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About 70 years ago, when India established its first Primary Health Center (PHC), on the recommendation of the Bhore Committee, the idea was that Indians would soon have access to equitable, affordable and quality health services. quality, responsible and adapted to their needs. . Decades later, there has been a phenomenal growth in the number of sub-centres (SCs), CSPs and community health centers (CSCs), trying to cope with the rapid population growth.
That said, large numbers of people continue to lack access to public health facilities. According to the Fifth National Family Health Survey, 2019-21, half of families in India generally do not seek care from public health facilities. Even for minor health problems like colds, fevers and diarrhoea, Indians are increasingly seeking private health care. Despite expensive treatments, people who access private facilities indicate the possibility of a lack of access and quality care in public health centers.
The NFHS-5 report shows that 49.9% of Indian households do not usually use a public health facility. This number is however lower than 55% from NFHS-4 in 2015-16. The choice of private structures over public structures was made by people from both rural and urban areas.
Why does India reject government healthcare?
Although there has been a marginal increase in the number of people using public health facilities since the last survey, it still hovers around half of the population. Nearly 40% of households that do not usually use a public health facility indicated that there was none nearby. The reason was mostly given in low income states such as Uttar Pradesh, Jharkhand or the hilly states of Uttarakhand, Sikkim and Mizoram. Transport services in remote hilly areas of the country are negligible, with poor road infrastructure. Most of the time, traveling long distances isn’t the most viable option, making private facilities the only choice. The country has almost twice as many private hospitals as public hospitals – around 43,487 compared to 25,7781. Access to private healthcare facilities is unquestionably easy.
Most public hospitals are often overcrowded and therefore many patients often choose private health centers for their convenience. This is not only true for primary health centers, but also for tertiary care centers such as AIIMS. Reports have shown that up to 10,000 people access AIIMS OPDs daily. Other reasons include inconvenient hours or being understaffed most of the time.
Improving public hospitals to improve health
India has experienced historic underinvestment in the health workforce. Hiring and filling vacancies across the country is the first step in this process. It is also very important to identify critical regions that need new infrastructure. Apart from this, there is a need for us to prepare healthcare professionals to mobilize in times of emergency like the COVID-19 pandemic.
Absenteeism is directly impacted by a shortage of supplies, insufficient infrastructure and poor staff supervision. These factors add to the already weak motivation, especially in rural areas. Ongoing and coordinated efforts to reduce the cost of labor will help.
Many people do not use hospital facilities due to preconceptions or simply a lack of awareness of services. Community health workers can play a huge role in linking people to health centres. Most of the time, ASHAs and ANMs belong to the community they serve and therefore already know the people, their culture and the local conditions. They can help bridge the gap by communicating about facilities and services in public institutions.
Alternatives to increasing the use of public health facilities
The important question we need to ask ourselves is whether we want to increase the use of public facilities or whether we want to improve the overall health of the population. Simply increasing public health resources is not the most effective way to improve health outcomes. The priority is that people have access to high quality, safe and affordable health care (Astana Declaration, 2018). In a resource-constrained environment like ours, we need to consider our constraints and work within them.
Along with the expansion of public health facilities, it is essential to make it easier for the private sector to fill gaps in health services. For this, rules like having a minimum number of chairs in a doctor’s consulting room [The Clinical Establishments (Registration and Regulation) Act, 2010] must be repealed. Regulations should attempt to address issues such as the information gap between doctor and patient. Allowing private companies to thrive would expand our country’s healthcare facilities, allowing the government to focus on providing quality healthcare to those most in need.
India still fails to meet the WHO prescribed 1 doctor per 1,000 people to 1 per 1,445 people. An important step in this process is to ease restrictions on the establishment and operation of medical and paramedical faculties. This would lead to an increase in the health care force that the country so badly needs. This situation is even worse in regions like Bihar, Madhya Pradesh and Jammu-Kashmir.
It is also important to ease regulations in the pharmaceutical industry and take full advantage of the country’s large drug manufacturing base. This will help manufacture and supply medicines and equipment at cheaper prices, making them accessible to a wider population.
A push to the population to increase insurance coverage would lead to a decrease in significant expenditure incurred by the public and ultimately lead to better medical and financial outcomes.
As we aim to achieve universal health coverage in India, it is important that we create sustainable health systems that put people first. With strong political and economic commitment, we can build resilient, agile and sufficient public health systems.
Dr. Harshit Kukreja is a research analyst at Takshashila Institution. The opinions expressed in this article are those of the author and do not represent the position of this publication.
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