PART IV
Healthcare system is currently undergoing a transformative journey. It’s strengthening coverage; government introduced structural reforms, services and increasing expenditure by public as well private players. However, the question of whether the expanding industry size translates into better quality services and improving outcomes for patients remains debatable.
Judging healthcare through Quality and Outcome Indicators
The efficacy of India’s healthcare industry can be measured based on how access to quality healthcare services trickles down into the lowest recesses of Indian society. Quality is a core dimension of health system performance means that the care provided is: Effective: achieving desirable outcomes, given the correct provision of evidence-based healthcare services to all who could benefit, but not to those who would not benefit. Safe: reducing harm caused in the delivery of healthcare processes. Patient-centred: Accessible and affordable quality care placing the patient/user at the centre of its delivery of healthcare.
Ground Realities: Putting Field Learnings into Action
Inadequate infrastructure, limited access to quality healthcare services, affordability issues, and regional disparities remain challenges for policy makers. The available data indicates around 30 percent of Indians do not have health insurance of any kind. Despite Govts hike health spending nearly 16.5 per cent increase in comparison to FY 2020-21 high out-of-pocket health expenditure (OOPE) is impoverishing some 55 million Indians annually, with over 17 per cent households incurring catastrophic levels of health expenditures every year, (WHO March 2022).
Implementation Of Equity and Access in Indian Healthcare: Current Scenario and Way Forward
Although India achieved the World Health Organization (WHO)-recommended doctor-to – population ratio of 1:1000 in 2018, still there is uneven distribution of health workers in rural and urban areas in the country .The National Health Policy 2009, health was prioritized as a fundamental right, several new health policies and schemes, insurance and introduction of private healthcare funding an increase in budget allocation for healthcare by vaccination drives, augmenting manufacturing of medical devices, special training packages , Artificial Intelligence/Machine Learning (AI/ML)-based standard treatment workflow systems to ensure proper treatment and clinical decision-making have been initiated for improving healthcare funding, equity, and access.
Due to space constraints as a Certified Professional on Healthcare quality, policy & planning I can provide here only with some general suggestions for improving healthcare delivery. State plays a key role in health development. The dramatic changes during the last four decades have greatly affected and led to a repositioning of the Government’s role in health as well as other social sectors for the efficient use of available resources. Since market forces fail to address properly the health needs of populations the States have an obligation to intervene to improve equity and efficiency, initiatives, reforms, and insurance schemes to carry out public health functions and to produce vital public goods which have bearing on health development.
Universal Health Coverage (UHC)
Implementing a robust UHC system can ensure that every citizen has access to quality healthcare services without facing financial hardships. Expand existing government healthcare programs, National Health Protection Schemes like Ayushman Bharat or the introduction of a new scheme to cover a broader range of services that provides financial protection and access to quality healthcare for all citizens, providing comprehensive coverage for primary, secondary, and tertiary healthcare services, including hospitalization and critical treatment especially those from economically disadvantaged backgrounds.
Health Infrastructure Development needs to focus on resource allocation policy of granting more funds to the healthcare sector especially in underserved areas, establishing more fully equipped hospitals with more beds, availability of essential medicines, upgrading existing facilities through advanced medical equipment. Considerable progress has already been achieved by having a hospital attached to medical college at District level.
Strengthening Primary Healthcare is crucial for early detection, prevention, and management of diseases. Investing in development and expansion of primary healthcare infrastructure in providing adequate staff and services at the grassroots level ensuring the availability of essential drugs and diagnostics providing essential medicines.
Health information technology and Digital Health Initiatives can improve healthcare delivery and accessibility. The HCO can promote the widespread adoption of electronic health records, telemedicine services, and interoperable systems to ensure seamless exchange of medical information enabling remote consultations to guide in management plans and thereby reducing the referral burden on secondary and tertiary hospitals.
Data driven decision making
Establish robust health information systems to collect, analyze, and utilize health data for evidence-based decision-on health trends, target interventions, and monitor the impact of healthcare initiatives. Digital platforms can also facilitate health information exchange, research collaboration, and real-time disease surveillance. This includes setting up telemedicine centers, providing internet connectivity, and training healthcare professionals in remote consultations.
The Skilled Workforce Development and Training program addresses the quality of care and shortage of healthcare professionals in underserved areas. Enhancing the number of medical and nursing colleges, skills and allied health professional training institutes are already in place. To encourage healthcare staff to serve in rural, remote areas offer incentives such as allowances, scholarships, loan forgiveness, and better career prospects.
Robust Quality Assurance Mechanisms are essential for monitoring and evaluating healthcare services compliance with ethical and professional standards. Regular inspections, clinical audits, and reporting systems can help identify and rectify any deficiencies, ensuring patient safety and enhancing overall healthcare services. The Govt must establish a regulatory framework by establishing TQM dept and /or Clinical auditor positions, enforcing Quality assurance and accreditation requirements to ensure that services meet the required standards for independent regulatory bodies like NABH for licensing and certification.
Encouraging research and innovation in healthcare by supporting partnerships between academic institutions, healthcare providers, and private companies can lead to breakthroughs in diagnostics, treatments, and healthcare delivery models. Sufficient funds to be allocated for research grants, to establish research institutions and develop indigenous solutions tailored to India’s unique healthcare needs.
Raising Awareness Saving illness by investing in preventive healthcare significantly reduces the burden of diseases on the HCO by preventing the development of chronic conditions. Launch nationwide programs to educate citizens about the importance of awareness on healthy lifestyle, disease prevention, and early detection of diseases. This can include initiatives such as vaccination drives, health screenings, regular health check-ups and immunizations and educational programs in schools and communities.
Public-Private Collaborations and Partnerships (PPPs) can leverage expertise and resources by sharing the burden of infrastructure development and services delivery. Encourage PPS investment to address resource gaps while ensuring affordable and equitable access for all sections of society especially in underserved areas. Recently, there has been a rapid expansion of the private hospital sector unfortunately lacks strict vigilance.
Health financing reforms
Sustainable and inclusive financing mechanisms such as health insurance schemes like the ABJAY and risk-sharing arrangements have emerged as a financing protection in India for addressing (OOPE); sadly falling short of the target, only 37% of the total Indian population is covered by health insurance. This is less than 50% of the originally targeted approximately 50 crore beneficiaries under the scheme, further enhancement by extending empanelment and strict auditing to save it from exploitation and abuses. It has been recommended several times that the government’s health expenditure be raised from the existing 1.2% to 2.5% of GDP by 2025.
Healthcare Visionary leadership is essential for implementation of initiatives. For careful planning, coordination, and adequate funding it is my humble suggestion that selection of CEO be on leadership managerial traits not merely on seniority basis and existing Healthcare Managers to have refresher courses on Quality tools like Lean six sigma, VMS seeking attention of respected Dr. Yashpal Sharma Director (Coordination), President AHA.
Worldwide, momentum is growing for health-care reforms that seek to achieve universal health coverage in low- and middle-income countries (LMICs). The Indian healthcare system is evolving towards better healthcare implementation and coverage. However, even today, the health-care system faces challenges, a few of which are yet to be addressed. Building a healthy nation, ample focus must be laid on each stratum of society, and no one should be exempted from quality healthcare by a roadmap towards universal healthcare coverage, and their implementation requires careful planning, coordination, adequate funding, and cohesive efforts of private and public sector towards building a “Healthy India”.
(Concluded…)
(DR. Fiaz Maqbool Fazili is a Certified Qualified Professional in Quality Healthcare Policy Planning and has worked as Director Total Quality management & team leader with national and international accreditation Bodies like JCI- CBAH_ NABH: GE healthcare international can be reached at [email protected])
