What are the problems with the Indian healthcare system which the Modi government will have to tackle?

After a strong mandate the Modi government has received in general elections, everybody is having a lot
of hopes from the government.  They are hoping and waiting for transformatory changes and  strong steps to be taken in direction of revival of the Indian economy. Very soon we will be having a draft of intention of the Modi government in our hands in the form of the union budget. What kind of changes are we going to expect for the healthcare sector?

We have a Prime Minister who seems to be pro reforms and above all we have a new Health Minister, who is a doctor himself. Will this combination add up to some bold steps translating into results or are we going to have the same run of the mill actions which would lead to no substantial changes in the long run?



There are a lot of issues which have been left unattended in the past ten years which directly impact the current status and the future of healthcare in India. The time will tell which of these issues are attended by the Modi government and which are left to hang in the continuing limbo:

  • Still the India’s government spends only about 1% of GDP on healthcare (rest comes from the private)
  • India is one amongst the countries having highest out of pocket expenditures (ranked 17th, WHO 2011), resulting from lack of trust in government facilities & hospitals and lack of any universal coverage schemes 
  • The last health policy we have dates back to 2002, we should be hoping that the new government will come up with a new policy which will reset the current direction
  • Government health administrative machinery as a whole is a hyper-divided structure with overlapping actions and schemes 
  • For instance, health ministry is responsible for quality and public health, but pricing and manufacturing of pharmaceuticals is with Department of Pharmaceuticals under the Ministry of Chemicals and Fertilizers. Ministry of Consumer Affairs and Food regulates some of the aspects. The commerce ministry deals with various trade related issues, whereas Department of Industrial Policy and Promotion (DIPP) looks after patents.
  • There are also various regulators such as National Pharmaceutical Pricing Authority (NPPA), Food Safety and Standards Authority of India (FSSAI), Drugs Controller General of India (DCGI) and Patent Controller General of India monitoring different issues in the sector under different ministries.
  • There are no streamlined processes or guidance for approvals or dealing with these departments. The beneficiary party has to run pillar to post paying “cuts” at every step in all these departments for necessary approvals for healthcare & pharma businesses
  • NRHM, a flagship scheme started by central government also has had its own set of problems which range from problems with timely procurement of medicines & supplies to lack of staffing in rural areas.
  • The lead professional body MCI itself has been a source of corruption when it comes to approval of private medical colleges

We as medical professionals have seen the quality of medical education & quality of life of young doctors go from bad to worse in past ten years. This can be attributed to one or more of the following unending list of problems which medical professionals are facing these days.

  • Vote bank politics increasing reservations without substantial logic
  • Dwindling meritocracy
  • Archaic medical education system failing to promote skill development
  • Uncountable number of scams in the selection process & open sale of medical seats
  • Lack of any coordination between the centre & states over critical selection processes continuing from many years without any improvement 
  • Disparity in standards of medical education across various states and centre sponsored colleges
  • Medical colleges getting approvals without facilities & requisite staff; government colleges failing to maintain their quality standards
  • Over exploitation of junior doctors by both government & private employers in terms of overtime, low pay scales, lack of facilities & mammoth contract bonds making a viable living from hard to virtually impossible
  • The pay scales in specific, in many states have not seen any raise to cover inflation leading to declining quality of life of Government doctors 
  • Dwindling levels of academic activities and increasing  use of young doctors as bonded labourers to cover up shortage of nursing and paramedical staff in government hospitals (especially in states like Tamil Nadu)
  • Doctors on rural services face problems with their families like no arrangements for proper education, transport and residence along with workplace issues including poorly equipped, under staffed and poorly supplied healthcare facilities

Many young doctors discouraged by a sky high heap of unattended problems either choose to migrate to foreign soils or many of them are not choosing to practice at all and looking for profession change. 

This is very much apparent with the rising number of Indian applicants to countries like USA, Canada, Germany, Australia and Ireland.  

In addition to this, the medical professional profiles you happen to see these days are swaying in the direction of non-practice corporate jobs which offer a descent lifestyle to young doctors. For instance this blog alone gets 200-300 search queries each day from google inquiring alternative career options after MBBS. The majority of these corporate jobs are for pharma majors or service industry working for the US and other countries. 

Till the date, I have read that the new government is planning to formulate a new Health Policy, a program on sanitation and start National Health Assurance Mission (I guess it must be the brand name they would use to promote after making a few tweaks to the NRHM). They will also do the usual - promoting yoga in AYUSH. They plan to continue to establish AIIMS like institutions in all the states. 

Let’s have hope that the new government will also be looking into some of the issues discussed above and plan for some incremental steps in the right direction. 


References

  • http://www.business-standard.com/article/economy-policy/health-high-on-modi-s-agenda-114051900925_1.html
  • http://www.business-standard.com/article/politics/govt-to-bring-in-experts-to-implement-health-schemes-effectively-114053001429_1.html
  • http://timesofindia.indiatimes.com/india/Presidents-speech-highlights-12-key-points-of-the-Modi-government/articleshow/36309560.cms
  • http://presidentofindia.nic.in/sp090614.html
  • http://content.healthaffairs.org/content/25/2/380.full