Dr. Ashok Raina, a noted physician, writes about the drawbacks of the current Indian healthcare system, discussing deep-rooted issues and possible solutions for betterment.

 

If the doctor cures, the sun sees it; if he kills, the earth hides it.

-  Scottish proverb

 

Our worldwide healthcare index stands at 68.04 of 33rd rank out of 76 countries of the world

Someone has rightly said: “Widespread existence of preventable diseases and deaths is a disgrace to the society which tolerates it.” And to be honest we as a social system have for a very long time ignored and tolerated preventable diseases and deliverance of standard comprehensive healthcare to one and all.

Whether it is communicable disease, maternal and child health, malnutrition, personal and surrounding hygiene or geriatric care, we still in the 21st century are far behind many nations who are much poorer than us. At times I feel it is not only the population explosion or lack of resources but it is inherent social laziness, our moral corruption, and our selfishness which makes us ranks so low in the healthcare setup. Especially, people who form the bulk of our society, live in periphery, are poorly equipped to understand the denial of their basic right to good health.

Our weakness lies in the fact that our policy planners never gave importance to primary care and ignoring the basic professional and ethical care deliverance at the grassroots levels has brought us to the current crisis. Unfortunately, even today a very few of the policy planners are of the view to strength the primary health care sector.

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Healthcare deliverance as recommended by Bhore committee

Bhore committee appointed in 1943 under the chairmanship of Sir Joseph William Bhore had recommended the following:

The short-term plan:

• PHC for every 40,000 population
• PHC to be maintained by at least two doctors, 4 PHN, 4 midwives, 1 nurse, and other staff

The long-term plan:

• Primary health unit for every 10,000 to 20,000 population with 75 beds
• Secondary unit with 650-bed hospital
• District unit with 2500-bed hospital

Unfortunately, the ruling elite never implemented the recommendations but truncated it to a large extent which has practically remained the same over the last seventy years except for a few whitewashes here and there.

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Repercussions of the system 

The system was grossly inadequate to implement comprehensive health care at the grassroots level. This resulted in the proliferation of ill-organised sectors of parallel/alternative medicine which has been one of the major factors ruining our healthcare system as ill-trained people especially the class four staff of hospitals and labs after attaining a few years of work experience mushroomed as doctors in far-away areas. Or, people who had gained experience as assistants in pharmacies of the hospitals opened their shops and started the loot. Not only that, trained pharmacists become doctors and started practising medicine unbridled.

Even government agencies are responsible, as to hide their shortcomings, created foot soldiers like Anganwadi workers without imparting proper training in at least basic hygiene. They were left without any proper supervision to work at grassroots level. Thus, some of them became so fearless that they took the place of doctors and unfortunately till lives were lost no one woke up to such a malady.

Dr. Raina recounts a personal experience

I am witness to one guy who had retired as a cleaning boy of the operation theatre at SHMS hospital, Srinagar, Kashmir (in the late 70s) became a famous circumcision surgeon, and I remember my surgery professor cribbing about it as most of the people would prefer to go to the quack rather than visit a well-trained doctor.

And until very late, such people worked unbridled without any fear of repercussions. At the same time, if at all a young doctor would dare open his private setup, competing with such people would often lead to starvation or bankruptcy for the doctor.

To survive, a trained doctor would have to be subservient to such quacks and unless the doctor too would join the rat race of malpractices and corruption, survival will be impossible. This resulted in a major brain drain in late 70’s and early 80’s, because most of the young doctors were either unemployed or poorly paid and with very a few avenues available for viable survival. This in turn further added to the strain on an already crippled healthcare system.

Thirdly, yet another ill-conceived policy decision of encouraging alternative medicine further added to the woes. As most of the graduates who graduated from alternate fields started practising Allopathic medicine especially using the Allopathic pharmacopoeia which further led to the deterioration of overall healthcare.

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Effects of poor policy implementation

Corporates mushroomed as vendors of healthcare

In recent times, our governing bodies went on committing mistakes in implementing policies which were never patient-friendly but resulted in corporates mushrooming as vendors of healthcare and thereby creating a billion dollar market for themselves at the cost of the common man and governments too went on doling SOPs in terms of subsidies to them, only to generate a wide gap in availability, sustainability, and affordability.

This added yet another blow to the already fragile healthcare system, as doctors turned agents and commission earners, new definitions of healthcare were promoted as targets and a successful doctor was gauged by the money he was earning.

This, in turn, led to a decrease in quality teachers being available in medical schools. The dedicated teachers of early seventies today are an extinct species and even if some are still left, they practically live a hand-to-mouth living. They are often seen cursing themselves for being so loyal to their profession.

Private medical colleges mushroomed without adequate control 

Adding fuel to the fire was when the government allowed private medical colleges to mushroom without proper control, facilities, proper teaching staff, and last but not the least the sale and purchase of medical seats, thus resulting in a chaotic state of affairs in our healthcare sector. A doctor who spends a crore on his admission obviously will be keen to get the returns rather than have faith and worship the Hippocratic Oath!

The pharmaceutical industry has left unhealed wounds

Last but not the least, the pharmaceutical industry has left a lot of wounds unhealed in our health sector. Without offending anyone, most of the houses have over the years only acted as scavengers, fleecing the common man. Yet, none other than the healthcare policymakers are responsible for the mushrooming of such houses who are in the sector only for money and exploit the common man for this.

The combination medications, the quality control for the sake of efficacy are all the prerogatives of the controlling authority but for the deep-rooted moral corruption of our society, most of the controlling agencies will be found sleeping. It is these very factors which have led to the abuse of pharmacopoeia.

Primary Healthcare has suffered

All these factors in combination or as a single factor have led to:

• Decrease in the quality of care
• Deficient primary health care at the grassroots level
• Uncontrolled price differences that a very few can afford to have access to good healthcare

Government-run agencies are mostly ill-equipped from the point of view of manpower, hospital bed strength needed to cater to the population it is meant for, financial constraints as our health care budgetary allocation is abysmally low to 4.8% of our GDP while for USA it is at 17.2% (year 2016).

Thus, people are forced to either mortgage or sell their properties in case of emergencies or languish in the most unhygienic, sub-standard, government-run public hospitals barring a few premier institutes of the country. There too, the priority is given to the VIPs and not the common man. 

If not this, the people have to be at the mercy of quackery and thereby all our indexes fail the international standards.

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The Ayushman Bharat scheme

Our Prime minister does seem to have a vision of integrating the healthcare system, reorganising it, and creating universal affordable healthcare for one and all by launching the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana from September 2018.

But again, a word of caution, as long as the government does not do their homework properly the fruits may not trickle to the common man. One has to wait and watch as to what and how these policy changes take place in order to benefit our health care system overall until we cease to be rated as poor healthcare givers in the world.

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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.