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The State Of Healthcare In India: Problems And Prospects

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It has been said that healthcare and education form the two most important and fundamental pillars of a welfare state. Unfortunately, both of these have been ignored in India for a long period. The condition of healthcare in India has never been satisfactory. India was ranked 145th among 195 countries as per the Healthcare Access and Quality Index 2016. It’s disappointing. 

At a time when the pandemic has challenged the capacity of well developed and advanced healthcare of western countries, Indian healthcare system seems to struggle with the ongoing crisis with its challenges and shortcomings.

These include insufficient hospital beds (0.7 per 1000 individuals), shortage of doctors (0.8 per 1000 individuals), shortage of paramedical and nursing staff, lack of medical equipment and devices, operational machinery and ventilators to be specific, low-quality care due to misdiagnosis by under-trained staff, unnecessary and expensive diagnosis, corruption and poor cooperation between public and private spheres, etc. 

Nearly 31.5% of hospitals and 16% of beds are located in rural areas where 75% of the total population resides. 

Moreover, there exists a rural-urban divide when it comes to healthcare service delivery. Affordability and accessibility of quality healthcare in rural areas have always been a concern. Nearly 31.5% of hospitals and 16% of beds are located in rural areas where 75% of the total population resides. 

If there is one reason behind most of the challenges of Indian healthcare in general, and public healthcare in particular, it is the inadequate government spending. India’s total healthcare spending (out of pocket and public), at 3.6% of GDP, as per OECD, is way lower than other countries. The government spending on healthcare has to be increased, without a doubt.

However, it is of equal importance for the Government to know where and how to spend. As long as the aim of Government is the translation of its healthcare expenditure into tangible economic outputs, issues on the ground will remain unsolved. Much of its expenditure has been done to strengthen the private healthcare sector which provides the majority of secondary, tertiary and quaternary care. 

Quality and affordable healthcare can be provided to a large population in roughly two ways. One is to make an investment in private healthcare and make it affordable to citizens by various means, including viability gap funding. The other one is to improve public healthcare and make it large, competitive and advanced. 

Unfortunately, India has followed the first option, which is not sustainable. The underlying idea behind this approach is the assumption, or perhaps misconception, of the Government that private healthcare is the epitome of quality healthcare, which is not true. Even private healthcare is not immune to corruption, the inefficiency of staff and infrastructural bottlenecks. It requires only a single visit to a large private hospital to observe prevalent unethical practices in the name of professionalism and service.

India needs a quality healthcare system which is affordable and accessible to most of the population. This can only be ensured if public healthcare is strengthened. The first and foremost step to be taken in this direction is upgradation of sub-centres and primary health centres. Overcrowding in district hospitals happens because we have shifted our focus from Primary and Secondary Healthcare to Tertiary and Quaternary Healthcare.

On the other hand, urban healthcare is dominated by single, unqualified practitioners since government healthcare is grossly inadequate to cater to a large population. Divide between the public and private sector in terms of service delivery, capacity and cost is a unique feature to the Indian healthcare system.

Healthcare
Under the Yeshasvini scheme, a family of five gets health insurance of up to ₹2 lakh per annum, for which they have to pay a premium of Rs 700.

The Government needs to adopt the PPP model in narrowing this divide. Few such successful models are Yashasvini Health Scheme of Karnataka, Arogya Raksha Scheme in Andhra Pradesh, Telemedicine initiative by Narayana Hrudayalaya in Karnataka, GVK EMRI, Chiranjeevi Yojana of Gujarat, etc.

Since there is a shortage of hospitals, doctors and medical staff, technology and innovative solutions can play a huge role in reducing the overcrowding of clinics. eHealth (which includes ePrescribing, Clinical decision support system, Telemedicine, Telesurgery, Consumer Health Informatics), mHealth and Telerobotic surgeries are of huge significance, provided that the government pay heed to promote it. Telemedicine, particularly, is a solution to various challenges of the Indian healthcare system. 

Moreover, biomedical research remains on the back seat in India, citing a lack of government expenditure. The Indian Council of Medical Research, a premier biomedical research agency in India, itself reported one of the lowest budgetary expenditures on research and development among major central government scientific agencies. Government spending has to be increased and incentives are to be provided to researchers to bridge the ever widening gap between academics and research. 

Changing disease profiles and the emergence of new zoonotic diseases has questioned our existing health approach. In this situation, one health approach, which aims to integrate efforts in medicine, veterinary medicine, public health, agriculture and environmental health, assumes a much important role. 

As I said earlier, a mere quantitative jump in spending without analysing where and how to spend takes our healthcare system nowhere. Steps such as strengthening infrastructure through sustainable financing and investment instruments, capacity building of the workforce including Auxiliary Nurse Midwives, adoption of new technologies viz. nanotechnology, biotechnology, machine learning, blockchain, addressing supply-side issues and regulation of medical practices is required.

Since health is under the State list of the constitution, corrective measures have to be taken by the centre to ensure effective cooperation for the betterment of health services. It is to be noted that in any healthcare system, there reaches a point beyond where the capacity of the healthcare system will fall short of resources. It is highly unrealistic to imagine, considering the population of our country, that supply will always outweigh demand. Can doubling the number of beds in hospitals guarantee that it is going to fulfil demand? 

Ensuring effective and efficient curative healthcare has become a challenge because enough attention has not been given to preventive healthcare. The outbreak of the Coronavirus is proof of that. Had the population been careful about sanitation and hygiene (WASH), outcomes would have been less disastrous.

The deplorable condition of sanitation and hygiene in government hospitals has never made policymakers and administrators concerned and attentive about the issue. After all, WASH has a direct relation with nosocomial infections and antimicrobial resistance.

Simple economics suggests to us that if we have supply-side constraints, we need to make sure the demand remain less. This can be ensured by looking for alternatives like AYUSH, strengthening preventive healthcare, using traditional knowledge and most importantly, by creating awareness which is one of the fundamental pillars of healthcare.

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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.

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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.

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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.

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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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