Build Healthcare System From Bottom

Context: Debilitating condition of primary healthcare in India is pushing people towards poverty and has been suffering continued political neglect.

Impact of poor primary health care:

• Pushing towards poverty:
  • Post-Covid care and hospitalisation costs are pushing the middle class into poverty, especially when there is a loss of incomes due to lockdowns.
  • As per the Central Government’s figures, there have been 2.6 crore recoveries so far across the country of those infected by Covid-19.
  • If 80% of these people recovered at home and each spent Rs 10,000, at a minimum, it amounts to Rs 19,700 crore of expenditure.
  • According to research reported by Pew Research Centre, US, before the pandemic, India’s poor, i.e. those with income less than $2 a day, were projected to be about 59 million.
  • Now, India’s poor are expected to reach 134 million, double what was projected earlier.
• Farmer suicides: About 40% of the suicides had happened because the farmer had been pushed to the brink by the costs of chronic disease in the family.

Reasons for the absence of primary healthcare:

• Over-promised policy ambitions: The policymakers of India were completely and desperately in awe of doing something heroic.
  • The policymakers preferred to concentrate on building physical infrastructure for grand hospitals and setting up tertiary care institutions and research centres.
  • Secondary and tertiary care facilities, on the other hand, require high investment, a certain commitment to research and results in the long term and can be easily provided.
  • While the primary healthcare requires large numbers of practitioners and little capital investment, it requires a social relationship between the practitioner and the patient, which the state is unable to provide.
• Less involvement of private doctors: Due to the alleged “moral hazard” by the public health establishment against private doctors’ involvement.
  • Their numbers till now have been too small to fully satisfy the needs of the people. Most of them come out of fly-by-night private medical colleges.
  • So wary has the public health establishment been of the private sector that for many years, the Rashtriya Swasthya Bima Yojana, the precursor to Ayushman Bharat, was administered by the Ministry of Labour rather than by the Ministry of Health and Family Welfare.

Way Forward:

• Building protocols for private engagement: The government should develop protocols that are used for everyday illnesses and tie the private primary healthcare doctor to these protocols.
  • Once protocols are created, they become the basis for the interaction between the health seeker and the health provider and leave little room for extortion by anyone.
  • Such protocols are already in place in Maharashtra since 2013. They played a major role in ensuring that patients were not fleeced and got quality healthcare.
• Build a system of healthcare that is developed from the bottom upwards: A system based on the general practitioner, who is based in and committed to a locality and is made to follow government-specified protocols for treating patients.