How skewed was healthcare access in India by the end of 2020?

The wisdom that lies in an old adage, “Health is Wealth” can’t be more reiterated than by the end of 2020 when the world was deeply captured by the COVID-19 pandemic (The Indian Express, 2020). Easy healthcare access was one of the key factors in boosting a person’s physiological and psychological well-being (Wendt & Frisina, 2009). The Healthcare system constitutes hospitals, medical equipment and devices, clinical research and trials, outsourcing, medical tourism, telemedicine, health insurance and vaccination (Leslie, et al., 2018). A well-functioning healthcare system can make a considerable contribution to a country’s economic growth and development.

Government schemes aiding India’s healthcare access

Healthcare in India reflects a spectrum of transformation, mainly due to determinants like rapid change in the pattern of consumerism, the onset of digital technologies, diseases and diagnosis, and institutional regimes for regulations. India has made remarkable progress in health indicators such as life expectancy, mortality rates, and immunization, over the years (IBEF, 2021). A number of government initiatives have made significant success, including the globally recognized National Health Mission, Rashtriya Swasthya Bima Yojana, and the most recent, Ayushman Bharat, which covers the cost of secondary and tertiary level hospitalization expenditure for the poor.

However, this traditional social sector is at a very crucial juncture with a burden of limited accessibility of healthcare facilities, low budget allocation, inadequacy in manpower and skyrocketing out-of-pocket expenditure. India was ranked 145th out of 180 countries in terms of healthcare access and quality. It continues to underperform in comparison to other Low and Lower Middle-Income nations, despite gains of 16.5 scores from 1990 to 2016 (Lancet, 2016).

The Covid-19 pandemic has demonstrated how a healthcare crisis may quickly turn into an economic and social disaster. This necessitates a paradigm shift in the Indian healthcare system, as well as the creation of an effective capacity building model. The aim of the article is to investigate the current landscape of healthcare in India by examining its performance.

Different types of healthcare systems in India

The government or public healthcare system has a limited number of secondary and tertiary care establishments in major cities. It also focuses on delivering basic healthcare access in rural regions through primary healthcare centres and Community Health Centres. Since independence, India has made incredible progress in terms of health service, adding a nexus of 1,58,417 Sub-Centres, 25,743 Primary Healthcare Centres, and 5624 Community Healthcare Centres. The private sector provides the majority of the healthcare in India accounting for 70% of its healthcare services and also, considering that more than 85% of tertiary care beds are in the private sector. (Economic Survey 2020-21, 2021)

The right to health is still not specifically recognized as a fundamental right in the Indian constitution. It is necessary to incorporate health as a constitutional and fundamental right in order to secure a stronger government commitment to health. Health is a state subject in India and ensuring the availability of suitable and sufficiently resourced health services and efficient resource allocation between primary, secondary, and tertiary care, as well as geographical regions, is critical.

Skewed healthcare access in India’s rural and urban areas

In India, 75% of the healthcare infrastructure is concentrated in urban areas, which account for just 27% of the overall population. The remaining 73 % of the country’s population does not have access to adequate primary healthcare. The health infrastructure in rural areas follows a three-tier system- Sub centre, Primary Healthcare Centres and Community Healthcare Centres. In rural India, only 11% of sub-centres, 13% of Primary Healthcare Centres, and 16% of Community Healthcare Centres satisfy the Indian Public Health Standards (Singh, 2020).

For every 10,000 people, there is only one allopathic doctor, and for every 90,000 people, there is only one state-run hospital. India’s rural health care scenario hasn’t altered much in the last decade. Patients are still in the hands of con artists and practices that aren’t based on science. In the event of an emergency, the villagers travel vast distances to the nearest hospital, and sometimes, their only feasible mode of transportation is private transport, which many cannot afford.

A substantial number of fatalities in India are caused by poor healthcare quality rather than a lack of access. The total number of doctors are approximately 12.55 lakhs in September 2020 and as of February 2021, the total number of medical colleges have reached a number above 562. Still, the figures for urban areas are also not that augmenting, where 3.4 qualified doctors and 3.2 qualified nurses are available for 1000 persons, respectively.

Recent developments in India’s overall healthcare system

The Indian healthcare industry was valued at INR 14.32 trillion in 2019 and is anticipated to increase at a CAGR of 34.04 % between 2020 and 2025, reaching INR 65.51 trillion by 2025 (Economic Survey 2020-21, 2021). The rise in demand for home healthcare equipment, digital healthcare solutions, and pharmaceutical goods are fueling market expansion. India’s hospitalization rates are among the lowest in the world, at 3-4 %; the average for middle-income nations is 8-9 %, while the Organisation for Economic Co-operation and Development average is 13-17 %. Out-of-Pocket Expenditure in India is the highest in the world.

Recent data, on the other hand, suggest that the distribution of government subsidies has improved in favour of the poor, particularly in the areas of maternity and child healthcare. The infant mortality rate has decreased from 74 per 1000 live births in 1994 to 33 in 2017, the maternal mortality ratio has decreased from 600 per one lakh live births to 122 per one lakh live births in 2015-2017, and the crude death rate and crude birth rate have both decreased to 6.3 and 20.2 per 1000 population, respectively. Since 1990, the average life expectancy has risen from 58 to 69 years (IBEF, 2021).

Key insurance schemes helping India’s healthcare access

According to the National Health Accounts, states’ share is 66 % for healthcare expenditure in 2017. India ranks 179th out of 189 nations for prioritizing health in budget allocation. However, the government has extremely laid emphasis by increasing the allocation by 137% for the health sector in Budget 2021-22, when badly impacted by the catastrophic pandemic. It is 1.2% of the GDP. The focus has been on healthcare and infrastructure in order to realize Atmanirbhar Bharat’s “Swashthya Bharat” or “Healthy India” vision. The flagship scheme- Ayushman Bharat aims to achieve Universal Health Coverage through two strategies:

1. The establishment of 1.5 lakh Health and Wellness Centers and,
2. The Pradhan Mantri Jan Arogya Yojana.

The Pradhan Mantri Jan Arogya Yojana intends to provide a health insurance cover for secondary and tertiary care hospitalization of Rs. 5 lakhs per family per year. The health insurance premium collection has gradually increased to 8 billion USD from 2016-2021 (IBEF, 2021). Financial assistance is provided in the following areas under the National Health Mission:

• ASHA workers,
• ambulances,
• mobile medical units,
• medications and equipment, and
• support for reproductive, maternal, new-born, child, and adolescent health.

During the COVID-19 pandemic, the Electronic Vaccine Intelligence Network under National Health Mission is being utilised with the necessary adaptation to ensure the continuation of vital vaccination services and to safeguard our children and expectant women from vaccine-preventable illnesses. Many social determinants of health approach are being followed by translating these into key interventions like- nutrition, sanitation (Swachh Bharat Abhiyan), accessibility (Gram Sadak Yojana), indoor air pollution (Ujjwala Yojana), drinking water (Har Ghar Jal) and gender (Beti Bachao, Beti Padhao and Sukanya Samriddhi Yojana). Changing lifestyles to cosmopolitan urbanity, unhealthy diet, stress and psychological problems, inadequate physical activities are also attributing to Non-Communicable Diseases. As individuals, it is our fundamental duty to keep our health intact. In India, Non-Communicable Diseases account for 55.4 % of disease burden and 62 % of deaths, with the number predicted to climb to nearly 70% by 2050. 

Artificial intelligence and machine learning is the key to India’s easy healthcare access

India began with a magnificent heritage of public health as evidenced by references to accounts of the Indus valley civilization (5500–1300 BCE) that describe “Arogya” as representing “holistic well-being,”. In today’s scenario, inadequate reach and fund, suboptimal insurance, lack of focus on preventive care, less impetus on medical research, unsustainable policies and shortage of medical personnel are some of the focal areas where India needs to consolidate and strategize for achieving its vision of ‘Healthy India’ and reliving its heritage.

Improving healthcare infrastructure by focusing on private hospitals and technology utilization like digital health using artificial intelligence and machine learning, will act as a catalyst to shape the overall healthcare market to provide quality and accessible care. India’s health system must be flexible in order for it to adapt successfully to future pandemics.

References

• Economic Survey 2020-21, 2021. Healthcare takes centre stage, finally!, New Delhi: The Department of Economic Affairs, Ministry of Finance.
• IBEF, 2021. Healthcare Industry in India. [Online]
  Available at: https://www.ibef.org/industry/healthcare-india.aspx
  [Accessed 24 July 2021].
• Lancet, 2016. Global Burden of Disease, London: Lancet.
• Leslie, H. et al., 2018. Health systems thinking: A new generation of research to improve healthcare quality. PLOS Medicine, 15(10).
• Singh, K., 2020. Strengthening Health Systems. Yojana, May, pp. 17-22.
• The Indian Express, 2020. Reset and reform. [Online]
  Available at: https://indianexpress.com/article/opinion/editorials/india-healthcare-system-coronavirus-6383650/
  [Accessed 24 July 2021].
• Wendt, C. & Frisina, L. R. H., 2009. Healthcare System Types: A Conceptual Framework for Comparison. Social Policy & Administration, 43(1), pp. 70-90.