‘Accessible, Available and Affable’ ought to be the motto of delivery arm of the healthcare

Healthcare spending by the government

Federal and state spending needs to increase. Realigning investment in healthcare with local economy is critical to have sustainability of any healthcare efforts for communities. Unfortunately, project success is measured by the monies spent rather than the goals achieved. The next government will do well to understand that. We need to set measurable goals and finalise tools prior to starting the project and be cautious of bias, wrong choices and subjectivity. Environmental engineering and local capacity building should be factored in any new project.

A J shaped curve can illustrate the relationship between healthcare outcomes and expenses. Incremental benefit can be had for minimally increasing costs. Monies should be leveraged to solidify gains. As a social enterprise we must avoid enticing, expensive adventures. Enabling and assisting health insurance coverage as well as allowing free market players to fulfil the need for tertiary care is a better use for the money spent.

Healthcare infrastructure

There is a gross mismatch between the services envisioned and delivered, wasting a lot of effort and money. Indian healthcare should focus on the ability to provide timely, effective and transparent medical care services to citizens. All medical facility design and development should only be undertaken after absolute clarity on the range of services deliverable.

Additional efforts should focus on the coordination and development of an integrated communications and information management platform developed across administrative or geographic regions in order to provide a central coordination point for sharing timely and actionable information. This would ensure the availability of critically important situational awareness to all elements of the emergency response system, including the hospitals, EMS and public health agencies. Further enhancement of this capability should ultimately including the building of a robust high-speed broadband network. In this way, investment in such a capability will be of dual use – helping to expand the scope of care during usual operations, and ensuring access to care in times of crisis.

Healthcare delivery

‘Accessible, Available and Affable’ ought to be the motto of delivery arm of the healthcare. Citizens must find it easy to engage in. Building parallel delivery systems of care is not only expensive to run and maintain but also are frequently in conflict with each other. So a developing nation like ours needs to build complexes which house all the facilities in one place for people to access all that the government offers. We need to be cognizant of the fractioning of the healthcare even more. Every year the government launches a scheme, which proposes to tackle a problem, but the results envisioned do not fructify as the monies spent (quite large sums) are easily dissipated in building an entire mechanism to deliver the product promised. Eventually the product delivery suffers due to lack of funds, and at times, tragically after the problem magnifies beyond control.

Medical education and training

Deep changes need to be made in the current laws governing Medical Council of India. Conflict of interest exist in the functioning of the council and powers prescribed to it. Accrediting agency for medical education ought not to have other functions. We need to create a separate body like Accrediting Council for Graduate Medical Education (ACGME) in the US. Education in this field is also a means to an end. Systems based practice and competency based learning is the way forward for failing education system. Vocational flavour to education is necessary. Medical students graduating in India compare poorly in skills to international peers. Experts in education and members of public representing end users should be brought in to align goals. Teacher requirement for postgraduate training are very restrictive and effectively removes highly trained doctors in private sector from teaching. This is exceptionally poor thinking and reeks of cartelisation of medical education.

Reducing the length of MBBS course have to be given a serious thought. Post MBBS opportunities need to expand. All government hospitals should be mandated to train residents.

Public health policies

Being a part of nation/society should fulfil the primal need of safety. Protection against external, internal, natural threats/calamities and diseases is a core function of any government. Protection by essence ought to be pre-emptive. Therefore the government must clearly distinguish the policy making by focusing on preventive health rather than the delivery arm. Merging delivery and preventive arms of the governmental effort in healthcare is a mistake. Neither is achieved effectively.

In our country most disease stem from poor state of habitat. Better habitats ensure better health of inhabitants. Sanitation, infrastructure, waste disposal, housing and community preventive healthcare can easily be envisioned to be a part of the same seamless solution. The state machinery is hopelessly caught up in semantics and is not a means to the end any more. Stakeholders from all parts of government machinery should come together to construct a solution. Various ministries, departments and personnel need to come together to formulate and execute a solution. Only the highest level of government can direct various departments to work cohesively on this root cause of illness in our society.

Healthcare manpower resource

Healthcare sector will have most number of jobs in the next decade. In addition, it will have the most diverse job requirements. Large numbers of semi-skilled workers are employed in healthcare today. Already a crunch exists in fields in nursing, paramedics and technical workforce. Economic exploitation of such workers is commonplace due to policy paralysis on training in paramedical and support services sector. Developing competency-based structured courses under university like IGNOU would transform the spectre in both government and private healthcare facilities. We have the largest population below 25 years of age. The biggest challenge in the next decade will be to provide employment. Only two sectors can provide jobs, infrastructure and healthcare. The incoming government should rapidly bring these young people in fold as certified skilled workers with good incentives and pay structure. Local skill development and employment will keep these people from uprooting. This will have a positive long-term economic impact on rural and semi-urban areas.

– Dr Vikram Khatri, Director, Critical Care and Emergency, Moolchand Medcity, New Delhi