08 August 2024 – The Indian Express

Evolution of the Healthcare System in India

• Every year on April 7, we commemorate World Health Day, a day to bring people together around the crucial issue of health equity, which is central to both global health and justice. According to the World Health Organisation (WHO), everyone has the fundamental right to health. “My Health, My Right” is the topic for this year. The COVID-19 pandemic, environmental emergencies, and widening socioeconomic divides all serve to emphasise the concerning disparity in access to health care.

• The WHO Council on the Economics of Health for All notes that more than half of the world’s population need full access to basic health services, despite the fact that more than 140 countries identify health as a constitutional right. Beyond social justice or legal reform, advancing health equity is evidently a source of hope for millions of people, as demonstrated by the passing of World Health Day in 2024.

• The Sustainable Development Goals (SDGs) target 3.8 (“Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all”) also focuses on inclusive healthcare. The United Nations defines inclusive healthcare as “everyone, everywhere should have access to the health services they need without risk of financial hardship.”

Inclusive healthcare: what is it?

• Care cannot be truly inclusive for everyone using a single formula. The sustainability of inclusive care is crucial. In other words, everyone concerned must be prepared to reassess and adjust as needed. Four characteristics of care that is inclusive are:

An inclusive culture:

• A company’s culture ought to incorporate inclusive care. Every member of staff that deals with patients, regardless of whether they hold an MD or MS, should be aware of the common obstacles that people encounter.
• To make sure that they do not provide patients with yet another obstacle to overcome, staff members should undergo frequent training. The first time you interact with a patient should be the start of inclusive care. Rather than being a box to be checked, a sustainable culture of inclusion is a method of giving each person who enters the place the greatest care possible.

Friendly Environments:

• Physical settings in inclusive care are accessible to individuals with a range of abilities. Clinical and logistical materials are included in the patient’s native tongues. Employees in inclusive environments ought to represent the same kinds of varied patient populations.

• Beyond the actual space used, inclusive care also includes the resources made available to patients. Large print, multilingual availability, suitable language (embracing all genders and sexual orientations), and cultural sensitivity are some characteristics of inclusive publications.

• Patients’ concerns are taken into consideration and they are involved in the decision-making process through inclusive care. When possible, healthcare professionals should collaborate with patients on an intellectual or educational level, taking into account their resources and accessibility.

What Does “Health Equity” Mean?

• No matter what their circumstances, everyone gets an equal chance to reach their maximum potential for health because to health equity. This concept transcends genetics by acknowledging the influence of social, economic, and environmental factors on health outcomes. The goal of WHO is to eradicate unfair and avoidable health disparities between various social and economic groups.

• In contrast to equitable access to healthcare, true health equity tackles the underlying causes of health disparities, such as prejudice, poverty, and inadequate access to a healthy diet, clean water, fresh air, and housing.
• Pandemics, climate change, and sociopolitical turmoil exacerbate these inequalities. India is a diversified country with large socioeconomic divides. This situation therefore touches a nerve. Compared to urban regions, rural communities have substantially less access to healthcare. This inequality is exacerbated by social and economic constraints.

• Achieving health equity requires a comprehensive approach that addresses the socioeconomic determinants of health in addition to legislative reform in order to ensure that everyone may enjoy a healthy life. To fully realise everyone’s potential for health, governments, communities, and individuals must work together to remove these barriers.
• What Kinds of Obstacles Affect Health Equity?
• The path to health equity is paved with obstacles, especially in multicultural nations like India, where issues range from deeply rooted societal inequities to global systemic health concerns. In this place, access to high-quality healthcare is a challenge for diverse people.

• The struggle for health equity faces worldwide issues that cut beyond national boundaries and necessitate coordinated global action. The COVID-19 pandemic has glaringly shown that underprivileged and marginalised populations are the ones most affected by infectious diseases, which exacerbates the disparity in health outcomes.

Concerns about Climate Change:

• Since low-income and vulnerable populations are disproportionately affected by climate change, there is a major health risk. Conflicts seriously impair the delivery of healthcare by destroying infrastructure, uprooting communities, and denying access to essential medical treatments.
• India-specific Difficulties

A sizable and varied populace:

• India’s vast and diverse population presents ongoing challenges to health equity, including noticeable disparities in access to and quality of care. Even though over the past 20 years, access to healthcare has increased, rural India still needs a lot of work.
• Urban slums account for more than 17% of India’s metropolitan districts, and their inhabitants have grave health disparities, according to the 2011 Census. Strict access to clean water, inadequate sanitation, and overcrowding all raise health hazards.
• In comparison to non-slum neighbourhoods, infectious diseases like tuberculosis are 1.5 times more common in slums, according to the Indian Council of Medical Research (ICMR).

Disparities by Gender and Caste:

• Gender and caste differences are significant. Data from the National Family Health Survey (NFHS)-5 (2019–21) shows that immunisation rates are lower and child mortality is greater among Scheduled Castes and Scheduled Tribes.
• The interaction of caste, gender, and economic status in health outcomes is further evidenced by the fact that 59% of women in the lowest wealth quintile experience anaemia, which is nearly twice as common as in the top quintile.

Non-Communicable Disease Burden:

• In India, non-communicable diseases (NCDs) are the cause of almost 60% of deaths. The Public Health Foundation of India emphasises the need for preventative healthcare and fair treatment access, noting that the economic impact of NCDs could exceed USD 6 trillion by 2030 and that stakeholders must act quickly to address this issue.

A severe shortage of physicians:

• These problems are made worse by a severe physician shortage; according to WHO data, there are only 0.8 doctors for every 1,000 people, which is less than the recommended ratio. The scarcity of health care workers is especially acute in rural areas, despite the fact that over 75% of them work in urban areas, which only make up 27% of the population.

Insufficient Financial Protection:

• Even with programmes like Janani Shishu Suraksha Karyakram, public health institutions still charge a high average out-of-pocket cost each delivery, especially in urban areas.
• The various Indian states range greatly in terms of both access to healthcare services and out-of-pocket expenses (OOPE). Out-of-pocket spending increased in many larger and northeastern states between NFHS-4 and NFHS-5.
• According to the most recent NFHS-5 survey, the average out-of-pocket cost per delivery in a public health facility is Rs. 2,916, and for both urban and rural areas, it is concurrently Rs. 3,385 and Rs. 2,770.

What Are the Different Ideas for Including in the Provision of Equitable Healthcare?

• Beyond upgrades to healthcare facilities, a comprehensive strategy is needed to address the wider socioeconomic determinants of health and address India’s health equity concerns. The government, civic society, healthcare providers, and communities must collaborate in order to advance India towards universal health coverage and a more equal future.
• Increasing health literacy is necessary to achieve health fairness. By integrating health education into the National Health Mission (NHM), India can empower its citizens to seek equitable care and make informed health decisions. This would help the country transform health equality into a shared, community-driven aim.

Government Intervention Is Required:

• Laws, innovative policies, and money are some of the ways that governments and officials can affect the state of health. To illustrate a commitment to lowering health inequities, India’s Ayushman Bharat programme offers free health coverage to the bottom 40% of the economic spectrum.
• The National Health Mission (NHM), comprising the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), aims to bridge the healthcare gap between rural and urban India by bolstering infrastructure, increasing accessibility, and offering critical services to disadvantaged groups.

Collaboration between the Public and Private Sectors:

• The public and private health-care sectors cooperate with the government to offer services to impoverished populations, with a focus on improving infrastructure, workforce development, and preventive education.
• Concerns with regional health are brought to the attention of and resolved through direct community engagement by non-governmental groups and civic societies. Through its partnerships with governmental and international agencies, they are able to develop health programmes that are sensitive to the specific cultural needs of the community.

• International organisations can support healthcare systems in underdeveloped nations by donating financial and technical resources. Infrastructure, education, and accessibility to necessary medications and technology can all benefit from this.
• International organisations like the World Health Organisation (WHO), the Global Fund for AIDS, Tuberculosis and Malaria, and the Gavi-Global Vaccine Alliance encourage information and resource sharing to improve health-care systems, particularly in developing nations like India. These organisations also support health initiatives in areas with limited resources.

Fostering Technological Development and Innovation:

• The commercial sector and nonprofit groups enhance accessibility and affordability while expanding reach and efficacy through technological advancements and innovation, especially in the field of digital health.
• Academic institutions and research centres provide vital information about health disparities and the effectiveness of interventions, helping to develop evidence-based practices and laws backed by empirical research.
• Innovation in healthcare is still fueled by technological breakthroughs, which improve patient care, diagnosis, and therapies. A few noteworthy developments are robotics and automation, wearable devices and remote monitoring, artificial intelligence (AI) and machine learning (ML), and precision medicine and genomics.

The Following Businesses Have a Significant Local Presence:

• Health equity depends on local organisations that are well-established. They actively engage in all stages, from planning to assessment, to ensure that health interventions are applicable and efficient. They also know exactly what is expected of them in their community.

• In order to achieve health equity, successful collaborations require open communication, mutual respect, and shared objectives. They have a significant emphasis on community empowerment, knowledge sharing, and capacity building, which means they are ready to adjust to changing health concerns and community demands.
• Good communication between all stakeholders, from grassroots organisations to legislators, can greatly improve health equity and open the door to a future in which everyone has access to high-quality healthcare as a right rather than a privilege.

• As per the fiscal year 2020 budget predictions, public health in India accounted for approximately 1.35 percent of the country’s GDP. Compared to the prior fiscal year, when healthcare accounted for roughly 1.29% of GDP, this was a little increase.
• The Union and States should increase their combined public health spending to 2.5% of GDP (Growth Domestic Product) by 2025, according to the recommendation of the Fifteenth Finance Commission.
• At the moment, 20% of people have both private and social health insurance, while the remaining 30%, referred to as the “missing middle,” do not have any coverage.

What are the Health Care Sector Initiatives?

• Mission of National Health
• Bharat Ayushman.
• AB-PMJAY stands for Pradhan Mantri Jan Arogya Yojana.
• Commission on National Medicine
• PM National Dialysis Initiative.
• Karyakram Janani Shishu Suraksha (JSSK).
• Rashtriya Bal Swasthya Karyakram (RBSK).

• Creating a healthcare system that upholds each person’s rights and dignity is the foundation of inclusive healthcare, not only offering medical care. It calls for providing healthcare services that are easily available, reasonably priced, and sensitive to cultural differences, as well as attending to the various needs of all individuals, particularly the marginalised and vulnerable. To improve health outcomes for everyone, inclusive healthcare is not only a practical need but also a moral obligation. We can create healthier, more just societies where everyone has the chance to lead a happy, healthy life by embracing inclusion in healthcare.