sector. If a major chunk of our people is poor, then a significant amount of emphasis has to be put on streamlining primary and secondary healthcare, which is within their reach. If this is not done, then there will be undue burden on tertiary care facilities, as people in need of medical interventions at secondary slip into the tertiary care zone every shortly. High end health care is available in government and private sectors. It is very costly in the private sector. Government hospitals are too crowded. For tertiary care one can't step into private hospitals if they don't have health policies. Poor people have been provided with insurance policies but these are not the panacea to the masses' health woes.

What is the way out? The Central and state governments are taking a number of measures like setting up one medical college for every three Lok Sabha seats, AIIMS in every State, upgradation of district and sub-divisional hospitals and creating newer and innovative facilities. Since the impact assessment is not very encouraging, there is a need for non out-of-the-box measures which are in sync with socio-economic and political needs and dynamics of a developing nation. What is required in large numbers are family physicians, who will help the masses in combating primary and secondary diseases effectively in rural and semi-urban areas. It will be helpful in eliminating quacks so pervasive in rural India and also in checking people's compulsive visit to towns even for smaller ailments. Therefore, each and every District Hospital should be upgraded to produce family physicians and engage them in imparting primary care and counselling to the masses. It will be a first significant step towards building resilient and inclusive healthcare. There are divergent views about the Cuba model of health services. Disagreements apart, one and all agree to the fact that Cuba has set an example of providing one of the best health care facilities among developing nations. Its national health programme addresses needs of over 95 per cent of the population in an effective manner!

There is also a need to define the role of private health service providers. Making the most of inadequacies in the government sector, they are into areas where returns on investments are adequate and guaranteed as well. During Covid-19 pandemic, they were accused of overcharging. Finally most state governments had to fix the rate for different charges. Though these rates were not affordable for the majority of us, the intervention was still a matter of big relief. Since we do businesses without empathy and sympathy, and are always in a tearing hurry to accumulate wealth at the earliest, people cannot afford the private sector for tertiary care. This should be 100 per cent the responsibility of the state, while private players should be asked to focus on primary and secondary healthcare. At the same time, there should be a blanket ban on government doctors doing private practices. District and Sub-Divisional hospitals should be the most vital point in our chain of providing health services to the masses. Outdoor patient patients (OPDs) should be withdrawn from all tertiary care government hospitals like AIIMS and PGIMER.

Recently, NITI Aayog released the 4th edition of the State Health Index for 2019-20 titled 'Healthy States, Progressive India.' It ranks States and Union Territories on their year-on-year incremental performance in health outcomes as well as their overall status. It is a good assessment exercise. The validated data sheets are shared with the states for verification, followed by video conferences with the states for resolving any disagreements or disputes. The final sheets thus settled are shared with the states, and after agreement, the data is finalized and used for analysis and report-writing. The report conveys among other things the need for sustained efforts to take our health services to the next level. Affordable and ethical health for people should be the first priority of people's government. Pricing of drugs and medical equipment is heavily tilted against patients. The gap between maximum retail price (MRP) and wholesale price is colossal. It should be addressed immediately. Small but honest efforts will catapult our health system to the next level.

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