The Indian public healthcare system is facing enormous challenges, and to address these, India adopted the National Health Policy 2017 which has the vision of ‘Ayushman Bharat’ (Healthy India) through Universal Health Coverage. India will not able to realise this vision if it doesn’t strengthen certain important parameters:
1. Bottom-up approach:
By forming health committees to address people’s concerns, the Gram Panchayats can build a framework that can be shared with and implemented by the District Planning Committee. With the involvement of health superintendents or health officials, MLAs and MPs, local governments, private medical institutions, district administrations and CSR initiatives, the shortcomings of health facilities and infrastructure can be addressed.
2. Change of attitude among young doctors to serve in villages:
Most young medical graduates usually prefer working in private institutions especially in the city because of better salaries or facilities. The government should try to encourage these medical graduates to work in rural primary health centres. This could be done by amending their syllabus to bring up the problems of village health centres, their inability to get emergency medical services due to poverty, major health problems faced by the people, schemes brought in by the government, etc. This could make young doctors more compassionate towards poor people in backward areas and work for them.
3. Controlling or checking private hospitals:
The Government of India, various state governments and employment organisations provide medical insurance facilities for the common people, employees and various citizens to reduce out of pocket expenditure upto a certain limit on health expenditure. Taking this as an opportunity, private hospitals across India are charging more to extract the money provided under insurance from patients even for small diseases or injuries. The state governments should strictly monitor these hospitals and regulate the prices for various services through policies.
4. Recording daily details about available facilities made available to patients:
You might know about the tragedy in Gorakhpur last year, where lack of oxygen killed several young children at a government hospital. To stop inadequacies like these, the availability of medicines, oxygen, unoccupied beds, the number of patients admitted and the number of patients visiting each hospital should be recorded daily. This could help in monitoring the process strictly and take preventive measures spontaneously.
5. Confidence building among people:
To improve the image of public hospitals and create confidence among the people, elected leaders and administrative heads should avail treatment only from government hospitals. During her last days, former Tamil Nadu CM, late Jayalalithaa was taken to Apollo Hospital and doctors from foreign countries were flown in for her treatment. Incidents like these show a lack of confidence in government hospitals and make the public lose trust in them.
6. Early comprehensive new-born screening:
Kerala State Government has recently started a unique initiative that will help in the early identification and management of all deficits in infants at appropriate ages so that the state’s burden of developmental delays and disabilities can be reduced in the long run. Under the CNS initiative, it plans to converge all newborn screening programmes under a single umbrella on a web-based platform, with a unified reporting system and link-ups with District Early Intervention Centres (DEICs) so that every infant is tracked. Thus, newborns will be assessed under four domains – visible birth defects, functional deficits (hearing issues, congenital cataract or heart diseases), metabolic disorders and neurodevelopmental issues. All Indian states should start similar initiatives to improve child health.
7. Efforts to be made towards a public-private partnership in setting up medical institutions:
Since it is not always easy to set up healthcare facilities in different parts of the country, the government can look into public-private partnerships. These institutions can serve as teaching centres for medical aspirants and also provide subsidised healthcare to the people. This step could also ensure an improvement in the doctor-patient ratio.
8. Learning from other states:
Regular transfer of knowledge should happen among the states to know how effectively services are being provided. Capacity building programs should also be conducted for doctors and nurses in emergency response. For example, after the outbreak of Nipah virus in Kerala, the state took immediate steps to contain the spread of the disease.
9. Employ more counsellors and psychologists:
As cities continue to expand, there is a huge pressure building among citizens, especially the youth. Local governments and municipal administrations should provide counselling centres for citizens. This would help address the extremely worrying rise of mental health issues in the country.
10. Enhancement of research activities in medical science:
There has been a lot of research in the field of cancer, tuberculosis, diabetes, etc but we have not been able to implement their findings and recommendations due to a lack of support from the government. So the government should encourage innovative research by providing fellowships and also provide more infrastructure for research.
11. A feedback mechanism should be brought into effect:
An app can be developed by the Government to take feedback from patients to know about the quality of services provided by government hospitals. They should be able to share whether the doctor came on time, about hospital cleanliness, whether the patients were able to get medicines easily, etc.
This automatically triggers performance appraisal of the doctors and makes them committed towards their duty. It also improves non-medical issues such as accessibility, waiting time, privacy, time with a doctor, administrative efficiency and other services such as food and lodging for families.
The hospital environment will be maintained clean and it creates a better opinion among the people.