5 reasons why India’s healthcare system is struggling

India’s healthcare system has been battling various issues, including the low number of institutions and less-than-adequate human resources for quite a while now. There’s a need to make people and processes in the healthcare sector made more accountable; for that greater operational transparency needs to be brought in urgently.

(1) Lack of infrastructure

• India has been struggling with deficient infrastructure in the form of a lack of well-equipped medical institutes.
• The rate of building such medical teaching or training facilities remains less as compared to the need of the hour.
• Private colleges built in rural areas find it quite difficult to recruit adequately qualified, full-time doctors due to a lack of proper living conditions, besides low pay scales.

WAY FORWARD – For a considerable time, the government regulation mandated that private medical colleges must be built on at least five acres of land. It is only now that the newly-constituted National Medical Commission (NMC) has put forward the idea to do away with the requirement of a minimum of five acres of land for setting up a medical college. Further, the commission has proposed to curtail the minimum number of beds required as a proportion of the number of seats in the college. In addition, the new regulations have also laid down the requirements for lecture theatres, libraries, laboratories, minimum bed requirement of the attached medical college, and location of faculty offices and accommodation of students.

(2) Shortage of efficient and trained manpower

• A severe shortage of trained manpower in the medical stream, this includes doctors, nurses, paramedics, and primary healthcare workers. The situation remains worrisome in rural areas, where almost 66 percent of India’s population resides.
• India has already achieved the World Health Organization recommended doctor to population ratio of 1:1,000 the “Golden Finishing Line” in the year 2018 by most conservative estimates.
• India’s doctor-population ratio is 1:834, assuming 80 percent availability of registered allopathic doctors and 565,000 Ayurvedic, Unani, Siddha, and homeopathic doctors (APRIL 2022)
• There are 1,301,319 allopathic doctors registered with state medical councils and the National Medical Commission as of November 2021. There are 289,000 registered dentists and 1.3 million allied and healthcare professionals in the country. There are 3.3 million registered nursing personnel according to Indian Nursing Council records. This includes 2,340,501 registered nurses and midwives and 1,000,805 nurse associates. The nurse-population ratio in the country at present is 1.96 nurses per 1,000 population

WAY FORWARD – The Indian medical education system has been able to pull through a major turnaround and successfully able to double the number of MBBS (modern medicine) positions during recent decades. Further, with an annual intake of 67,218 MBBS students within the next 5 years, the system will add 4,70,526 MBBS doctors (from 2017) to a total of 14,93,385 by 2024 even if no new college campuses are set up with more MBBS admissions. On the other hand, India’s population has been projected as 1,447,560,463 by 2024. So, by 2024, the doctor–population ratio is expected to be around 1.03 per 1000 population. It is clear that India will reach the WHO standard of 1:1,000 doctor (only modern medicine)–population ratio within the next 7 years by the current demographic trend, a year before India’s 75^th independence anniversary.

(3) Unmanageable patient-load

• Serving a population of 1.4 billion remains a Herculean task in itself when it comes to suitably managing healthcare facilities.

WAY FORWARD – There is a need to adopt technology wherever possible to streamline the operational and clinical processes for healthcare facilities in order to manage efficient patient flow. In addition, there is the challenge to think beyond the obvious and promote virtual care protocols, and telehealth services, which can be leveraged to reduce the patient-load burden to a large extent.

(4) Public health policy and proactive healthcare

• Ideally, the public health policy needs to be focused on proactive healthcare, not reactive healthcare.
• Recently Ayushman Bharat scheme, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the universal health insurance scheme, has received considerable attention and resources than the health and wellness centers (HWCs) component.

WAY FORWARD – This asymmetry needs to be suitably addressed for the growth of healthcare in the future.

(5) High out-of-pocket expenditure remains a stress factor

• 65 percent of medical expenses in India are paid out of pocket by patients.
• While public hospitals offer free health services, these facilities are understaffed, poorly equipped, and located mainly in urban areas.
• It is a known fact that accessible and affordable healthcare in the public sector can considerably reduce the rise in dependence on private institutions.

WAY FORWARD – Increase the adoption of health insurance. In this regard, the government and private institutions both need to work together. Adoption of digital insurance processing solutions integrated with the healthcare ecosystem for faster turnaround time for insurance processes will also motivate the adoption of health insurance.