Why healthcare infrastructure in India needs more attention?

Pallavi Jain, MD, Krsnaa Diagnostics explains why for an ideal healthcare infrastructure system in India, a holistic and sustainable approach needs to be at the heart of healthcare delivery improvement

The Indian healthcare landscape is quite diverse and is characterised by a range of factors and internal and external elements. This holds true globally as well. Countries and their healthcare systems have defined their healthcare systems depending on their population and disease profile; and the COVID-19 has demonstrated the kind of negative impact that can be prevented by strengthening the healthcare systems.

At one end of the spectrum is the glittering steel and glass facilities supplying high-tech medicine to the well-heeled, primarily metropolitan Indian. At the other end of the spectrum are the dilapidated outposts in the far corners of “other India,” struggling to live up to their name as health sub-centres, yearning to be turned into sanctuaries of health and wellbeing. With the current rate of population growth, increasing burden of diseases in the country, this spectrum is expected to broaden considerably, offering even more complexity in the future.

The need for strong efficient healthcare systems was felt when the nation was grappling with surge in COVID-19 cases and was facing shortage of ventilators, hospital beds and oxygen cylinders. As the Indian government is ensuring universal healthcare for all, the fast-changing population demographics and its implications on the healthcare system remains a cause for concern.

India has an extensive healthcare system, however, many differences remain in quality between rural and urban areas, as well as between government and private healthcare. While the National (Rural) Health Mission has done a lot to enhance the infrastructure of India’s government-run healthcare system, many primary healthcare centres (PHCs) lack basic infrastructural facilities like beds, rooms, toilets, and drinking water facilities, clean labour rooms to deliver babies, and electricity regularly (Kasthuri, 2018).

According to the Rural Health Statistics from MoHFW 2021, there are a total of 5439 PHCs in the urban areas and of 3966 PHCs in the tribal areas as on 31st March 2021.

The recent NITI Aayog report 2021 titled ‘Reimagining Healthcare in India through Blended Finance’ highlighted that 50 per cent of India’s population has access to 35 per cent of hospital beds, thus indicating a strong need to strengthen healthcare infrastructure to ensure access to healthcare facilities for all.

To ensure health facilities for the people living in rural India, the government has established 24,855 PHCs, 15,8417 sub-centres, and 5,624 community health centres as per 2020 data (Primary Health Centres (PHCs), 2020). The government-run health care system comprises limited tertiary and secondary health institutions in major cities, and it has focused on providing primary health facilities, in the form of Primary Health Centers (PHCs), in rural areas. The Indian Public Health Standards (IPHS) stipulate the provision of primary health care for the rural population via sub-centres, primary health centres (PHCs) and community health centres (CHCs), whereas secondary care is provided via district hospitals and sub-district hospitals.

Recent experiences strongly recommend that a revision of the Indian Public Health Standards (IPHS) is needed for the district hospital, sub-district hospital, community health centre, and Primary Health Centre (Sodani, n.d.). Together, these are the nerves of India’s public healthcare system, and the standards on district hospitals for the provision of services, staffing, facilities, supplies, equipment, supplies, and infrastructure needs to be re-examined. Public and private health systems are placing a tremendous burden on India’s ability to develop outstanding leaders and healthcare professionals. Health data needs to be the policy priority in India’s urban public health.

To combat all the above health infrastructure issues, the Government of India launched the PM Ayushman Bharat Health Infrastructure Mission (ABHIM). In the next 4-5 years, the goal is to improve the vital healthcare network from village to block to the district to regional and national levels. There are three sides to this mission. The first is the development of complex diagnostic and treatment facilities. The second is connected to the testing network for illness diagnosis. The third issue is the growth of current pandemic research centres, specifically for infectious diseases.

Some other major innovations and reforms that were introduced to improve the Indian Healthcare infrastructure (Indrani Gupta, 2020)

• Launching Ayushman Bharat, which includes the National Health Protection Scheme (Pradhan Mantri Jan Arogya Yojana) for tertiary care coverage for vulnerable people and the health and wellness centres initiative for comprehensive and integrated primary care delivery.
• Establishing the National Health Authority to carry out the PMJAY.
• Launching the Swachch Bharat Mission to provide universal sanitation coverage and eliminate open defecation in the country.
• Launching Indradhanush Intensified Mission 2.0 to attain 90 per cent immunisation coverage for children under the age of two.
• Providing nutritional and social assistance to all National Health Protection Scheme TB participants.
• Replacing the Medical Council of India with the National Medical Commission and establishing consistent medical education standards.
• Establishing a health technology evaluation board within the Department of Health Research to examine all medical technologies.

However, for an ideal healthcare infrastructure system in India, a holistic and sustainable approach needs to be at the heart of healthcare delivery improvement. Some of the key steps to strengthen healthcare infrastructure, particularly in rural India, are:

Long-term Public-Private Partnerships (PPPs) to ensure inclusive healthcare

PPP partnerships can transform India’s rural healthcare system with a long-term sustainable model in more ways than one. Given the growing population of our country, state efforts alone will not be enough to strengthen the health system. The PPP can help to overcome financial, technological, educational and human limitations.

Ongoing support and skills development

According to a report released by the Union Ministry of Health and Family Welfare, there is a 76.1 per cent shortage of medical specialists in 5,183 community health centres in rural areas. Qualification courses and continuing education programs for physicians can help to remedy the shortage of trained doctors in rural areas.

Continuous upgradation of testing equipment and training of medical staff

Rural areas lack essential facilities such as state-of-the-art medical equipment and trained medical staff to operate the equipment. While medical devices can still be constantly updated, training workshops for medical personnel to know how to effectively handle, operate and manage these devices are also crucial. As new technologies emerge, the need for training becomes constant and needs to be identified.

Establishment of a field oversight committee

A local oversight committee should be set up to develop a set of basic and complementary strategies to promote access to better health care and to oversee the implementation of rural health care initiatives. A field oversight committee is needed to revitalise rural health through effective oversight of rural health improvement activities.

A strong healthcare system can only be built with continuous commitment and consistent effort. It has become equally important to strengthen the AYUSH network to further improve the health outcomes. The main objective should be to improve preparedness beyond COVID and not just focus on short-term fixes that will restore the system to the same old state once outside help is withdrawn.