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(Manish Rathi is an Indian Engineer currently employed by , and about various topics in India like IT, software adoption, and, of course, health. He chimes in here with his thoughts on the current state of healthcare in India.)
Over the last few months, I have had an opportunity to present my thoughts/views on the state of Healthcare Services in India in different types of people settings – big and small/formal and informal – including the one which I described in my .
At a crossroad
Based on my observations and my views (and after validation from various different sources), I had mentioned that I sincerely felt Healthcare Services in India is at a crossroad in its phases of evolution. Many had asked me why I felt that way. To explain my reasonings and arguments for such observations is the motivation behind writing this post.
Before I make my case, I hope you have had an opportunity to read various of my other previous . Hopefully, after reading those you would have realized that I am no medical practitioner nor do I have any association with any policy making organization. My views are more from my observations and experiences from .
‘Being at a crossroad’ for me means that the contrasts between the state of various things or options starts becoming so evident that people dealing with it (be it individuals or society or a country) have to very often face or deal with options and associated consequences of each option. In some sense it is about making a selection which potentially would determine the direction in which we as individuals or society would go. In the healthcare case, in some symbolic sense, I felt that the state of matters or the options provided by the Indian Healthcare Services seems to have started showing various different signs of contrasts. Hence my argument for Healthcare Services being at the crossroad!
To look at the contrasts one has to have an objective view. A view from a 10000 feet! From such a high view, IMO, if we were to look at the ‘state-of-the-union‘ of the healthcare system – I felt that we can see distinct two categories – the ‘good news‘ category and the ‘bad news‘ category. The ‘good news‘ bucket has the real progress which the country has made in comparison with the previous decade/s. And the ‘bad news‘ category contains the increasing developments which in some sense the dampens the ‘good news‘ category.
When you look at the baggage which India carries (over-population, years of apathy towards infrastructure development, traditional social lack of awareness towards health management, etc.) and then put things into perspective – one cannot miss out the noticeable growth and progress being made in the last decade in the area of Healthcare. And it is continuing. At a national level, India is among the top contender for the destination in the area of .
If I were to look at the local level – especially at my home town – the medical specialists and the treatments which were only available after traveling more than 400 miles to the West, is now available within miles. Indian Medical System seems to have gotten into a factory-like approach in churning out specialists in a recurring way. The private hospital chains (’s, ’s of India) seems to have started taking steps in providing healthcare management facilities (although still affordable to a subset of the population) which even the respected Government-run medical hospitals (, , etc.) seemed to have ignored over the years. Recent news about or Apollo venturing into advisory services in helping other nations to open up the hospitals are some big validations of the progress. Investments in this field are coming from all corners with McKinsey predicting that the to about $52 billion in 2012 (from the current $35 billion) and to about $150 billion in the year 2017.
Indian government (possibly under pressure from World Health Organization too) have been increasing the number of medical colleges by more than 12-15% year-by-year since the last few years. Increasing population, increasing income, increasing reporting of medical ailments can only be good news to any investor (pun intended!). So in a sense there is a big air of optimism around which one can certainly feel if one looks around.
However along with the above sense of progress there are also instances or developments which are so visible around which makes one think that many things are also ain’t going the right way from the healthcare perspective in India.
Progress made in the healthcare options is not yet reaching to all in the society at the pace it should ideally be. 80% of the Healthcare providers and specialists are concentrating on the 20% demography located in the urban areas (hence the rural areas continue to suffer). Common basic mistakes in medical treatments which probably would be synonymous to the state of medical system in a third-world country are still being made (e.g. babies being declared dead only to found alive after couple of hours, incidences of some doctors refusing to treat HIV patients because of social taboos, etc.).
The relationship between the doctors and the patients have increasingly started coming under big strain (both ways) with increasing number of incidences where law-of-the-land have been broken by either parties.
Cases of medical malpractices which frequently comes to the fore typically leaves a stink and big blot with the progress. Accountability is a key component in any progressive system and Indian healthcare system continues to lack in that to a big extent. My personal confidence in the maturity of the Indian Healthcare system maturity also got shaken when I read that Indian Medical Association (IMA) itself came forward and said that they have lost track of number of doctors in the country in the recent years. I had also recently blogged about my of the Indian Healthcare System during the H1N1 outbreak few months back.
I am not sure how many of you have also noticed this contrast the way I am seeing it. Please do not get me wrong here. My intention is not to paint a black or a white picture here. In my conversations with many on this topic – that is lot of contrasting opinions out there about the state of the things. And hence the extra motivation to my point of this post. Because of such visible contrast, my opinion is that India’s Healthcare System is at a critical crossroad as it continues to evolve fast. The steps it takes in the next few years would determine its long-term success. But the good news is also that such contrasts opens up lots of new opportunities too.
Your thoughts and comments are welcome.
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interesting and leading towards seeking more detailed information
Hi Manish,
I agree with you that a glaring contrast exists between the advancement in medical technology in the urban India and the lack of basic medical facilities in the rural areas. Corporate health care is booming in the cities, servicing the Indian middle and upper classes, while the rural population suffers without even the basic medical facilities.
Medical professionals by and large are reluctant to serve in rural areas, which lack facilities that are available in the cities. Some corporate hospitals do indeed reach out to some pockets of rural areas, where due to poor paying capacity viability of the service becomes an issue. Government units like public health centers are often under-staffed, lack proper infrastructure and supplies.
National level policy changes are required to bridge the visible gap in the availability of health care services between urban and rural areas. Doctors should be encouraged to work in rural areas by providing monitory incentives. Some suggestions in this direction are already made by the Government.
Accountability, commitment and ethical behavior from service providers will improve customer confidence. Medical services should be made cost effective and accessible to all. Health care in India has great potential for growth and is likely to succeed if it becomes inclusive.
Regards,
Rathika
Dear Dr. Rathika –
Thank you for your thoughts. What you have written is all correct.
While some of the glaring challenges certainly needs to be fixed and resolved if India dreams about having a mature and sustainable healthcare system like any developed country, we should also take a moment and also acknowledge the progress which India has made in the recent years. To be honest – there is a lot. My guess is that the new progress has brought in newer sets of challenges.
Regards,
Manish
From LinkedIn Discussion:
As someone said "Indian health care is an example of pockets of excellence in an ocean of inadequecies". But we have come a long way for sure. But yesterday in NDTV i saw some unnerving statistics on the problem on hunger in India. It said that 50% of the world's hungry were in India in spite of some of the fact that some of the world's largest feeding programs are run by India…
I would be very interested in working with private health enterprises on their program for rural health.. if such opportunities exist.
Best Regards
Venkat
By Venkataraman S Pursuing Healthcare Administration
Part of the reason for that is that India does not function too much on loans / credit cards like other Western countries although we have lot of poor to feed and rural health system is lacking I would be wary to trust the numbers. I strongly believe that India needs few visionaries that can help the country think out of the box and not mimic the West. There certainly are lot of good things in Western medical system such as strong work ethics, legislation/laws protecting individuals and community at large and a systematic analysis and ongoing attempts to self correct their deficiencies. But they have their own flaws.
Alternative medicine today that is popular with a select few, niche group is more expensive abroad and part of ancient Ayurvedic healing methods from India. However we don't know how to deliver well, present, package and sustain the quality. Combination of the ancient healing measures, spread of telemedicine and EMR can make the difference. We have talent but when it comes to implementing we fall short of perseverance and preservation of our strong holds while working on our deficits.
Interesting facts!!
Recalling the Declaration of Alma-Ata..
The International Conference on Primary Health Care, meeting in Alma-Ata in the year 1978, expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. Goal of "Health for All" was proposed and was formally put forth in the 1978 WHO-UNICEF Alma-Ata Declaration.
Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life.
Primary health care is the key to attaining this target as part of development in the spirit of social justice. Where are we(India) today?
Regards
Sunitha Blossom
Computer Sciences Corporation- Healthcare
Sunitha –
Thanks for pointing out the historical perspective of Declaration of Alma-Ata. To be very honest – I personally was not aware of that. While I am not sure how India is tracking to that, I am pretty sure that there are organizations like WHO who are auditing Healthcare in countries like India on a periodic basis and working with the governments to see how they can fill in the gaps.
"Health for All" is a broad goal or similar to vision statement . I am sure that someone would have broken that vision into year-by-year achievable targets. So my guess is that India is still going through that journey.
Hope this helps.
Thanks
Manish Rathi
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