Marcellus: “Something is rotten in the State of Denmark”
Horacio: “..then we should let God take care of it”
The conversation snippet from Shakespeare’s Hamlet sort of explains the current state of India’s public healthcare. The public healthcare system of the country severely suffers from access, quantity and quality issues.
Numbers speak for this.
Last year a World Health Organisation report on India’s healthcare workforce found that only one in five doctors in rural India are qualified to practice medicine. There is one government doctor for every 10,189 people and one hospital bed for every 2,046 people. The growth in healthcare has been tremendously slow due to the lack of funds. Very little expenditure on public health is seen in India. According to T.S. Vijayan, the chairman of Insurance Regulatory and Development Authority of India (IRDAI), 62% of the total medical cost of India is ‘out of pocket’ expenses i.e., the people paid for those expenses out of their own pockets, which is quite high when compared to the United States in 13.4% and the UK at 10%. While several healthcare programmes have been introduced time and again, our country continues to face health issues and health problems.
For this feature released on World Health Day, when the international theme is Universal health coverage: everyone, everywhere, Chaaipani team decided to take a deeper look at how accessible is Indian healthcare.
While Sharika visited several government hospitals in Bengaluru, Kanal visited hospitals in Mumbai – Both metro cities.
Glimpses from public healthcare in Karnataka – An account by Sharika Nair
My research and analysis was an eye-opener. I started off by visiting one of the hospitals in my vicinity.
The hospital was severely understaffed with just one doctor and three nurses, a lab technician, a security guard, a driver and an aaya. All the staff members have been working in the hospital since it started in 2001.
“I work 20+ hours and sometimes it becomes so busy that we can’t even go out to have a coffee,” said Janaki (name changed) who has been working in the hospital since the past 17 years.
Daily, the hospital has around 50-60 OPD (Out Patient Department) cases to attend to, out of which the number of deliveries is monthly 12 to 16. Though the hospital’s official timings are till 4.30 pm, it functions for 24 hours and often, the nurses are called from their homes in the middle of the night to attend to emergencies.
Janaki stays right behind the hospital and comes running whenever the need arises.
There are several such Janakis who are providing their services in government hospitals in spite of being overworked throughout the year. Often an appeal or request to the government to provide these hospitals with more staff and facilities go unheard.
In a couple of bigger government hospitals, several doctors were of the view that the condition w.r.t hygiene and facilities have improved through the years. Some hospitals were 25- bedded ones and had an exclusive gynecology and pediatric department as opposed to the smaller ones, wherein the only room that existed was a labor room.
Noticed in 4-5 hospitals, what was shocking was security. Any patient is free to walk in without being checked. Even if a security guard is hired, generally he/she is unskilled. At several instances, doctors have been attacked and even threatened to be murdered if they didn’t look into the cases immediately. In this scenario, one would wonder whom to feel sorry for? The doctor or the patient’s family? This is due to the staggering number of doctors in our country, due to which there will always be an immediate need for them.
Imagine a situation wherein the patient and his family are desperately seeking medical aid and the doctor who has to juggle between patients is left in a dicey situation. Cases like these aren’t uncommon in government hospitals.
The appalling condition of the government-run hospitals in Mumbai – What Kanal Patel observed
Being from Baroda, a tier two city, I used to believe that the metro cities have a better lifestyle. Coming to Mumbai, I was struck by the beauty of the nightlife, locals and an amazing work life till I started doing my research for this article.
My illusion quickly faded as I visited the first hospital ESIC Hospital and Dispensary in Chakala. As I got off on the gate, I noticed that the facility is under construction yet working. As I went inside, the image was just appalling. On every floor, the left wing after the elevator is under construction and also running general wards next to the construction site. The dreadful sight didn’t end here. I could find cats running on every hospital floor. I tried talking to the authorities and administration, to which they refused. I waited for some time and tried meeting different people but all a miss.
My second hospital was KEM i.e., the King Edward Memorial Hospital in Parel. Just by looking at the colossal building, I could only imagine it to be the most reputed and well-maintained hospital but the reality was far from different.
As I entered, I could see the visitors sleeping on the floor as the facility did not have a proper sitting space with broken benches. Till this point, I was about to negate my boss, Shruti’s story from her last visit to KEM – which was about 6 months back. Back then, Shruti took to social media and did review the hospital on Google.
As I moved further, I could experience what Shruti experienced. It is still the same. I could still find a cat in the gynecology department and I also found a dog! The people who were sitting on that floor were found feeding them and the doctors were also walking around as if it was very normal.
With a little bit of Google-ing, I got to know that this is a big problem around India. There is another similar case from Bhatinda in the Bhai Mani Singh Civil Hospital. The stray dogs roam freely in the women and children department which is considered to be the most sensitive ward for any hospital. The staff of that hospital remains to be the mere spectators while the family or visitors of the patient try to chase them away.
Delhi’s Bara Hindu Rao Hospital, a hospital meant for humans is a destination for troops of monkey and stray dogs that bite the doctors as well as patients.
Animals can carry various infections and diseases.
Some countries have adopted a policy of a therapy pet for people suffering from critical illnesses but these therapy pets are not strays but professionally disinfected animals.
Clearly, Mumbai has two extremes – Either the glittery Lilavati & Nanavati hospitals, which are no less than 5 stars or the other category as described.
The dominance of the private sector
Health care services are being ruled over by the private sector. India approximately has 9.3 lakh doctors but still lags when it comes to accessibility to the poor. ‘Local Quacks’ and ‘Jhola Jhap’ doctors are often consulted for quick and cheap treatments.
Niti Aayog, the government’s policy think tank, has suggested a model that provides for a greater role for private players in India’s healthcare sector.
Ravi Duggal from advocacy body Centre for Enquiry into Health and Allied Themes said that the private expenditure and investment on health was bound to go up when the government was not spending enough money on building and maintaining facilities.
“When NITI Aayog itself is promoting private companies, the public facilities do not stand a chance to compete. The encroachment of private sector in healthcare has been happening for two decades but it has become quite rapid in the last few years as people are forced to pay for health at private healthcare providers instead of getting treated at public facilities,” says Ravi Duggal
Silver Lining for Public Healthcare? Yes.
The current situation looks depressing. Equal opportunity to quality healthcare looks like a far reality – but there sure is a visible intent by the decision makers to make things right.
The government has been taking some active steps—such as increasing the number of drugs under price control. While price control appears to be a solution in the short-term it is rarely a good solution in the long-term because it keeps professional profit motivated players out and encourages participants to cheat and creates incentives for the well-to-do to use illegal methods to get around it. While framework adjustments like requiring the prescription of generics (India is the generics capital of the world after all) make sense, outright price control of the type now mandated for stents is poor policy.
– Narayan Ramachandran is chairman, InKlude Labs, Sourced.
A common solution to treating issues related to the productivity of public health sector is PPP (private-public partnership). It might not seem to imply privatization alone, however in the long run; it might further increase the gap between the rich and the poor. Effective addressing of public health challenges necessitates new forms of cooperation with private sectors (public-private partnership), civil societies, national health leaders, health workers, communities, other relevant sectors and international health agencies such as WHO, UNICEF, Bill and Melinda Gates Foundation, World Bank.
National Health Policy 2017 has proposed raising public health expenditure to 2.5% of the GDP of India and widening the scope of primary health care packages available through health and wellness centers. A comprehensive primary health care package shall include geriatric health care, palliative care, and rehabilitative services. The policy advocates allocating upto two-thirds or more of resources to primary care, followed by secondary and tertiary care. It also recommends incorporation of digital tools for healthcare systems, health programmes in the school curriculum, better access to AYUSH remedies through co-location in public facilities, boosting the practice of yoga. Under a ‘giving back to society’ initiative, it also hopes to encourage voluntary service in rural and under-served areas by healthcare professionals.
Initiatives such as Sanjeevan by SNEHA (Supported by Siemens India) can also help bridge the gap. Sanjeevan is a van service that runs in the communities of most vulnerable pockets of Kalyan-Dombivali Municipal Corporation region offering free preventive, promotive, and curative health care, including referrals and follow-up services.The van currently visits 10 areas of the Municipality, servicing communities with a majority of migrants, including daily wage laborers, construction workers, vendors, etc.
Do you know of any such initiatives? Share your experiences with public healthcare facilities, any initiatives and ideas to solve it with us in the comments section or on [email protected]
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