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On The Brink Of Collapse: The Inefficiencies And Challenges In The Indian Health System

Right to health is a fundamental right in India[1] and has been constantly upheld by the supreme court through several landmark judgements[2]. Despite such strong prevalence and recognition of this right in the country, very little effort has been made by the state to uphold it. August 2017 saw the death of 290 children due to lack of oxygen cylinders in a government run medical college[3].

The following month further saw the death of 49 children due to lack of basic medical facilities in another state run facility. In a recent incident three women from Uttar Pradesh were negligently injected with anti- rabies vaccine instead of Co-vid vaccine in a government hospital[4].

There has always been a dire need of health care reforms in India, long before the pandemic highlighted the inefficiencies in our system. India spends only 1.8 percent of its GDP on healthcare adding it to the list of states which spends the least on healthcare in the world and to the list of countries with highest 'out-pocket-expenditure'.[5]

The government has attempted to tackle the issue of healthcare in India by launching overly -ambitious universal healthcare schemes like Ayushman Bharat Yojana, Pradhan Mantri Suraksha Bima yojana, Aam Aadmi Bima Yojana, etc. However, these schemes failed drastically to bring about any substantial change in the healthcare situation in India due to several reason like lack of infrastructure, lack of funding and allocation of budget, largescale corruption, loopholes in the policies, etc.

Despite having made substantial progress across certain health indicators like maternal mortality, malnutrition and considerably widespread diseases remain prevalent in India. A report published by national statistical office in 2018 highlighted only 2/3rd of children in India were fully immunised[6] .

Several factors are responsible for this:
  • Functional Illiteracy:
    The lack of awareness among the Indian population regarding their own health is widespread. A study indicated that only 1/3rd of antenatal mothers were aware of the adequate knowledge on breastfeeding practices. Another report suggested that only 11.3 percent girl in Haryana were adequately informed on reproductive health issues[7]. The reasons behind these significantly low numbers are low emphasis on education within the Indian healthcare system, low functional literacy, low concern regarding health within the population, among several other factors.
     
  • Lack of accessibility to quality healthcare:
    Several factors like availability, supply, utilisation of services and social, cultural and financial barriers determine accessibility to healthcare. It has been observed that 'Physical reach' is one of the major factors resulting in lack of access to healthcare in India. The criteria determining 'physical access' states that a healthcare facility can only be said to be accessible if it is present within five kilometres from the place of residence[8].

    Based on this criteria a report published by IMS institute for healthcare informatics stated that healthcare facility was only available to thirty seven percent Indians in rural areas. Keeping aside the 'physical access' determinant there is also a lack of access to quality healthcare resulting in lack of basic facilities like beds and bathrooms even in PHC's.
     
  • Lack of manpower in healthcare:
    India has a severe shortage of manpower in the healthcare sector with approximately 20 healthcare personnel's working per ten thousand people. The distribution and availability of these personnel's also varies based on the region, with lesser availability of workforce in poor and rural areas resulting in shortage of qualified healthcare workers in these regions.
     
  • Lack of affordable quality healthcare:
    Private sector healthcare is the key service provider in India. Despite public sector healthcare being either free of cost or of minimal cost there is a considerable inclination of the population towards private sector healthcare due better quality and reliability of its services as compared to public sector healthcare.

    This results in the private sector healthcare to charge hefty amounts for its services. Lack of affordable and unregulated health care services in India have resulted in a majority of population to either get exploited by the private sector healthcare providers or to receive below par treatment at public institutions.
Other factors like lack of accountability , unequal quality of treatment based on caste, class, gender and most Importantly lack universal health care scheme and practice of 'out-of- pocket' payment methods for healthcare also play an important role in the deteriorating condition of India's healthcare.

Step Forward:
There is a need for the government to take substantial steps to increase awareness regarding health within its population. Studies have shown that 'behavioural change' interventions have brought about impactful results[9]. There is also a need for the state to determine the existing barriers causing hinderances in making healthcare available to everyone.

Further it is important that a policy is formulated on 'Health Human-Power' which provides measures to ensure that every Indian has access to a trained and a qualified healthcare personnel. It is also essential that the government gives urgent attention to the current healthcare crisis in the country and raises its allotted expenditure on health to at least a minimum of 6 percent of GDP in the short term.

This will improve the current condition of public healthcare services with better quality infrastructure, affordable quality healthcare services. Improved infrastructure of healthcare services in rural and poor areas will also attract more qualified healthcare workers. There is also requirement to strictly regulate private healthcare service providers in order to protect the public from exploitation.

Most Importantly it is essential for India to adopt an effective universal healthcare policy, compulsory health insurance for every citizen and increase its spending of 1.8 percent to at least a minimum of 6 percent of total GDP on its healthcare. n

End-Notes:
  1. INDIA CONST. art. 21.
  2. Pt. Parmanand Katara v. Union Of India, A.I.R. 1989 S.C. 2039 (India).
  3. Omar Rashid, 'Gorakhpur Hospital ignored warning on oxygen supply', The Hindu (2017).
  4. Sandeep Rai, 'Three women administered anti raboes injections instead of covid vaccine, probe ordered', The times of India (2021).
  5. Banjot Kaur, 'Union Budget 2021-22: how goof is the hike in allocation for health?' Down to earth (2021).
  6. National Statistical Office, Ministry of Statistics and Programme Implementation, Government of India , NSS 75th Round (July 2017-June 2018).
  7. Mittal K, Goel MK 'Knowledge regarding reproductive health among urban adolescent girls of Haryana', Indian J Community Med. (2010)
  8. Munjanja SP, Magure T, Kandawasvika G. 'Geographical access, transport and referral systems, Maternal and Perinatal Health in Developing Countries', CAB International e books (2012), pp. 139-54.
  9. Kotwal N, Khan N, Kaul S. 'A review of the effectiveness of theinterventions on adolescent reproductive health in developing countries', Int J Sci Res Publ ( 2014;4:1-4).

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