‘Addressing maternal and neonatal mortality should be one of the foremost healthcare agendas of the government’

Before we even analyse what should be the healthcare agenda for the next Government we must appreciate some of the facts that are not very encouraging.

One third of the country’s population cannot access even primary healthcare. One third of our population in rural areas does not go to hospitals because of the expenses associated.

Making healthcare more accessible

Out of pocket payments of patient’s healthcare are still the norm with almost 40 per cent of Indians from the rural segment and approximately 30 per cent of Indians from the urban segment. They actually finance the healthcare needs by taking loans or disposing of their most precious assets!

Given the above the first step that the Government has to take is solving the financial burden faced by a large chunk of Indian population, from rural areas as well as urban areas, by creating a method through which healthcare services will be utilised by a prepayment mechanism. This is mind boggling as the task is not easy considering theenormous numbers in India.

In independent India, it is unacceptable that one third of our population cannot access even primary healthcare. This must be made into an agenda that is taken up by the Government on war-footing. It is a fundamental right that basic health facilities are accessible and available for all. The challenge really is on how to ensure that there is adequate staff in the very remote area of India to man the health centre’s as well as look after their safety and security. The understanding of local traditions, taboos and such like issues will be a challenge. But if the Government puts its mind to it, is not a challenge that is insurmountable as the Government is ably supported by a very adept administrative service that has produced the best results in the most challenging issues that the country has faced.

Reducing maternal and neonatal mortality

India is leading when it comes to maternal and neonatal mortality. This is the gold standard of the quality of healthcare of any country and till this is seriously addressed by the government no amount of the most sophisticated hospitals or the latest technology of medical equipment will improve the healthcare in the country. This should be one of the foremost healthcare agendas of the government.

Emergency services in obstetrics and gynaecology is woefully inadequate in the rural areas and this is one of the primary causes of maternal and neonatal mortality. We need the Government to change its approach and ensure that the local people are trained on site, given incentives to remain in that location and refresh their knowledge in periodical manner, at a higher centre.

Proper implementation of healthcare schemes

Central and state governments have to continue work in tandem as they have been and ensure that healthcare is made accessible at the rural level. It is not that outstanding schemes have not been set up by the government. The National Rural Health Mission is an excellent initiative by the government as is the Rashtriya Swasthiya Bhima Yojna. Some of the state government funded health insurance schemes have been hugely successful. These have to be expanded and made more effective in the penetration in the rural areas.

Technology for progress

The government will require to use technology for the citizens who are located in rural India. Thus apart from investments in the healthcare programme, the Ministry of Information Technology needs to lend the health ministry a helping hand to ensure that technology penetrates hinterland. This may require some amount of research and innovative models to be put into place.

Insurance is key

The government also seriously needs to look at ensuring that insurance based schemes are strengthened.

Health insurance premium should be highest in the younger age groups when they have the capacity to earn and the risk of serious illness is less than in the senior years when the capacity to earn is less and the risk of illness is far greater. In the years when an individual has increased risk should be when he pays the least premium as his capacity to earn has decreased considerably. This will help reduce the financial burden on the seniors.

There is need also to ensure that recent advances or enhancement of knowledge base of the primary and secondary healthcare workers in the rural areas are upgraded or that may create a mismatch in their understanding of case management. Again the Department of Information Technology can assist the healthcare ministry so that classroom-based teaching is made available for the primary health worker at the rural level.

Prepayment schemes for metros

The government will also have to face challenges in the metros. Herein there has been a paradigm shift in the quality of healthcare. It is second to none in the world. However there is a real need for standardisation as well as some beneficial prepayment schemes for tertiary and also quaternary level of care.

India has a dynamic potential to lead the world and its population is its strength. However it is essential that its population is healthy so that the country is in a position to utilise this enormous human capital in its progress and march into the future to be recognised as a global super power.

– Dr Sujit Chatterjee, CEO, Dr LH Hiranandani Hospital, Mumbai