Public health care struggles for a cure

Recent incidents of lapses in private hospitals have raised questions over quality of healthcare

In the first of a three-part series, Business Standard takes stock of the public health care system.
 
The capital’s G B Pant Hospital has become a familiar place for Baghpat’s Sunita Kumari (name changed to protect identity). She travels almost 50 km to reach the hospital from her home in Western Uttar Pradesh twice a month to get her sister treated for a heart ailment.
 
This has been their routine for the past three years.
 
Kumari decided to consult doctors at this Delhi hospital after months of failed attempts to receive quality care at primary health centres nearer her home. The visits to Delhi, doctors tell her, will have to continue indefinitely.
 
Like Kumari, several hundred thousands of patients from small towns and villages travel to cities in search of adequate facilities. Most have to depend on government-run hospitals such as G B Pant for affordable treatment.
 

Source: Ministry of Health and Family Welfare

These government hospitals offer consultation for free or token payment. The All India Institute of Medical Sciences (AIIMS), for instance, charges Rs 10 from each outpatient. But, getting consultation or treatment at these hospitals is not easy.
 
Government hospitals are under pressure due to a rising number of patients and limited infrastructure and personnel. This is evident in the long waiting period, running into days, to get consultation. Those who can afford opt to go to private hospitals.
 
Rising health insurance is also taking patients away from government hospitals in a limited way. The Rashtriya Swasthya Bima Yojana, an insurance scheme for the poor, leaves a lot to be desired. The Centre has been trying to formulate an insurance scheme for families below the poverty line but nothing has been finalised.
 
The problems
 
That Kumari and people like her have not found quality health care closer home shows the abysmal spending by the state on health infrastructure. A recent NITI Aayog presentation says spending on health infrastructure by state governments has risen only 0.07 per cent of gross state domestic product in 2015-16 from 2014-15. The Centre spends less than 5 per cent of GDP for health infrastructure currently, and plans to step it up.
 
India, the second most populous country with 1.3 billion people, is facing a severe shortage of health professionals. The health ministry’s data show the number of doctors at public health centres is about 3,000 less than the desired strength of 25,650 as of March 2017. India requires 65,018 nursing staff at public health centres and community health centres. There is a shortage of 13,194. The requirement of specialists is 22,496 but shortfall is 18,347.
 
As for pharmacists, 31,274 are required in public health centres and community health centres. Here, too, there is a shortfall of 7,092. India requires 31,274 technicians in laboratories but the shortfall is 12,511.
 
The pressure is evident on government hospitals. Randeep Guleria, director at AIIMS, says the hospital has enough doctors for surgeries and they are willing to put in extra time.
 
“However, operation theatres are limited. AIIMS plans to add two dozen operation theatres over the next couple of years.” The pressure is more in segments such as ear-nose-throat, where the waiting time for patients is more than a year. Those wanting to get a neurosurgery at AIIMS might have to wait for up to six months.
 
While the government has made plans to build branches of AIIMS, experts say these branches will take at least five years to help decongest the Delhi AIIMS. The minister of state for health Ashwini Choubey  recently said deficiency of faculty and doctors was preventing AIIMS from achieving full functionality. Even after recent recruitments, AIIMS has only 45 per cent of its sanctioned positions filled.
 
Other government hospitals battle similar problems. G B Pant, for instance, is trying to recruit retired health care professionals. To add to the woes, doctors at these hospitals also deliver lectures as most of these institutions are also medical colleges. A senior doctor from a government hospital says, “We are not able to put in as many hours as we can because classes also have to be taken.”
 
In government hospitals, health care experts say, three pregnant women share one bed. Beds in the intensive care units are inadequate and some patients are kept in emergency wards.
 
The solution
 
Health care experts say the solution lies in implementing a referral model, as is being done in the United Kingdom. Referral model of treatment involves referring a patient to a clinic based on the requirement — primary, secondary or tertiary — instead of everyone flooding tertiary care hospitals.
 
Sudha Pillai, former secretary at the Planning Commission, says the state and central governments should negotiate insurance covers properly with hospitals. The government should deliver primary and secondary health care because doctors tend to prescribe unwarranted tests and medicines. By setting up dispensaries in small towns and strengthening employees’ state insurance hospitals, one can improve the public health system, Pillai says. She is also in favour of stringent laws to regulate the private sector.