By Meena Ganesh,
Indian Union Budget 2021-22: Vaccines for COVID-19 are finally under production. With this breakthrough, and many structured and effective therapies to combat the coronavirus, there is no doubt that 2021 is going to be landmark one for the healthcare industry. This is the time to look back at the weak links of our healthcare ecosystem as exposed by the pandemic and take steps to cover the gaps in infrastructure, facilities and financial provisions in the upcoming budget. The rapid spread of the contagion and the peculiarities of this problem made it amply clear that the conventional healthcare system in India is inadequate to handle a pandemic of such magnitude. At the peak of COVID-19, we saw an absolutely exhausted healthcare system fighting valiantly, but getting overwhelmed at the scale of the problem. Doctors and nurses put in excruciatingly long shifts exhausted in their PPE kits and in most places, the patients had to be simply turned away. The pandemic has already infected almost 1.5 crore people across the country and the death toll is about 150,000 and rising. Thus, the case for greater budgetary allocation on healthcare is stronger than ever.
In the month of May last year, the central government had announced a stimulus package of Rs 20 lakh crore, out of which Rs 15,000 crore was provisioned for ‘COVID-19 Emergency Response and Health System Preparedness’. Just about half of that amount – Rs 7,774 crore was to be spent in 2020/21, and the remaining has been earmarked for the next four years. While this was appreciable, it is not even close to the investment that is required to improve the quality of public healthcare in India. Moreover, the approach has to be systematic, sustained and multi-frontal and greater investment is needed. In the last one decade, India’s public healthcare budget has hovered in the range of 0.9% to 1.3% whereas the actual healthcare spending is about 3.8% to 5% of the GDP. This clearly indicates a very high out-of-pocket-expense on healthcare by the public. Further, even the budget allocated to healthcare is greatly unutilized by various state governments and sometimes half of the funds allocated are not even spent. This lack of budget and spending has led to a primary healthcare network that can’t manage any secondary and tertiary healthcare needs of the public, leave alone a pandemic of this scale. Barring a few major hospitals such as AIIMS, Safdarjung and RML hospitals in Delhi, PGIMER in Chandigarh and a few others, most of the government sector hospitals are lacking in capabilities to address all contingencies.
Despite the numerous constraints, it is really commendable to see how the conventional medical service providers, doctors, paramedics, private out-of-home healthcare providers and all other stakeholders put up a valiant effort. It would not be wrong to say that we have successfully outperformed some of the most advanced countries in the world. Time has come when we have to make provisions in the upcoming budget to put in place a system that is not responsive to a situation such as this, but rather preventive and capable of rapidly scaling up the service delivery if and when required. Such a transformation can be brought about by integration of new age healthcare technology and care practices.
Another major challenge that needs to be addressed through infrastructure is the rural-urban divide in healthcare. Despite about 75% of Indian population residing in rural areas, the healthcare concentration is heavily skewed in the urban areas. The absence of hospitals and qualified doctors in the rural areas results in patients from all over the country travel to major cities and incur a lot of additional expenses as well as loss of wages for the patients’ attendants. This is where the delivery of health services in the rural areas through e-health/e-medicine and other such technology driven means is going to play a transformational role. To make this happen, the government must ramp up the medical as well as training infrastructure in a big way. The best and fastest way to ensure quality healthcare access in the rural India is through e-health/e-medicine services. Funds must be allocated towards skill development of teachers, nurses, paramedical staff and caregivers. Further, by making budget allocations for development of telemedicine and home-based healthcare ecosystem in the country, it is possible to best harness the available resources to cover the whole country. This can be done through a public-private partnership in a speedier and more effective manner. Through development of an alternate on-demand home healthcare system, we can reduce the burden on institutional healthcare. Investing in out-of-home healthcare is less cost-intensive than building and maintaining new hospitals, and the system can leverage available resources to cover a much larger number of patients and healthcare seekers. Another key benefit of telemedicine is that It offers a quick, absolutely safe and widespread access to quality doctor consultations throughout the country. It eliminates the need for an in-person interaction between the doctors and patients, making everyone stay safe from virus exposure and allowing doctors to attend to patients located at a distance.
There is an urgent need to increase allocation to meet the various needs of India’s healthcare sector. After the pandemic driven economic downturn, it is time for the country to bounce back economically in a strong way and budget infusion is critical to make that happen!
(The author is MD and CEO, Portea Medical. Views expressed are personal.)
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