By Dr Kafeel Khan
10 December is celebrated as the Human Rights Day across the world. On this day, let us talk about the most important pillar of universal human rights, which is the Right to Healthcare and its assessment in India.
The Supreme Court of India has held healthcare to be a fundamental right under Article 21 of the Constitution but due to differential distributions of services, power, and resources, it has resulted in inequalities in healthcare access.
Access and entry into hospitals depend on gender, socioeconomic status, education, wealth, caste and location of residence. Large numbers of tribes and ex-untouchable that live in isolated and dispersed areas often have a low number of professionals. 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. India state has grossly under-invested in the area that should matter the most.
We don’t need a global pandemic like the coronavirus for the public health system to collapse. Today as I am writing this article, the coronavirus has claimed approximately 0.15 million lives in India. But as all the resources are diverted for combating Covid-19, around 28000 people are dying every day because of non-Covid reasons.
The Covid-19 pandemic has pushed India’s fragile public health system, which was already overstretched and overburdened, to the verge of collapse. The healthcare system of India has been in deep shambles & needs deep introspection.
After the BRD oxygen tragedy, I started touring all over India conducting hundreds of free medical camps and realized that BRD oxygen tragedy was just a brutal face of our broken health system. I started collecting data from National Family Health Survey (NFHS), different government health agencies, World Bank, WHO, UNICEF, UN and the information presented in this data was so staggering that it shocked me to the core.
Here are some of the points which highlight the shocking status of our healthcare system and need to be highlighted on the International Human Rights Day.
- The public spending stagnated to 1.2% of total GDP to the world average of 6-8%, India ranks 170 out of 188 countries in domestic general government health expenditure as a percentage of GDP.
- India ranks 145th among 195 countries in terms of quality and accessibility of healthcare: Lancet.
- India ranks 94th out of the 107 countries in the Global Hunger Index (GHI).
- India ranks 144 out of the 156 countries in world happiness Index.
- India ranks 129 among 189 countries human development index (HDI)-UN.
- India ranks 150th in female health and survival among 153 countries — Gender Gap Index.
- The fundamental aspect of healthcare — primary healthcare is in shambles. There is only one primary healthcare centre (often manned by one doctor) for more than51,000 people in the country.
- 8-40 % of people (around 63 million) that are hospitalized are pushed either into lifelong debt or below the poverty — Medical debt is a major cause of poverty in India.
- 9-50 % of children are malnourished and only 62% are immunized. Malnutrition caused 69% of deaths of children below the age of five in India, according to UNICEF.
- One in two women of reproductive age is anaemic.
- 10-India reported 8.82 lakhs under 5 years of child deaths, the highest in the world. UNICEF 2018.
- 4.5 lakh people die of tuberculosis every year.
- India has the third-largest number of people living with HIV in the world.
- India is the diabetes capital of the world—India is home to 77 million diabetics.
- Doctors without formal training provide up to 75% of primary care visits.
- According to the State of Global Air (SOGA) Report, 2020, long-term exposure to outdoor and household air pollution—contributed to 16,67,000 deaths in India in 2019.
- There is a stark divergence in healthcare-74% of doctors are in urban areas that serve 28% of the population.
- The private sector consists of 58% of the hospitals in the country, and 81% of doctors.
- Post Covid-19 mental health crisis is looming for us.
- India faces scarcity of oxygen, PPE kits, ICU equipment, medicine, sanitizers as cases surge.
- About 10.5% of medicines sold are substandard and falsified-WHO.
- 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).
- Most hospitals in India are overburdened, understaffed and ill-equipped, but medical tourism is booming which is expected to reach 372 billion $ by 2022.
Considering these findings of India’s healthcare system, we can’t afford to be silent spectators. At a time when India is struggling with the dual burden of Covid-19 pandemic and economic slowdown, it’s time to make a fresh beginning for the improvement of our healthcare system. Healthcare reforms need a thorough introspection, debate & corrective measures and mere cosmetic changes won’t help. We need immediate action, bold reforms & sustained campaign to deliver healthcare to rural India.
Some of the approaches towards a solution are given below:
- Universal access to good quality health care services without anyone having to face financial hardship, for all at all ages irrespective of caste /religion /region /gender /disability/economic status.
- Free consultation/drugs/diagnostics and free emergency care services in all public hospitals.
- Make the “Right to Healthcare” a justifiable right through the enactment of appropriate legislation.
- Increase public health expenditure to 5% of the GDP.
- Uninterrupted supply of Oxygen, PPE kits, ICU equipment, Medicine, Sanitizers.
- Training of Doctors/Paramedics in Intensive care.
- Immediate & legible Compensation in case death of corona warriors.
- Increase free testing capacity to 1 lakh/million population, Immediate Sero-Survey of Covid-19 Antibodies to all over India to know the real extent of the disease.
- Curb on rumours, unscientific views.
- Re-distribution of all resources taking care of non-Covid diseases.
- Fill all the existing vacancies and create new jobs every year.
- Post Covid Care Clinic at each PHCs.
- Universal Immunization – including MMR, Pneumococcal, Typhoid, Hepatitis-A, HPV, Chickenpox, Rota Virus, JE, Influenza, COVID-19 vaccine.
- Universalize and expand the ICDS programme to effectively cover under-5 children and universalize community-owned CMAM (community-based management of malnutrition) programmes and daycare services as an important intervention in malnutrition.
- Decentralization: 60% of the expenditure being borne by the Centre and 40% by states.
- To have at least 5 beds per thousand population distributed in such a way that it is accessible within golden hour rule.
- Regularize all contractual health workers (e.g.-NHM employees) including ASHA, Anganwadi and helpers involved in the delivery of public health services.
- Universalize Maternity Benefits.
- GST exemption for OPD/IPD Products and drugs for serious ailments.
- Strengthening of Health Management Information system.
- Strengthening Medical Disasters & Health epidemics system.
- Population Stabilization should be on the priority list.
- Control of Tuberculosis, HIV/AIDS, Vector-Borne Disease, Non-Communicable Diseases.
- Clinical Psychologist/Psychiatrist/Counselor at each PHCs.
- Measures-Formulate long-term plans to reduce Air pollution.
- Enhancing the validation, evidence & research of the different health care systems as a part of the common pool of knowledge. Formulate and implement a comprehensive policy on occupational health and Adolescent/ sexual health.
Our demand for this Human Rights day should be for ‘Right to Healthcare’ to be implemented and practised. This is how we can build a strong and healthier India.
Dr Kafeel Khan is at Department of Pediatrics, BRD Medical College, Gorakhpur, U.P