Health Care Reforms in India: Making Up for the Lost Decade

The book offers insights on the challenges and opportunities to improve healthcare outcomes in India

Health Care Reforms in India: Making Up for the Lost Decade is a book authored by Rajendra Pratap Gupta, a public health expert. It offers an in depth look at India’s healthcare system and documents the development of India’s healthcare sector in the last six decades. It offers insights on the challenges and  and opportunities to improve healthcare outcomes in India.

Gupta states, “We need to define the problem of Indian healthcare, as it has become a ‘business’ and is not a profession anymore. India’s so called health care system is actually a healthcare market place, which is unregulated and corrupt. Though everyone needs it, everyone hates it!”

Book: Health Care Reforms in India: Making Up for the Lost Decades
Author: Rajendra Pratap Gupta
Publishers: Reed Elsevier India
Pages: 456

Defining an ideal healthcare system, the author also says that we need a healthcare system which is:

• Pre–emptive
• Comprehensive
• Holistic
• Coordinated
• Accessible, and
• Outcome-driven accountable care

He also recommends several measures to revamp the state of healthcare in the country like:

• It is time to look beyond the disease and illness-centred models of healthcare and also focus on age-related new paradigm of health.
• We need to empower the patients without their having to move outside their homes. There is a huge scope for resorting to a model of care that is built on awareness, sensitisation and promotion of healthy habits rather than building a system that aims at and is driven by doctors, medicines and hospitals.
  Currently, the main focus of healthcare for NCDs in many low and middle-income countries is hospital-centred acute care. This is a very expensive approach that will not contribute to a significant reduction in the NCD burden. To ensure early detection and timely treatment, NCDs need to be integrated into primary healthcare.
• Ministry of Health and Family Welfare (MoHFW) should start a national and regional health quiz contest with attractive prizes. This will serve the purpose to attract and engage people towards health and to increase their knowledge as either passive listeners or active participants.
• ‘Pharmacists and nurses’ hold the key to better healthcare and this relationship must be leveraged for healthcare. It might be worth considering the frontal role of nurses and pharmacists as a gate keeper or health counsellors rather than a doctor.
• A family health kit for every household that includes the thermometer, glucose monitor, BP machine, weighing scale and OTC medicines can be provided by the government in a phased manner. This will be the first step in providing primary care for all.
• Innovate rural healthcare delivery in villages. It is time to have a programme – GP @ GP (general physician at gram panchayat) as a key deliverable for rural healthcare.
• India can look at taking a cue from the GPs practice system of the NHS, UK; where the GP form the foundation of NHS but they are contractors to NHS and are paid per capita annual payment. GPs do the role of gate keeper in the UK’s health system as over 90 per cent of all healthcare consultations and interactions are with the GPs. Empanelling of existing private practitioners in India will mean a huge saving on salaries (in CHCs and sub-centres, this is the major portion of the expense), infrastructural investments and terminal benefits that have to be offered to permanent staff of the government.
• Indigenous systems of medicine looks at the past to claim their position and modern medicine looks at future to claim its space and so, the future of indigenous system is limited. Indigenous systems have to become forward looking and most importantly, address the issue of outcome validation studies to reclaim its space.
• All the officials must be trained in modern management techniques. All officials of the state and central administration, including the secretary and the minister, must spend between 10 per cent and 25 per cent of their time in remote areas of the country as ‘surprise’ visits.
• Also, it must be made compulsory for all healthcare providers – both, public and private, including stand-alone practitioners, to disclose their admissions, treatment charges and success rates.
• Medical education and training needs fundamental reforms. Medical Council of India (MCI), Pharmacy Council of India (PCI) and Nursing Council  of India (NCI) protects the turfs and interests of the professionals they represent but there is no one to take care or talk about the interests of the patients around which the health care system revolves. All these three bodies need to be merged into Health Council of India (HCI), with representation from the non-medical fraternity, patient groups and the public.
• There should be health guidelines for the population, base on age groups, stating the details of self-checks and physician routine checks that one must undertake every year.
• Healthcare should not be just process and treatment driven but outcome driven, with prognosis. Improved outcomes should not just underpin any intervention but also be the part of the entire continuum of care.