The Economic Survey 2018-19 states 60 per cent of primary health centres in India have only one doctor, while about five per cent have none.(PICTURE FOR REPRESENTATIONAL PURPOSES ONLY)
The Economic Survey 2018-19 states 60 per cent of primary health centres in India have only one doctor, while about five per cent have none.(PICTURE FOR REPRESENTATIONAL PURPOSES ONLY)

Yourspace: Maximum illness, minimum healthcare

Our readers and prominent city doctors tell us why public healthcare is in a shambles and what can be done to improve it...
Hindustan Times, Pune | By HT Correspondent
UPDATED ON JUL 28, 2019 05:07 PM IST

We have never given importance to medicine and public health. In the last seven decades post-Independence, not a single general election was fought where public health issues were at the centre of a political debate. It explains why our expenditure on public health is still as low as 1.3 per cent of gross domestic product (GDP). I want to draw the attention of authorities towards the poor state of affairs of public health system. We need to rejuvenate it at the earliest. Superficial dressings are not going to help. We need a paradigm shift.

Following are some of the measures our planners should mull over to bring effective changes in our public health system.

Check on rampant privatisation of medical education: Qualified workforce for public health system is coming from our medical colleges. Rampant privatisation compromising with quality directly impacts public health services.

To fill vacancies in public health on war footing: In almost all states there are vacancies of key public health personnel from medical officers, specialists and paramedics. These vacancies affect the functioning of system.

Need efficient administration: Our failure in public health is mainly because of poor management of administration. Why doctors are unwilling to join our public health system? We need to make our administration more transparent and sensitive to the needs of workforce in the system. Corrupt practices in appointment, transfers and promotion must not be tolerated. We need to have a human resource department which can motivate doers in the system and address workforce-related issues.

Increase expenditure: We need to increase expenditure on public healthcare. Health expenditure is one of the major reasons of debt and poverty.

Dr Pradip Awate

Rising healthcare expenditure responsible for situation

The recent incidents of death of at least 140 children in Muzaffarpur, Bihar and death of at least 60 children due to lack of oxygen in Gorakhpur hospital in Uttar Pradesh in 2017 signifies serious crisis in the public health system in our country. There is practically very little expansion in number of public hospitals and health centres in rural areas in the last decade despite growing population. Many reports on farmer suicide in Maharashtra, and other states, have mentioned rising healthcare expenditure as one of the main reasons for rural indebtedness and stress leading to suicide. On one hand rural hospitals and community health centres are lying vacant while on the other district hospitals and medical colleges are overcrowded and many posts are lying vacant positions in public health system. In Maharashtra, at least 16,000 posts are vacant in the public health department alone.

India spends the least amount of money on public healthcare. High income countries spend 5.2 per cent of their GDP on public healthcare, but India spends only 1.3 %. Many doctors prefer private sector for lack of incentive in public health system. There is no mechanism for systematic promotion and career opportunities for doctors joining public healthcare system. Following steps could improve public healthcare in our country -

1) Increase spending on public healthcare.

2) Priority should be given to provide essential primary healthcare across the country.

3) Provide free OPD care and free medicines.

4) Efforts should be made to attract trained doctors and nurses to join the public healthcare system through systematic incentives, career progression pathways and better working environment.

Dr Abhijit More

Take steps to attract trained doctors to join public healthcare system

There is no denying that healthcare for general public is pathetic. One of the main reasons is lack of manpower. Qualified doctors, nurses and paramedical staff either prefer to work in first tier cities or choose to go abroad. We need to put in place a system where the medical staff can serve the Indian citizens first for at least two years before they choose to practice in India and two years once they come back to India after their abroad stay. It is estimated that there is shortage of two million doctors in India, including rural areas. The authorities need to increase public healthcare budget. Will our leaders seek treatment from public hospitals that are mostly in a pathetic state? If they cannot, how can they expect common people to visit these health centres. Private medical colleges should also participate in public healthcare and make posting in rural areas for their medical students a compulsion.

Dr Bipin Vibhute

Facility available for the wealthy; no care for poor

Even after decades of India’s independence, our public healthcare system is not effective enough to accommodate the needs of 1.37 billion people. Politicians are busy dividing the quality of healthcare: special treatment for the wealthy; no care - or the worst form of care - for the poor sections of society. The health secretary and health ministers are responsible for the state of public healthcare in the country. The system has failed due to poor budgetary allocations, lack of good hospitals and government-run medical colleges. There is no vision for improving public healthcare system in our country. There is no accountability for public servants and the government relies on NGOs to improve the situation, whereas, the administration is supposed to take care of it. Hence, healthcare in India needs immediate attention before ‘bad becomes worse’.

Dr Vinay Thorat

No hope for crumbling healthcare system

The apathy shown by various governments over time to the all-important public healthcare is disheartening and disappointing. Authorities seem unconcerned by the lack of qualified, dedicated and responsible doctors in primary health centres. The internship after MBBS where doctors have six months of rural and six months of urban posting is the only influx of doctors there. The only option available will be making it worthwhile in terms of money, proper accommodation and travel provided to doctors willing to work in the peripheral areas. No amount of forceful posting will help. A panel of honest, true to the profession doctors and politicians with a heart can bring about a change for the better. No amount of deaths due to lack of medical facilities are going to open the eyes of our government as there is ‘no vote bank’ here; so why care, which is their basic understanding.

Dr Hillary Rodrigues

Poor doctor-patient ratio in the country

In India, there is one government doctor for every 10,189 people. The World Health Organisation (WHO) recommends a ratio of 1:1,000. The figure shows that the public healthcare system is in a shambles. Lack of adequate facilities limits the doctor’s ability to perform to their best of abilities, leading to poor job satisfaction. There is a sense of insecurity with an increasing threat of violence, when outcomes do not meet expectations of the patient or their caregivers particularly due to factors beyond the control of individual doctors. In addition, inadequate compensation for their services and limited growth prospects further dissuades many. Instead of knee-jerk responses, a multi-pronged approach towards providing modern equipment, adequate support staff and a safe environment to work in is the need of the day.

Dr Avinash Ignatius

Primary healthcare needs top priority

Primary healthcare and emergent healthcare (required under Article 47 and 21 of the Indian constitution) needs cardio-pulmonary resuscitation (CPR). For this, India needs a policy change with stringent analysis of contact case so that infections spread cycle can be stopped. All over the world in primary care this is the job of public health detectives. Cases of Acute Encephalitis Syndrome reported in Bihar or Uttar Pradesh should not occur year after year.

Dr KK Aggarwal

Increase the number of govt-run medical colleges

There is need to increase the number of government-run medical colleges. Medical doctors are not attracted by government salary package because it is extremely low. Hence, an increase in govt-run medical colleges will help to bring change in the healthcare sector. We need to revamp medical health services and need to appoint national commission/committee for making new policies to improve healthcare in the country.

Dr SN Pathan

All levels in public health system are weak

What I feel is that all levels in public health system are weak. Not just primary health care system. Primary health care system is narrowed down to providing maternal health services but it has been denying all other aspects. There is huge crunch of trained staff, both medical and paramedics in the system. As, primary and secondary systems are not working efficiently, there is huge pressure on public healthcare tertiary centres, which are under-funded. This is only a move towards privatising healthcare system.

Anand Pawar

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