DISRUPTION IN PRIME INVESTIGATION AGENCY (CBI)-ALOK VERMA CONTROVERSY
February 20, 2019
PAST, PRESENT AND FUTURE OF INDIAN GOVERNMENT
March 2, 2019

HEALTH INFRASTRUCTURE: A CRITICAL ANALYSIS OF PUBLIC POLICY GAPS

Health Infrastructure is an important indicator of well-being of the people in a welfare state mechanism. The population of India has been growing at an unprecedented rate and growing at almost 18 million per year, India will be the most populous nation by 2030 and the health infrastructure to deal with the population growth is inadequate. The outbreak of many communicable diseases in various states have shown the inadequate health infrastructure that is present to tackle the disease. The outbreak of chikungunya in New Delhi gave us a clear glimpse of a crippling healthcare system and the lack of timely action from the government.[1] Problems of shortage of resources, beds, expensive Medicines were recorded. In June 2011, more than 50 children died in Bihar because of a mysterious disease which included the symptoms of high fever and unconsciousness; the doctors from the National Institute of Virology visited the hospital full of infected children after several days but even they could not identify the disease.[2] The health infrastructure has time and time again fared very poorly in relation to dealing the outbreak of diseases in the country and has led to many fatalities which could have been prevented if the resources were provided.
I have identified the following inadequacies of the heath infrastructure in India:
  1. Lack of healthcare Centres: In relation with the population and the number of people being affected with the diseases and requiring medical treatment, the number of healthcare system is dismal. The human resource of this country has been dying from preventable and curable diseases because of incompetent hospitals which do not have adequate number of equipment, doctors to look after the patients and technology to detect the problem. According to the National Health Profile,[3] there are 1,45,894 Sub Centres, 23,391 Primary Health Centres and 4,510 Community Health Centres in India as on March 2009. Thus, the major problem of health infrastructure that has been plaguing the country is the lack of Health care centres in relation to the population of our country.
  2. RuralUrban Divide: It was nearly four decades ago that economist Michael Lipton brought to the fore the concept of an urban bias in the process of development and held that it was perhaps most importantly manifested in the form of state health resource allocation that favoured urban priorities.[4] It has been seen that access to hospitals and health care resources is easier in urban areas in comparison to rural areas and hospitals are concentrated in “metro-cities” with the rural areas being neglected. The Central Government Health Scheme has health facilities in many cities and numerous dispensaries but is shows huge discrepancies as two-third of it concentrated in the original four metro cities. Another major issue tackled in rural areas is of absenteeism and unavailability of doctors in times of need.  Therefore, the rural-urban disparity is clearly visible in the health care industry and has afflicted some serious damage to the development of our country by augmenting this divide and making the rural people suffer more.
  3. Shortage of Doctors, Staff and Beds: This challenge faced in the Indian set up revolves around two key determinants, namely, increase in physical buildings and capital expenditure and secondly, human health resource, its availability and effective utilisation, both of which together form the two key determinants of the health delivery ecosystem. In India, there is one government allopathic doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people.[5] India is lagging behind even at the global level as India’s ratio of 0.7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the World Health Organisation’s (WHO) global average of 2.5 doctors and nurses per 1,000 people.[6] Another example which highlights the abovementioned problem is of the second largest hospital in the country after All India Institute of Medical Sciences[AIIMS], namely, Ram Manohar Lohia[RML] hospital where surprisingly, there is just one bed per 55 patients in Centre-run RML Hospital which means if a patient visits the super-specialty hospital, the probability of getting a bed is extremely less.[7] One underlying issue which this example brings into limelight is of the blame game between the union government and the various state government as public health is a state subject.[8] It has been argued by many jurists that in a welfare state like India, the union govt should take responsibility of the matter and provide support to the state government during these outbreaks and the state and the central govt work like a well-oiled machine as envisioned in the constitution. One striking problem in our country is the qualifications of the doctors where it turns out that the doctors are not qualified to practice medicine. According to a WHO report, published in 2016, said 31.4% of those calling themselves allopathic doctors were educated only up to Class 12 and 57.3% doctors did not have a medical qualification.[9]
  4. Increase in Number of Medical Colleges: There aren’t enough number of medical colleges for students to get their degrees and cater to the needs of the people. The number of colleges in our country are very meagre in number in relation to the number of students who sit for the examinations and also in relation to the population of our country. An added layer of difficulty in the minute number of colleges present in our country are of competition and fees of the fees. In 2018, the number of students which gave the medical entrance examination, namely, National Eligibility cum Entrance Test [NEET] were an unprecedented 13[10] Lakhs for only 60,000 seats with the ratio of candidate to seat being exponentially high and the fee structure of private medical college are so high that it becomes practically impossible for a middle-class individual to afford medical school. A unique problem in the Indian set up in the existing medical colleges is of the students not being able to complete their degree in the fixed time period due to unavailability of teachers, no funds with the college etc. Another difficulty faced in the Indian set up is of the nursing school and inappropriate working of these schools. It has been seen that nurses have not been properly trained in schools due to lack of infrastructure and work as appendages of the district hospital. In 2004, 61.2% of nursing schools/colleges were found unsuitable for teaching.[11] Thus, it is seen that India is in dire need of qualified medical professionals to deal with the growing population of our country which can only be achieved by increasing the number of Medical colleges and making them more accessible and thus allowing more students to pursue medicine and become doctors and help save our very important human resource.
Considering the above-mentioned challenge, it is felt that the Government in a welfare democracy like India needs to play a major and bigger role in the health care department to improve the infrastructure and make it more accessible. It is high time for the government to bring some changes in public policy and improve the health care infrastructure for better accessibility of health care services to the people of the country.

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REFERENCES

[1]Jha, D.N. 2016. “Dengue: Ads Only After Outbreak”, The Times of India, September 27. [https://timesofindia.indiatimes.com/city/delhi/Dengue-Ads-only-after-outbreak/articleshow/54532837.cms}

[2] “54 Died Due to Mysterious Disease in Bihar: Minister” in The Times of India, 21st July, 2011

[3]http://www.cbhidghs.nic.in

[4]Lipton, 1977, ‘Why Poor People Stay Poor: Urban Bias in World Development’, Cambridge

[5] Sharma, 2017. “India’s public health system in crisis: Too many patients, not enough doctors”, Hindustan Times, August 29.

[6] Karan Thakur, 2017. “Mind the gap: Health workforce shortage”, Daily Pioneer, August 7.

[7]https://www.dnaindia.com/delhi/report-hospitals-face-acute-shortage-of-beds-staff-doctors-2570284

[8] VII Schedule of the Indian Constitution

[9] Ibid

[10] Bhandary,2018 “NEET 2018: Competition Getting Tougher”, April 18.

[11]Ministry of Health and Family Welfare (2005), Report of the National Commission on Macroeconomics and Health”, available at <http://www.who.int/macrohealth/action/Report%20of%20the%20National%20Commission.pd>

ABOUT THE AUTHOR

 

 

 

Amogh Mittal is a first year law student at Rajiv Gandhi National University of Law, Patiala. His areas of interest are public policy and debating.

 

 

 

 

 

In Content Picture Credit: Rediff

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