When we attained freedom from British rule, the path ahead was beset with challenges. Poverty, illiteracy and malnutrition were rampant. Life expectancy was a mere 32 years. Today, as we celebrate 75 years of Independence, we must take stock of our present and plan for the future.
Early on, the importance of public funding for healthcare was realised by policy-makers. The Health Survey and Development Committee had been set up in 1943 under the chairmanship of Sir Joseph Bhore. It submitted a voluminous report in 1946, which has constituted the blueprint for our public healthcare model. A three-tier architecture was created, comprising the Primary Health Centres (PHCs), Community Health Centres (CHCs) and District Hospitals (DHs). These institutions continue to constitute the backbone of the public healthcare system in India. A few years ago, the concept of mohalla clinics was introduced in Delhi and with time we will learn of the efficacy of this experiment.
The number of these healthcare centres has increased substantially, but we have been unable to keep pace with the exponential rise in our population. Problems of disparity in access and an urban bias persist.
Though guidelines (IPHS or Indian Public Health Standards) have been formulated under the National Rural Health Mission (NRHM) prescribing the number of doctors/specialists in PHCs, CHCs and DHs, the quality of these facilities varies from state to state, depending upon the vision of the leadership. The Covid pandemic exposed the inadequacy of these institutions. An urgent intervention to improve the situation on the ground is necessary.
Since the early 1990s, the private sector has played an increasingly important role in healthcare. Nursing homes and private hospitals have mushroomed. The emergence of private healthcare facilities even led to India emerging as a destination for ‘medical tourism’.
Unfortunately, the rise of the private sector has coincided with a decline in standards in the government institutions. It must not be forgotten that private healthcare is expensive and practically unaffordable for many. Estimates reveal that nearly three million people fall below the poverty line each year owing to expenditure on sickness. Medical insurance is hardly ubiquitous. In these circumstances, the importance of public healthcare facilities cannot be overstated.
Notably, the Government of India initiated the Ayushman Bharat Yojana in 2018, which is a salutary measure. The scheme covers secondary- and tertiary-care hospitalisation up to Rs 5 lakh annually. It is expected that nearly 40 per cent of our population will benefit. One can say from experience that the success of this venture will depend on a very robust system of execution and monitoring. It is heartening that initial assessments show a significant positive impact.
Another vital facet is medical education. Medical colleges equip and train successive generations of professionals, including doctors and nurses. Government institutions like the AIIMS and the PGIMER, Chandigarh, have been at the forefront of this endeavour. Medical education has attracted private investment too. However, private colleges were plagued with problems like shoddy standards, improper admission procedures and capitation fee.
An attempt was made to clean up the admission system through the introduction of the NEET entrance exam. This reformatory step has met with substantial success in terms of curbing the ills of tainted admissions. While issues of a rural-urban divide have been raised in relation to performance in the NEET exam, the problem can be addressed. A possible solution is to have a hybrid model for admission to medical colleges, giving weightage to performance in the state/central board examination in addition to the NEET score.
We now have nearly 90,000 undergraduate seats every year. The focus should also be on elevating the standards of education and training. Lack of good teachers and adequate infrastructure in medical colleges must be addressed.
It would be a mistake to hastily increase the number of colleges/seats at the cost of quality infrastructure and faculty. It is ironic that many PG and super-specialty seats are lying vacant and don not attract deserving students/residents. Even medicine as a career is no more a priority profession in India among the bright youngsters. It is a serious concern and we must strive and take steps to ensure that the medical profession attracts and retains our brightest young minds, for we can ill afford mediocrity in healthcare.
Medical research and biomedical innovation are the other areas of concern. India’s pharmaceutical industry has thrived, having grown to become the third largest in the world. India is the largest exporter of generic medicines across the globe.
However, research has lagged behind. We have been unable to foster an ethos of creative ideation and research. Infrastructural bottlenecks, such as the absence of large animal experimental facilities, have compounded the problem. Animal experimental data is a requirement for human trials of any drug or biomedical device. In the absence of any national facility, the researchers and industry have to go abroad, incurring a huge cost on getting this data before any human trial.
The Atmanirbhar Bharat and ‘Make in India’ paradigms should be tailored and applied to medical care and research. Pioneering research and innovation are essential for raising healthcare standards while reducing costs.
Despite the difficulties, I remain sanguine. We are capable of building a world-class healthcare system which is accessible to all — rich or poor, rural or urban. We must recognise healthcare as a basic human right and formulate sensible policy priorities accordingly.
We will do well to remind ourselves of the words of the country’s first Prime Minster from his famous ‘Tryst with Destiny’ speech. Referring to Mahatma Gandhi, the Father of the Nation, he said: “The ambition of the greatest man of our generation has been to wipe every tear from every eye. That may be beyond us, but so long as there are tears and suffering, so long our work will not be over. And so we have to labour and to work, and work hard, to give reality to our dreams. Those dreams are for India, but they are also for the world.”
Let us pledge to redouble our efforts to fulfilling Gandhi’s dream of wiping every tear from every eye. In the healthcare realm, India can become a beacon for the world.
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