Major Problems Of India’s Healthcare System And How Can The Govt Cure Them

India has only 10 lakh registered doctors to cater to 1.3 billion citizens. As per the MCI claims, half of the doctors in the country are quacks( unregistered doctors who don’t hold a degree in allopathy). While urban areas have 58% qualified doctors, in rural areas the number is as low as 18.8%.

India continues to spend about 1.2% of its GDP on health sector far less than some of the poorest countries of the world. We are ahead of only a few countries like Myanmar, Pakistan, Sudan and Cambodia.

However, the availability of public health care services is abysmal. There is only one government allopathic doctor per 10,189 people, only one government hospital bed per 2046 people, and one state-run hospital per 90,343 people. Out of 1 million doctors in the country, only 10% of them work in the public health sector(according to National Health Profile). They lack good infrastructure, proper management, dedicated staff and many other things which are required to provide reasonable and appropriate healthcare.

In 2014, 38.2% of India’s population was below the poverty. These people depend on government hospitals for their treatment. Many times they go to hospitals with one disease and come back infected with some other illness due to improper sanitation and inadequate quality of care provided by the staff. In 2017, around 300 infants died in Gorakhpur Baba Raghav Das Medical College due to poor management and a shortage of oxygen supply. But there is little to no evidence to suggest that the government has learnt from its previous mistakes.

India spends only 1-2% of it it GDP on healthcare. With the investment on private healthcare the overall spending stands at 4.5%.

Foreign patients also are coming in large numbers to India for relatively cheaper private healthcare. They mainly come from the Middle East, Africa, Pakistan and Bangladesh for paediatric cardiac surgery, liver transplants, etc. Some even have started coming from UK, Europe and North America for cheap and quick coronary bypass or orthopaedic treatments. This is ironic that while people from other countries are utilising our private healthcare services while its citizens are reeling under catastrophic healthcare expenditure.

After independence in 1947, the private hospital used to provide services to only 5-10% of the patients, but today its accounts for 82% of outpatients visits and 58% of inpatient. Government have supported private sector by releasing prime land resources at low rates, by exemption from taxes and duties for importing drug and high tech medical equipment.

Many private players in healthcare sectors have shifted to profiteering over the last couple of years. They now dominate the upper end of the market, with five stars hospitals manned by foreign-trained doctors who provide services at a rate which only rich people can afford. But the public alternative is so worse, with the long waiting time , dirty surrounding and lack of proper equipment. Many tests cannot happen because of the lack of facilities and medicines. As a result, patients don’t have any choice other than turning towards private sector hospitals.

Private hospital charge so high that more than 40% of all patient admitted in the hospital have to borrow money or sell their assets, and about 25% of farmers are pushed below the poverty line due to the burden of the out of pocket healthcare spending.

Last year, Fortis Hospital in Gurugram billed a dengue patient around Rs.16 lakh for 15 days treatment in its intensive care unit. Despite that they could not save that patient. Despite having new technology and well-trained doctors, there have been many cases of medical negligence in private hospitals. Max Hospital in Shalimar declared baby died when he was alive.

What’s The Solution?

The government needs to price the services in a serious manner. Today in most of the states, health schemes of Central government do not have perfect pricing system which actually should be based on open tender. Maybe fixing the price in the form of a package of services with similar processes will be helpful

In the UK and Thailand, 80% of services provided is by the Government Hospitals where doctors and staff salaries are fixed. In Japan, private doctors offer services based on fixed prices by the Ministry of Health in consultation with staff holders. Government ensures that there should be no overbilling by imposing stringent penalties.

We need some companies which can bring together different healthcare components such as doctors, hospitals, clinics, diagnostic centres together on one platform and provide home services.

Startups like PORTEA provide home care services. It says “It provides chemotherapy for 30-40% less fee than what hospital charges. The cost of the drug as well as admission and nursing charges are nearly Rs 25000 in an average private hospital compared to Rs 16000 if treatment is given at home. Home care services also reduce the risk of secondary infection.

Healthcare cost comes down if the government stops looking at the poor patient as a source of revenue or some burden on taxpayers money. If a patient pays Rs 1000 for healthcare services then about Rs 250 goes to the government as various taxes. Income tax exemption for the hospital as an incentive won’t reduce healthcare cost for the patient but will benefit the promoter.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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