Assessing Health Care conditions in India: A sorry state?

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To effectively assess health care conditions in India, it is important to correlate Health and Health care. Health needs to be distinguished from health care with a simple understanding that, health is a function directly linked with health care. We cannot define health within the frame of meagre “disease free”. Good health’s results in an individual’s ability to free from disease and the extent of the individual’s freedom from it.

In short, one understand by health as an individual’s wellbeing. This comprises of his/her consciousness towards illness and wellbeing, factors responsible behind his/her wellbeing, availability of health care services in his/her region, quality and economics behind the care as well as the available scientific knowledge in making him/her free from illness. Health care is just not limited to medical treatment, but also comprises preventive care. It does not necessarily mean expenditure of the government on individual health for pre-and post-treatment, it rather includes incentives provided both by the government and by the private enterprises for citizens to avail.

Today, the centre of our subject is India, a developing economy, where private health care “highly expensive” schemes dominates the health sector, which results in a fallout in health economy. Health care is recognised as a public “social sector”. Both the supply and demand of this economy cannot be left in the hands of a “private regulation”.

District administration must ensure appointment of trained, skilled knowledgeable staffers while ensuring that the management maintains the highest working quality.

It is important to note that, health has a direct impact on productivity and economic growth, despite of which, it remains to be enriched with unregulated policies. A country such as India, where people with a viable asset such that of their bodies, health comprises more important even than their household economics. Good health which is an enemy of illness, is crucial not only for every individual, which also ensures their survival in the society. If the State continues to ensure this fundamental right to every citizen than the State too should take the responsibility to protect their citizens from mortality inadequate nutrition, hunger and undernourishment. Sadly, the state, hasn’t fulfil in its duty, enough.

Right after independence, the nation took aggressive steps to achieve the socialistic targets which they expressed repeatedly in their Five-Year Plans. Since then, government has taken ambitious steps to eliminate social issues such as poverty and malnutrition which promoting universal health care system, however, the coordination and correlation between planning and implementation continues to lack.

Issues in Health Care system

Today, when looking at the progress achieved and those achieved in the previous years, would seem to be remarkable, but the reality of what is achieved falls out when we compare the set targets and goals achieved. One such example is the national health of 1983. It had set targets, which were supposed to be achieved by 1985, 1990 and 2000. However, after comparing the sets of goals to be achieved, it speaks its own truth: today, the expected targets set stands unachieved. The only set targets achieved were “life expectancy, polio immunization and crude death ratio”. Although, India did perform comparative better than countries with the same GDP, it is important for policy makers not get “distracted”. Armed with necessary skills and knowledge, strong administrative base, and sustainable growth India can set remarkable records. Few of the major issues leading to failure of health care reforms is the governments ineffective policies to control communicable diseases, inspite of being equipped with cost effective policies and state of the art technologies. Their inability to control over communicable diseases has resulted in the deaths of children during infancy.

Inadequate policies towards women and children

Due to inadequate women and children dedicated health care policies, followed by poverty and massive social exclusion, women and children particularly SC and ST are worst affected. The causes primarily responsible for their exclusion involve vivid factors, from inadequate demographic dividends to poor socio-economic conditions, anaemia and undernourishment, followed by absence of trained care takers in angadbadi and rural hospitals. It is imperative to reform primary health care system while ensuring the implementation of effective policies to combat under-nutrition/ anaemia while extending to pre-maternal care.

It is important for policy makers to shift their attention to the issue of gender disparity in health care services. Gender disparity and it’s shocking outcomes continue to shake the foundations of primary health care policy in rural households. The involvement of states in providing adequate health care services have been rather “absent”. It has not only failed to provide adequate health care services in the rural households but also failed to involve public sector enterprises in health care; it rather allowed the growth of private sector enterprises, which when it comes to rural health care management fails.

It is important for policy makers to address the need for health care services a using a multidimensional view. There is a huge difference between the availability of health care services in rural and urban demographics, which on many occasions policy makers replicated.. The sole survival of rural households depends on social sector reforms. Hence, when children growing up in rural households witness gender disparity in health care and other services too witness discrimination against women.

Also, rural households in India, particularly the tribal communities have their own “medical treatments”. Some tribals continue to believe in their “pre-conceived” beliefs linking hostile spirits with one’s medical treatments. They then perform various rituals and use “magic” as means to cure. This is possible because of district administration’s poor efforts to educate communities on health care which results in no health consciousness.

Today, the private sector is sole contender, armed with technology and expertise in the Indian health care industry. It is currently dominating the Indian health care sectors, and either of economic constraints, people continue to prefer private sector’s guidance. Moreover, the sector continues to work without any regulation, hence the cost, the quality of the treatments, and the goals so set by the government remains variant and unachieved. Today, the poor are provided with a health care system for which they cannot afford. Deprived of this necessity, they are forced again into a situation of illness and disease; and this illness make them poorer. It is important for policy makers to understand the importance of rural health care system, which inspite of being a social service must be available for all. Simultaneously, it is also important for district administration to ensure that, private sub district and district level hospitals have public centric policies rather that of profit, with a well-qualified and unbiased operating mechanism and staffs followed by adequate sustainable financial system and fairly appointed contractual staffers, completing the circle with a sustainable and efficient working ethics.

District administration must ensure appointment of trained, skilled knowledgeable staffers while ensuring that the management maintains the highest working quality. Additionallly, it is important for policy makers to address the depleting quality of health care services, while ensure good governance of public health institutions. There is an absolute need to reinforce good infrastructural facilities with proper maintenance checks to keep an eye on the troublemakers, if any. More importantly, absence of talented skilled individuals in middle and upper management of health care institutions results in a weak leadership, which policy makers must ensure to fill the positions with desired candidates. Additionally, availability of medicines in rural hospitals is rare, which the district administration must ensure adequate and frequent supply of medicines in the designated institutions.

While creating a policy, policy makers need to have “result oriented approach” and must focus on number of services delivered, availed by independent households.

The need for a new health care policy

From, a developing economy to an emerging economy, India has embarked a journey to become a global leader, hence an inward focus especially strengthening health care system would prove to be an effective step in the battle against poverty, malnutrition and hunger. In the last decade, government introduced key health care reforms and continue to show determination in creating easy access to health care systems for all. The current regime’s commitment towards strengthening health care system was first seen in the Union Budget 2017 which talked about eliminating Kala-Azar and other diseases by 2020. The government then struck plans to eliminate tuberculosis by 2025 and talked about transformation of over 1.5 lakh Health Sub Centres into wellness and health centres, accessible by all.

Although, there are some steps the government fails to address. There has been substantial progress, but a lot needs to be done, especially when it comes to actively involving local government, district administration and empowering blocks and villages while ensuring they remain socially and economically ready.

Possible Solutions

The current regime continues to show its resilience towards health care reforms, but the gap between planning and implementation continues to grow. Below are some possible solutions, which would strengthen health care reforms and bridge the gap between planning and implementation to deliver required health care results.

Policy makers must provide opportunities to the rural households and cover as much as objectives as possible by streamlining a single program or an initiative. There are various programs headed by the Departments of Ministry of Health and Family Welfare along with sister ministries i.e. Ministry of Women and Child Development, Ministry of Labour and Employment, and Ministry of Water Supply and Sanitation, with overlapping agendas and poor inter agency interaction. By streamlining, all the participating agencies/ministries can sync with the same program and proposals, enabling the rural households to enrol and avail. Using the same mechanism, the leading ministry can then initiate different policies which could then be synced with local administration and participating agencies/ministries.

One way to ensure effective implementation is to create a dedicated health policy and implementation department within the ministry of health in both the centre and the state level. This department will be tasked to coordinate with sister agencies/ministries as well as liaise with district administration from time to time. The department can invite subject matter experts from the academic sector which would further help in strengthening the initiatives.

While creating a policy, policy makers need to have “result oriented approach” and must focus on number of services delivered, availed by independent households.

Policy makers need to ensure active participation of state governments and private entities, to ensure timely implementation of policies. The state government would then reach inaccessible p, regulation of all healthcare populations. Centre should promote greater allocation of state government in primary health care. It is imperative for policy makers to strengthen institutional working mechanism, ensuring equal voice within the organization, respecting the independent advice of experts, while reinforcing the institution’s ability to track and monitor progress while becoming a key link between the state and centre. Moreover, for effective results, centre should ensure equal distribution of resources with the state.