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India's healthcare system is a story of contrasts. On one side, we have state-of-the-art hospitals in cities, serving the wealthy urban population with advanced technology and care. On the other hand, rural areas and remote regions face a severe shortage of basic healthcare facilities, with many health centers lacking even the most essential equipment. This growing divide between urban and rural healthcare highlights the urgent need for creative solutions to bridge this gap and ensure quality care for everyone, no matter where they live.
Our country has a rich tradition of public health that dates back to ancient times. References to the Indus Valley Civilization (5500–1300 BCE) highlight the concept of "Arogya," or holistic well-being. The Chinese traveler Fa-Hien (AD 399–414) also praised India’s curative care facilities during his travels. However, in today’s scenario, a population of over 1.29 billion presents immense diversity and an equally enormous challenge to healthcare delivery systems. The WHO’s call for “Universal Health Coverage – Everyone, Everywhere” underscores the magnitude of the task at hand.
India faces numerous challenges in ensuring healthcare access to "everyone" and "everywhere." These challenges are encapsulated in five key areas:
1. Awareness or the Lack of It
A significant proportion of Indians lack awareness about health issues. For example:
(a) Only one-third of antenatal mothers have adequate knowledge about breastfeeding practices.
(b) A study in urban Haryana revealed that just 11.3% of adolescent girls had correct knowledge of reproductive health.
(c) Among older populations, only 20.3% were aware of common causes of illnesses and their prevention.
This lack of awareness can be attributed to factors such as low educational levels, inadequate functional literacy, insufficient focus on education within the healthcare system, and a general low priority for health. Encouragingly, behavioral change interventions have demonstrated that raising awareness can yield positive outcomes. For instance:
(a) In Bihar and Jharkhand, targeted interventions improved awareness and perceptions about abortion.
(b) Adolescent health awareness programs significantly increased knowledge on environmental health, nutrition, and reproductive health.
2. Access or the Lack of It
Access to quality healthcare remains a critical issue. A 2012 study found that:
(a) Only 37% of rural Indians could access inpatient (IP) facilities within 5 km.
(b) 68% could access outpatient (OP) facilities.
(c) Geographically isolated regions, like the Himalayan areas, often depend on airlifting of essentials, highlighting the infrastructural gap.
Despite government efforts like the National Rural Health Mission, many primary health centers (PHCs) lack basic amenities such as beds, clean labor rooms, drinking water, and electricity.
3. Absence or Humanpower Crisis
India faces a significant shortage and uneven distribution of healthcare workers:
(a) There are only 20 health workers per 10,000 population, with 31% being allopathic doctors and 30% nurses and midwives.
(b) The poorer northern and central states have fewer healthcare workers compared to southern states.
(c) In rural PHCs, 27% of doctor positions and 40.7% of male health worker posts are vacant.
While private healthcare dominates urban areas, rural populations often rely solely on government services. The lack of qualified personnel discourages health-seeking behavior, further widening the urban-rural health divide.
4. Affordability or the Cost of Healthcare
(a) About 75% of healthcare expenditure in India is out-of-pocket, making catastrophic healthcare costs a major cause of poverty.
(b) The public sector offers low-cost services but is often viewed as unreliable and of poor quality.
Solutions to this problem include scaling up government health expenditure from the current < 2% of GDP to 5-6%, improving rural infrastructure, and implementing national health insurance programs effectively.
5. Accountability or the Lack of It Accountability in healthcare encompasses responsibility to patients, peers, employers, family, and society. The lack of accountability in healthcare delivery often leads to unmet expectations and a failure to uphold the principles of service and care.
