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| Need to revamp healthcare | | | Sunita Vakil
Given that India is a notable laggard in providing quality healthcare for all despite its impressive economic growth, the need of the hour is to totally revitalize the healthcare infrastructure in the country to deal with the newer challenges in the healthcare.
There is an old saying that a healthy nation is a wealthy nation. It needs no reiteration that the health of a nation is dependent on the health of its citizens and healthcare is the segment that has to be given primary importance. A healthy nation, therefore, is possible only if its health services are geared up sufficiently to keep pace with the growing population and new challenges.
Indeed, health and education are two sectors that deserve priority over all else. Universal access to education and healthcare are fundamental necessities for any society to progress. Being the second highest populated country, India needs to focus to a great extent on the healthcare sector. Notwithstanding the government's proclamation time and again that health and education are their top priority, the facts are quite appalling . Though it is true that the healthcare sector in India has developed considerably since independence but it is also true that we are still lagging behind in providing quality healthcare for all. It is disappointing that in a nation that aspires to be a superpower, ironically healthcare for all, especially the rural poor, still remains a distant dream. Whatever development has taken place in the healthcare sector remains mostly as urban centred while a large portion of rural population still struggles for basic healthcare facilities. Even after 60 years of independence, 65% of our population does not have access to modern medicine. One can well imagine the situation in villages where around 70% of our population lives. More shocking are the facts like the availability of only one healthcare provider per sixteen villages and poor proportion of 1.03 beds per thousand population. These are serious problems that indicate how much of a shambles India's public healthcare system is in. compounding the issue is absenteesim of doctors, low levels of skill of health providers, shortage of medicines and callous attitudes of paramedical staff in rural areas. Consequently, health outcomes in India are worse than neighbouring countries like Sri Lanka and Southeast Asian countries like China and Vietnam.
Though India does not rank among the poorest countries of the world, yet the allocation of funds towards healthcare is very meagre and the governments to do not pay much heed to public health related issues. The total health expenditure in India is only 4.8 percent of the GDP which is far lower than the WHO recomended 6.5 percent. Only countries like Nigeria, Indonesia and Bangladesh have lesser expenditure . Statistics reveal that the annual per capita public health expenditure in the country does not exceed Rs.200.
This accounts for the absence of quality public healthcare in India. In contrast, many developed countries spend 7 to 10 percent of GDP on health, with the US spending as much as 14 percent. With 143 doctors per 10,000 people the ratio of doctors substantially is low in India. The number of hospital beds is also relatively very low. A survey reveals that there is a shortage of 19,269 sub centres, 4,337 primary health centres and 3,206 community health centres in the country. The consequences are all around for us to see. The public health service is ailing with an overwhelming majority of sick people being left to fend in a woefully inadequate healthcare system. With the allocation of funds taking a backseat, it is tough to carry on with the existing ramshackle infrastructure, leave alone augment it. While this is only part of the problem, rising incidence of communicable diseases like Malaria over the last few years further compounds it. Most certainly, the country is not geared up to competently deal with newer challenges like heart diseases, sexually transmitted diseases and other vector borne diseases like dengue and chickengunia. Given this alarming situation , it is imperative to revitalize the healthcare infrastructure in the country.
The issue is not just the dearth of well equipped health centres but also their effective functioning. There is an inverse relation between patient requirement and the existing delivery mechanism. There are other problems as well like laxity, apathy and negligence. Doctors and other hospital staff, especially in government hospitals, tend to be lax in their jobs and most often play truant. The gruesome death of five infants in a government hospital in Patiala highlights the abysmal condition of our hospitals across the country. Infact, a joint study released by research firm Ernst & Young and FICCI titled "Fostering quality healthcare for all" identifies the lack of medical infrasturcture, equal distribution of healthcare facilities and low accessibility of healthcare facilities as key factors that need to be addressed by India to achieve "quality healthcare for all." The report also points out that a multi-pronged proactive approach rather than a reactive approach is the need of the hour. lagged behind in achieving the supposed mark
It is not just the doctors and medical staff who are reluctant to serve humanity in hilly, inaccessible terrains but the government has also failed to put the necessary infrastructure in place so that the populace does continue to suffer. The Health Ministry's move to make rural postings compulsory for doctors keen to study further may be an appreciable. But what can be achieved by this ruling if there is nothing for them to do due to lack of basic equipment, medicines and lab facilities for simple tests? Doctors who are posted at such centres tend to be cynical and demoralised, and rightly so. The number of primary health centres and community health centres may have gone up from 725 in 1951 to 1,68,986 in 2004 but it is equally true that many of them are ill equiped to function effectively while some exist only on paper. Having said that it is necessary to overhaul medical services in rural areas. We should also ensure that problems like shortage of medicines, absence of basic equipment and absenteeism of the madical staff are tackled effectively.
Though the fact that India has made tremendous advancement in the area of healthcare for the past few years may sound great, the reality is that the rural health infrastructure in our country is woefully inadequate. Notwithstanding the ritualistic exhortations to doctors by the successive governments to serve rural areas, people are forever complaining about their non- availability in their places of duty. Probably, this unavailability of doctors was the reason the government's much touted National Rural Health Mission lagged behind in achieving the supposed work. Besides , there is not only a dearth of adequate number of doctors in primary as well as community rural healthcare centres, these is also a shortage of paramedical staff like technicians, lab assistants and others. As a result, people in rural areas are at the mercy of unqulified practitioners who tend to exploit them. According to chronic care foundation only 34% percent of the rural population has access to deagnostic centres. This speaks volumes about the deplorable . Healthcare infrastructure in rural India No wonder patient influse to city hospitals is assuming alarming proportions.
While the current election season would have been a good time for political parties to raise this issue, yet their manifestos hardly make a mention of healthcare. Tragically, no political party has illustrated any plans for improving deteriorating health services of the country. Even if they talk of providing qualitiy health care as a prepoll promise, they never follow it up after being voted to power.
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