Challenges in Healthcare Sector



Health OutcomesPopulation statistics: Birth rate: Death rate: Total fertility rate: 2.4 Healthcare statistics:Life expectancy at birth: 68 years Neonatal mortality rate (with 28 days): 28/1000 Infant mortality rate (<1 yr): 34/1000 Child (<5 yrs) mortality rate: 50/1000 live births Maternal mortality rate (within 42 days) : 168/1000 Disease burden: India has 17% of population accounts for 20% of Global Burden of Disease and is undergoing an epidemiological transition that the non-communicable diseases dominate over communicable in the total disease burden of the municable diseases: NCD: In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause. India bears 32% of the global burden of respiratory diseases Malnutrition: 38% children under 5 are stunted and 15% children under 5 are wastedImmunization rates: Immunization rates in India are among the lowest in the world for almost all vaccines (BCG, DPT, Polio, Measles, and Hepatitis B). In fact, outside Sub-Saharan Africa, one has to go to conflict-ravaged countries like Afghanistan, Haiti, and Iraq etc. to find immunization rates that are lower than India’s. Challenges in Healthcare SectorPopulation:?The population during the last 45 years has increased at the rate of 2.2% per annum. On average 17 million people are added every year to its population Infrastructure:?The existing infrastructure is not enough to serve the needs of the growing population. The public healthcare institutions are under-financed and short staffed. The doctor to patient ratio is dismal at 1:1700. The beds to patient ratio is far too low. Only 1.3 beds per 1000 people in 2010; global average is 2.9, WHO guideline is 3.5; 63% of these beds are in the private sector. Rural-Urban disparity:?Rural India accounts for 70% of the population but accounts for only 30% of the healthcare services. This shows a huge demand-supply gap in the rural areas. Private sector is highly concentrated in urban India while PHCs are short of more than 3,000 doctors (~40% short of expected #s)Low government spending:?Public expenditure on health accounts for ~1.15% of the total GDP which is abysmally low when compared to WHO recommendation of 5% and global average for countries is 6 %. In addition to this low public expenditure on health, what stands out is that public expenditure accounts for only 30% of the total health expenditure (world average: 63%; most EU countries: over 70%, Bhutan- 72%)High out of pocket expenditure:?Out of pocket expenses account for 62% of the expenditure which is very high when compared to 13.4% in US, 10% in UK and 54% in China. The poorest 20% in India spend ~12% from their income while rich spend ~2%- many poor have to sell their land pushing them into vicious poverty Insurance:?76% of Indians do not have health insurance. Government contribution to insurance is just 32%. Low insurance penetration forces people to spend out of pocket.Dual disease burden:?While the problems of Maternal, infant mortality, communicable diseases still exist lifestyle diseases like hypertension, diabetes are on rise. It is observed that the disease burden due to communicable, maternal, neonatal, and nutritional diseases dropped from 61 per cent to 33 per cent between 1990 and 2016. In the same period, disease burden from non-communicable diseases increased from 30 per cent to 55 per cent.Gender discrimination: 53% women between 15-43 years are anemic (UNDP) which contributes ~20% of maternal deaths. ~30k girls under 15 are not only married but borne children at least once.Malpractices in the sector:?Selling substandard and counterfeit medicines, unnecessary hospital admissions and exploitation.Adequate attention has not been given to alternative healthcare practices like Homeopathy, Ayurveda, Unani.Opportunities/Way forwardInvestment in healthcareNational Health Policy 2017 recommends increasing the public expenditure on health to 2.5%, which should be adhered to. This could help reduce out of pocket expenses.Private investment in educational institutions should be encouraged. This would help increase the number of graduating doctors in a year and address the problem of doctor-patient ratio. Start-ups are investing in healthcare sector from process automation to diagnostics to low-cost innovations. Policy and regulatory support should be provided to make healthcare accessible and affordable.Focusing of primary care/rural areas:India needs to shifts focus from secondary and tertiary sectors to primary care. PHCs should be made attractive to doctors by providing incentives and making rural service mandatory for medical students.Proper implementation of initiatives like Rashtriya Swasthya Suraksha Yojana is needed to increase insurance penetration.Working towards Universal Health Coverage (UHC):?India should take cue from other developing countries like Thailand to work towards providing UHC. UHC includes three components: Population coverage, disease coverage and cost coverageTech based solutions and campaignsLeveraging the benefits of Information Technology:?computer and mobile-phone based e-health and m-health initiatives were launched on World Health Day (7 April) in 2016. These include the Swastha Bharat mobile application for information on diseases, symptoms, treatment, health alerts and tips; ANMOL-ANM online tablet application for health workers, e-RaktKosh (a blood-bank management information system) and India Fights Dengue. Data Analytics:?Big data analytics could be used in tracking patient data, treatment prescriptions, etc.Social campaigns: Spreading awareness about non-communicable diseases like hypertension, diabetes. Healthy lifestyle should be promoted with yoga, meditation. Active participation and campaigns helped the eradication of polio. Success was achieved in reducing the incidence of HIV AIDS by providing information and spreading awareness. Similar strategies can be used for containing the spread of diseases like Tuberculosis, dengue.Other high level interventions: Focus should be shifted to preventive healthcare from curative healthcare. Universal immunization helps reduce the incidence of communicable diseases and thus reduce the costs of curative care.National Health Regulatory and Development Framework needs to be made for improving the quality and accountability. It should put out standard treatment guidelines for public and private providers, frame a patient’s charter of rights, engage with professional associations and civil society, and establish a regular audit system.Establishment of Ministry of AYUSH provides an opportunity to explore alternative medical practices. AYUSH systems should be made mainstream in healthcare along with allopathy. Research and development should be encouraged in these domains and awareness need to be created.Reforms (Sen and Dreze)We need to stop believing, despite all evidence, that India’s transition to good healthcare can be easily achieved through private healthcare and insurance; this hasn’t happened anywhere in the world, and most developed countries contribute to well over half of the national health expenditure We need to devote more resources as a proportion of GDP to public expenditure on healthNeed a renewed focus on PHCs, village-level health workers, preventive health measures etc.National health Policy 2017 Objective 1: Improve Health Systems PerformanceCoverage of Health Services50% increase in public health facility utilization by 202590% coverage of family planning, antenatal care, newborn, immunization by 2025Cross Sectoral goals related to health (SBM, intoxicants, diet, accidents, gender violence, mental health, pollution)Objective 2: Health Systems strengthening (Paisa, junta, clinics, MIS)Health finance Public health expenditure to be increased to 2.5% of GDP by 2025Health Infrastructure and Human ResourceEnsure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority districts by 2020.Establish primary and secondary care facility as per norms in high priority districts by 2025.Health Management Information (National health Stack Gyaan)Objective 3: Policy thrust for the aboveAchieve and maintain elimination status of TB 2025, Measles 2020, Leprosy by 2018, Kala-Azar and Lymphatic Filariasis in endemic pockets by 2017.NMR of 16 by 2025, TFR of 2.1National Health Stack (NITI Aayog)National Health Electronic RegistriesCoverage and Claims platform- Integrated with PM-RSSMPersonal Health RecordsNational Health Analytics PlatformSupply chain managementCore health related CSS schemesICDS MDMAayusman Bharat (RSSY)National Health MissionSwachh Bharat Mission National Rural Drinking Water MissionOther important schemes:PM Surakshit Matritwa YojanaIndradhanush India Newborn Action PlanPM Jan Aushadhi Pariyojana (NPPA)Addressing tobacco, alcohol and substance abuse ................
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