The pandemic has unravelled India's broken health care system and we must implement urgent reforms to fix the Indian health care system, writes DR KAFEEL KHAN..———.TODAY, on Human Rights Day, let us talk about the most important pillars of all human rights: " Right to Healthcare"..Healthcare is a fundamental right, but it is not fundamentally a right..The Supreme Court has held healthcare to be a fundamental right under Article 21..However, due to a differential distribution of services, power, and resources, there are many inequalities in access to healthcare..“The World Bank estimates that 90% of all health needs can be met at the primary healthcare level. Yet, India has grossly under-invested in this area that should matter the most..Access and entry into hospitals depend on gender, socio-economic status, education, wealth, caste, and location of residence. A large number of tribes and ex-untouchables, that live in isolated and dispersed areas, often have low numbers of medical professionals from their communities..Those with the greatest need often do not have access to healthcare..The World Bank estimates that 90% of all health needs can be met at the primary healthcare level. Yet, India has grossly under-invested in this area that should matter the most..You don't need a Corona epidemic, for the public health system to collapse..Today, the coronavirus has taken approximately 0.15 million Indian lives. But as all the resources are diverted for combating COVID-19, around 28,000 people are dying every day because of other health complications that have nothing to do with Covid..The Corona pandemic has pushed fragile India's public health system that was already overstretched and overburdened and is on the verge of collapse..Healthcare in India is in deep shambles and the state needs to deeply introspect on its condition..“The fundamental aspect of healthcare, which is primary health care, is in shambles. There is only one primary healthcare centre, which is often manned by one doctor, for more than 51,000 people in the country..After the BRD Hospital's oxygen tragedy, I travelled all over India and conducted hundreds of free medical camps. I realized that the BRD oxygen tragedy was just a brutal face of our broken health system..It forced me to examine data from the National Family Health Survey (NFHS), different government health agencies, World Bank, WHO, UNICEF, and United Nations, and the staggering data shocked me to the core..Public spending on health stagnated to 1.2% of total GDP as compared to the world average of 6-8%..India ranks 170th out of 188 countries in domestic general government health expenditure as a percentage of GDP..India also ranks 145th among 195 countries in terms of quality and accessibility of healthcare according to Lancet..It gets worse..India holds the 94th position out of the 107 countries in the Global Hunger Index and 144th out of the 156 countries in the World Happiness Index..India ranks 129 among 189 countries on the Human Development Index (HDI)-UN..As per the Gender Gap Index, India ranks 150th in female health and survival among 153 countries..One in two women of reproductive age is anemic..“There is a stark divergence in healthcare, as 74% of doctors serve in urban areas that hold 28% of the country's population..The fundamental aspect of healthcare, which is primary health care, is in shambles. There is only one primary healthcare centre, which is often manned by one doctor, for more than 51,000 people in the country..Moreover, doctors without formal training provide up to 75% of primary care visits..At present, there are 541 medical colleges (280 government and 261 private-total 80,312 undergraduate seats ) but only 64 PG Institutes (36,192 seats)..There is a stark divergence in healthcare, as 74% of doctors serve in urban areas that hold 28% of the country's population..Moreover, the private sector consists of 58% of the hospitals in the country and employs 81% of doctors..Most hospitals in India are overburdened, understaffed and ill-equipped. Yet, medical tourism is booming which is expected to reach 372 billion $ by 2022..“Around 8.40% of the population (approximately 63 millions ) who are hospitalized are pushed either into lifelong debt or below poverty..According to WHO, about 10.5% of medicines sold are substandard and falsified..Medical debt is a major cause of poverty in India. Around 8.40% of the population (approximately 63 millions ) who are hospitalized are pushed either into lifelong debt or below poverty..9.50% of children are malnourished and only 62% are immunized. According to UNICEF, malnutrition caused 69% of deaths of children below the age of five in India..In 2018, India reported 8.82 lakh deaths of children under five years of age, which is the highest in the world as per UNICEF.4.5 lakhs die of tuberculosis every year..India had the third-largest number of people living with HIV in the world..India is the diabetes capital of the world with over 77 million diabetics..Rising air pollution is another cause of concern. According to the State of Global Air (SOGA) Report, 2020, long-term exposure to outdoor and household air pollution has contributed to 16,67,000 deaths in India in 2019..“We can't afford to be silent spectators to the healthcare crisis, especially in a time when India is struggling with the dual burden of corona pandemic and economic slowdown..As COVID-19 cases surge, India faces scarcity of oxygen, PPE kits, ICU equipment, medicines and sanitizers..Post- COVID, a mental health crisis is looming..We can't afford to be silent spectators to the healthcare crisis, especially in a time when India is struggling with the dual burden of corona pandemic and economic slowdown..It's time to make a fresh beginning for Healthcare..Healthcare reforms need thorough introspection, debates and corrective measures. Mere cosmetic changes won't help. We need immediate actions, bold reforms and a sustained campaign to deliver healthcare to rural India..What are the Solutions and what should be the Approach?.“We need to increase our public health expenditure to 5% of the GDP..Universal access to good quality health care services must be ensured. No one should have to face financial hardship, irrespective of age, caste, religion, region, gender, disability or economic status. Free consultation, drugs, diagnostics and free emergency care services should be made available in all public hospitals..It is important to make the "Right to Healthcare" a justifiable right through the enactment of appropriate legislation..We need to increase our public health expenditure to 5% of the GDP..The state must ensure an uninterrupted supply of oxygen, PPE kits, ICU equipment, medicine and sanitizers during the COVID-19 pandemic..There is an urgent need for the training of doctors and paramedics in Intensive Care..Immediate and legible compensation should be given in case of the death of corona warriors..Free testing capacity must be increased to 1 lakh for a population of a million..Additionally, Sero-Survey of COVID-19 antibodies must be immediately put into effect all over India to know the real extent of the disease..The government must take strict steps to curb rumours and unscientific views..The state must also re-distribute all resources to ensure care for non-COVID-19 diseases..All existing vacancies must be filled and we must aim to create new jobs every year..A post-COVID Care Clinic must be established at each Primary Healthcare Centre all over India..The state must aim for Universal Immunization that includes MMR, Pneumococcal, Typhoid, Hepatitis-A, HPV, Chickenpox, Rota Virus, JE, Influenza along with COVID-19 vaccine..Universalise and expand the Integrated Child Development Services programme to effectively cover malnutrition for children under 5. It is necessary to universalize community-owned CMAM (community-based management of malnutrition) programmes and daycare services as important interventions in addressing malnutrition..Decentralization is important. Around 60% of the expenditure is being borne by the Centre and 40% by states..The state must aim to have at least five beds per thousand population distributed in such a way that it is accessible within the golden hour rule..All contractual health workers (e.g.-National Health Mission employees) including ASHA and Anganwadi workers and helpers involved in the delivery of public health services must be regularised..Maternity benefits must be universalised..GST exemptions should be provided for Out Patient Department and in-patient department products and drugs for serious ailments..We must strengthen the Health Management Information system and medical disasters and health epidemics system..Population stabilization should be on the priority list..Diseases such as Tuberculosis, HIV/AIDS, Vector-Borne Diseases and other Non-Communicable Diseases need to be brought under control..A clinical psychologist, psychiatrist and counselor must be appointed at each Primary Health Centre..Measures need to be formulated on long-term plans to reduce air pollution..We must enhance the validation, evidence and research of the different health care systems as a part of the common pool of knowledge. Formulation and implementation of a comprehensive policy on health is the need of the hour..Let's demand "Right to Healthcare".Let's build a strong and healthier India..(Dr. Kafeel Khan is an Associate Professor at BRD Medical College, Gorakhpur, Uttar Pradesh. Views are personal.)
