The healthcare sector in India is booming in terms of revenue generation and employment creation. In India, healthcare is divided into two segments - public and private. The public healthcare segment is responsible for maintaining the primary health requirements in rural and urban areas and is funded by the government. The private healthcare segment in India is mainly focused in urban centres.
The healthcare market is expected to increase about three-fold by 2022 and result in `8.6 trillion. This growth is to be augmented by a surge of 20-25% in the medical tourism sector in India. The number of medical tourist arrivals in India increased to 1.07 million in 2018 from 0.98 million 2017. However, the rural healthcare sector still faces a plethora of challenges and needs focused policy-level interventions.
Urban versus rural healthcare
In India, 75% of the healthcare infrastructure is concentrated in urban areas where only 27% of the total Indian population is living. The remaining 73% of the country’s population is lacking proper primary healthcare facilities. Private healthcare has been witnessing steady growth whereas there is a serious degradation in the quality or infrastructure in the public healthcare sector. The rural healthcare in India is characterised by under-staffed facilities with bad infrastructure and low availability of medicines. According to a KMPG report, “74% of Indian doctors are catering to the needs of the urban population.”
Dr. Anup Sadhu, a radiologist, told BE, “The situation of rural health care in India has not changed much during the past decade, though it is difficult to gauge from it from outside. The patients are still in the hands of quacks and unscientific medical practices. The villagers have to travel a long distances to the nearest hospital in case of emergencies and their only viable transportation is private transport which many cannot afford.”
Most people in rural India opt for government healthcare facilities because of monetary issues and as transport options to the urban centres are not very affordable. Despite that, only 11% sub-centres, 13% Primary Health Centres (PHCs) and 16% Community Health Centres (CHCs) in rural India meet the Indian Public Health Standards (IPHS). Only one allopathic doctor is available for every 10,000 people and one state run hospital is available for 90,000 people.
Dr. Sadhu said, “The most important factor is turning a deaf ear to the patients or their relatives. Their innocence is exploited and they are not allowed to know their rights. Poor literacy is a factor. The doctor in the rural set up is rarely available; most of the centres are run by unskilled or semi-skilled paramedics. In a situation which is beyond control, the patients are sent to the tertiary care hospital where they get more confused and get easily cheated by a group of health workers and middlemen.
Non-availability of basic drugs is a persistent problem of India’s rural healthcare. If there are two or three doctors in a rural hospital, they usually share their duties on mutual basis for 1-2 days per week and the rest is managed by a pharmacist or a nurse. In many rural hospitals, the num-ber of nurses is much less than required.”
Apart from these, there are certain other constraints that work impede the rural healthcare sector:
Infrastructure: The biggest concern for the rural healthcare system is the lack adequate infrastructure. Satnam Singh, AGM, Smile Foundation, told BE, “The existing healthcare centres in rural areas are under-financed, uses below quality equipment, are low in supply of medicines and lacks qualified and dedicated human resources. On top of it, underdeveloped roads, railway systems, poor power supply are some of the major disadvantages that make it difficult to set up a rural healthcare facility.”
Doctor: Patient and Nurse:Doctor Ratio: Both these ratios contribute collectively to the inadequacy of the rural healthcare system. Every doctor needs a nurse to cater to their patients. Singh says, “The rural healthcare infrastructure is three-tiered and includes a sub-centre, a PHC and a CHC. PHCs are short of more than 3,000 doctors, with the shortage up by 200% over the last 10 years to 27,421 as per a report by India Spend.” A patient is not always treated on time in rural India since the doctors are less in number.
Insurance: Insurance is something that is severely lacking in rural healthcare. India has one of the lowest per capita healthcare expenditures in the world. The government has only contributed to about 32% for the insurance in healthcare sector in India which is sufficient.
Affordability: This is a constraint since people cannot afford the upmarket health services when they need to visit private hospitals. With the advancement of technology, healthcare is also becoming increasingly costly. The cost of diagnostic facilities is also going up. Along with that, there are commissioned charges that most people don’t understand.
Lack of Awareness: Awareness about proper healthcare is insufficient in India. Singh added, “The population needs to be educated appropriately on basic issues like the importance of sanitation, health, nutrition, hygiene and on healthcare policies, importance of medical services, their rights, financial support options, the need for proper waste disposal facilities. It is very important to inculcate a health seeking behaviour in them.”
Lack of Medical Stores: Medicines are often unavailable in rural areas. Dr. Sadhu also said, “Supply of basic medicine is irregular in rural areas. The fair price shops (PPP model) are located in tertiary care and secondary care hospitals. These fair price shops charge differently in different locations. Discounts vary from 50% to 70% by the same provider on the same medicine.”
The growth of the healthcare industry in India can be inclusive if it can overcome its major shortcomings. With the growth of lifestyle diseases and need for affordable healthcare, the sector may witness a threefold jump to reach $372 billion by 2022. The focus needs to be shifted to the primary healthcare sector since it lacks treatment quality and presently has minimal access to vaccinations and medicines. There are certain changes that should be incorporated in this sector. Stipulated medical services to the rural areas should be made mandatory for medical graduates. There is a lot of civil society movement in the rural healthcare sector and this need to be encouraged. People need to be educated about their rights and basic healthcare issues.
Singh informed, “A well-equipped mobile healthcare unit is capable of performing simple diagnostic tests, pre and post-treatment care, lab testing, dental treatment and minor surgeries. Patients feel convenient to come to the mobile healthcare unit as they don’t have to travel too much. This has subsequently led to improved treatment and prognosis. One of the major benefits of launching mobile healthcare units is that it results in an increase in awareness among the rural population. The rural communities are now much more aware about prevention, screening, and chronic disease management. Mobile clinics ensure that good quality healthcare reaches the vulnerable sections of society. Being the first point of contact for the underprivileged population, these services ensure better prevention and chronic disease management by spreading awareness.” Proper sanitised environment, availability of blood, medicines and ambulances along with certain other infrastructural changes can bring positive changes to the rural healthcare sector.
There have been a number of government initiatives to develop the rural healthcare system.
The Union Budget 2017-18 focused on boosting the rural healthcare sector in terms of infrastructure, stability and availability of better resources. The allocations were raised by about 27%.
Rashtriya Swasthya Suraksha Yojana is a national scheme that focuses on registering Below Poverty Line (BPL) families for an insurance that gives an annual expenditure limit of up to `100,000 per family along with a sum of `30,000 for senior citizens.
Information technology is also playing a strong role by integrating the different services with IT panels for better reach and faster treatments. Hospitals empanelled under the government insurance scheme are IT enabled and connected to servers in the districts.
The ministry of health and family welfare launched computer and mobile-phone based e-health and m-health initiatives like the Swastha Bharat mobile app, ANMOL-ANM online app, e-RaktKosh and India Fights Dengue.
The healthcare sector is poised for growth in the coming years. The challenges and shortcomings need to be resolved to ensure this growth. With medical tourism on the rise, the country is expected to make changes on a much faster pace.