Reimagining health care system in India


By DM Deshpande

What was feared in the last few months seems to be coming true. Well, at least in metro cities of Delhi and Mumbai-shortage of hospital beds, medical personnel and equipments such as ventilators. Although some success has been achieved in terms of slowing the doubling rate of COVID-19 spread in the country, increase in the number of cases presents a grim scenario. 

Worse, epidemiologists predict that the highly contagious virus is yet to peak in India. To add to the gloom, with return of lakhs of migrant workers to their villages, the pandemic may be on its way to invade rural India too. That will be a recipe for disaster as the rural health care is abysmal, dis-functional and far from being up to the task of combating coronavirus.

Public health care in India remains one of the most neglected areas notwithstanding the claims made to build a modern welfare state. Population of 1.3 billion and public investment of less than one of GDP as per the National Health Profile present a sharp contrast that has meant no public health care facility in most parts of India. Estimates vary widely but according to Fitch Solutions, India has 8.5 hospital beds for 10,000 people and eight physicians per 10,000 persons. 

Fortunately recovery rates from COVID-19 are pretty good so far-more than 50 per cent. Yet it is indeed a scary picture. Within India, there is a huge disparity. States such as Kerala and Goa have better public health care facility whereas Bihar and other states in north lag behind substantially.

An estimated 80 per cent of the population does not have access to insurance which means most of the poor and perhaps lower middle class too have to meet their medical expenses from their meager incomes. The pandemic is certain to push at least 10 million people below the poverty line because of protracted lock downs, loss of incomes, livelihoods and the like. About 62 per cent of all the hospital beds and ICU are with private hospitals. They are catering to no more than 10 per cent of the COVID-19 load.

With numbers of positive cases galloping, more private participation will be required. It has been legally facilitated by invoking the National Disaster Management Act. Maharashtra has already taken control of 80 per cent of private hospital beds till August 31.  The pandemic has brought out glaringly how important it is for the state to ensure public health care through its own delivery mechanism.

Crisis is also an opportunity to change tacks. President Obama pushed the Affordable Care Act in the aftermath of crisis in 2008. It has substantially reduced the numbers of uninsured in the US. It has also resulted in reduced poverty levels. After World War II, England initiated National Health Service while it was relatively poor. Now it cuts across party lines in terms of popularity even among the political class.

It is high time that India too seized this opportunity. The Prime Minister did usher in a massive health insurance program for the poorest 100 million households. What was perhaps needed was a universal health program. The problem with a program that is targeted only at the poor is likely to end up as a poor program. A universal program gains much more solidarity and appeal by avoiding the stigma of targeting. With highly expanded coverage private health care providers tend to take cue and expand quickly. Cost benefit ratios in health care for a developing nation are too well known.

Good starting point for the government would be to build hospitals in tier 2 and 3 cities. Central agency could be tasked to give a standard design-a module which can be added/ multiplied depending on the numbers that need to be catered to in a region. This will help in placing bulk orders for fabricated materials, furniture etc. Large orders for steel, cement and other infrastructure goods could help kick start the economy reeling from twin problems of pandemic and recession simultaneously.

The government should fund the project in a combined form of grants and soft loans to the states. China built two hospitals in Wuhan within a week; India need not strive to match the feat but multiple projects need to be planned and executed on a war footing. The upper limit should be pre-determined and not exceed a month- and- half or two months at the most. States should arrange for additional land if required, manpower, medicines etc.

In order to mitigate manpower shortage, as rightly suggested by eminent Dr.Devi Shetty, final year graduate and post graduate students should be deemed eligible to take up their respective positions as doctors, nurses, para medical staff till the pandemic lasts. As we look at larger numbers of positive cases emerging, supply of manpower to man risky positions assumes utmost importance.

Rather unfair, but it is said that India misses no opportunity to miss an important opportunity. That trend needs to be reversed now, for at stake is not just the health and well being of thousands of people now but will bode well for the nation in several years and decades to come.  

The author has four decades of experience in higher education teaching and research. He is the former first vice chancellor of ISBM University, Chhattisgarh.