By Aravindan Srinivasan
Over the years, India has been proactively pursuing improvements in healthcare infrastructure and capacity building. The pandemic, however, pushed India towards recalibrating its primary healthcare ecosystem and devising more innovative solutions for improving last mile access. For instance, by the end of last year, under Ayushman Bharat, the Indian Government surpassed its promise of establishing 50,000 Health & Wellness centers (HWCs) to over 1,60,000 functional HWCs. While these efforts are being made in the right direction, gaps remain due to the massive demand of the country.
The problem is three-pronged. Firstly, the growth of India’s healthcare system is being curtailed due to the lack of basic hardware like hospitals, beds, and medical equipment. Even today, primary healthcare centers (PHCs) across the country do not have adequate infrastructural facilities like beds, rooms, toilets, drinking water facilities, clean labor rooms to deliver babies, and electricity regularly. A recent report by the World Health Organization (WHO) highlighted that India has only 0.5 public hospital beds per 1000 population. India needs 3.5 million additional hospital beds to adequately serve the healthcare needs of the population.Secondly, there remains a shortage of physicians – which may prove dangerous in the wake of another health crisis. The stock density of doctors and nurses/midwives is 8.8 and 17.7, respectively, per 10,000 persons as per National Health Workforce Accounts (NHWA). All these estimates are well below the WHO threshold of 44.5 doctors, nurses, and midwives per 10,000 population. Medical personnel are also not adequately trained, equitably deployed, or motivated to deliver healthcare services at an acceptable level.
Lastly, the public healthcare delivery system is almost entirely financed by tax, at both the central and state level. Without the development of sound middleware that could incorporate private financing and business models, the system cannot improve, as it would keep the expenditure on public health very limited.
Focusing on the Good: Healthcare initiatives & steps taken thus far
In terms of strengthening the hardware aspect of healthcare infrastructure, India has been making significant strides by establishing hospitals in remote areas and introducing innovative solutions like solar power in locations where grid connectivity is yet to be established. In the last few years, large-scale development has taken place in the northeast region. As of February 28, 2023, a total of 7,588 Health and Wellness Centres (HWCs) have been set up in the North Eastern States.
When it comes to developing software, the people and skills that are the heart of the healthcare system, the Ministry of Health and Family Welfare continues to provide technical and financial support to the States/UTs for their health system strengthening including that of Primary Health Centres (PHCs), Community Health Centres (CHCs), and District Hospitals (DHs) through the National Health Mission (NHM). Further, the Indian government has also signed loan agreements recently to strengthen health infrastructure with international agencies like Asian Development Bank (ADB) to boost public health expenditure and make the healthcare sector lucrative to investors.
In a positive move, many impact-led organizations that work in difficult-to-reach rural areas have also innovated to improve access, responsiveness, and quality of care. They are doing this in multiple ways, such as, by empowering ASHA workers, training nurses, and working on paramedical services like ambulances, community-based preventive health models etc.
The role of private-philanthropic players in improving healthcare systems through systemic investments
There’s no denying the fact that there is a need for increased investment in both the hardware and software aspects of the problem that includes the construction of new healthcare facilities along with the improvement of existing facilities and the training & recruitment of more medical professionals respectively. The construction of new healthcare facilities and recruitment of medical personnel to bring life to these facilities will ensure that more rural populations will have easier access to healthcare services. Increased investment in the sector will also help reduce the financial burden of healthcare expenses from patients and make healthcare affordable for citizens. This can be made a reality through the involvement of private philanthropic entities. For example, to ensure easier access to healthcare services for rural populations such as tele-health, diagnostics and essential pharmaceuticals, it may be useful to explore partnership-based models for augmenting existing primary healthcare centers (PHCs) of the government with private sector-supported satellite clinics.
Private philanthropic players can play a vital role in improving skills in the sector. By increasing investment in vocational institutes for healthcare professionals, private entities can not only aid in creating employment opportunities for local people but also ensure qualified first-level care reaches communities. With strong public-private partnerships in place, we can achieve the delivery of better healthcare services to rural populations.
When it comes to philanthropies and foundations, impact investing provides some hope, with 21% of all impact investing expenditures from 2010-2019 being for the healthcare space. India. As per the India Philanthropy Report 2023 by Bain & Company, healthcare and education sector received around 55% contributions from private givings in the form of CSR in 2021-22. However the givings have been noticeably conservative and there is a low risk appetite for system changing bold initiatives.
In conclusion, greater investment in population health would make people, particularly vulnerable population groups, more resilient to health risks, and make the healthcare system in India, risk-proof. Without strengthening health systems through greater investment and accountability, wider social issues get perpetuated. For instance, poverty, low education levels, and unhealthy lifestyles will only take India further from realizing its SDGs. With an intersectional view on health, India will not only be able to achieve SDG 3 viz. Good Health & Wellbeing but also create significant headway in realizing targets across sustainable goals.
By Aravindan Srinivasan, CEO, AVPN India Foundation & Director – Thematic Collaborations, AVPN
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person / organisation directly or indirectly.)