Healthcare Infrastructure in India: Challenges and Solutions

The provision of quality medical services to all is more than just a right; a healthier mass means enhanced human capital whose dividends only a prosperous nation can reap. The initiatives aimed at providing them to all citizens are a fundamental component of the country’s primary objectives, striving to enhance the quality of life for all individuals.

Illustration by The Geostrata

These benefits not only improve the quality of life but also establish a safety net for those who lack financial security, reassuring them and their loved ones that the government is attentive to their well-being.

Over the past decade, the Indian government has consistently raised its healthcare expenditure as a percentage of the annual budget.

Some initiatives, like the National Urban Health Mission and the National Rural Health Mission, have been in place for a while. These initiatives were designed to enhance access to healthcare facilities in urban and rural areas, respectively. However, they were discontinued in 2020.

Under many of the beneficiary schemes being run by the government in the country, the flagship one is definitely the Ayushman Bharat Yojana, also known as Pradhan Mantri Jan Ayoga Yojana (PMJAY). 

INDIA'S TRYST WITH PUBLIC HEALTH INSURANCE SYSTEMS

This public health insurance scheme started back in 2018, as a result of a study conducted by Global Burden of Disease Study, a research program which conducted a detailed medical survey of all the regions in India, on the risk factors of various diseases. This study also highlighted the need for insurance coverage for a large number of people.

Pradhan Mantri Jan Ayoga Yojana when launched encompassed a dual strategy aiming to enhance the primary healthcare infrastructure through the establishment of 150,000 Ayushman Bharat - Health and Wellness Centres (AB-HWC) which are now known as Ayushman Arogya Mandirs, nationwide by 2022, alongside providing significant financial security through secondary and tertiary healthcare insurance to the most disadvantaged 500 million Indians.

In recent years, the Indian healthcare infrastructure has faced significant challenges due to the COVID-19 pandemic. Nonetheless, PMJAY has effectively navigated through these challenges, accomplishing numerous remarkable feats.

Over 86.90 crore individuals have undergone screening for non-communicable diseases, including 29.95 crore for hypertension, 25.56 crore for diabetes, 17.44 crore for oral cancer, 8.27 crore for breast cancer, and 5.66 crore for cervical cancer.

In addition to this, the government has also launched a teleconsultation service for the public, named E-Sanjeevni. Through this service, more than 4 lakh daily teleconsultations occur, facilitated by the Ayushman Arogya Mandirs.

The majority of services offered by ABHWS are universal and free for all to access. Healthcare insurance benefits are provided to individuals with Ayushman Cards, offering coverage of up to ₹5 Lakhs.

Additionally, numerous other features have been incorporated into this mission. There has been a longstanding debate about maintaining a medical ID for individuals, containing the patient's complete medical history. With each card, the patient's medical history is readily available. This undoubtedly aids medical professionals in diagnosing and treating patients more effectively.

MoH also incorporated this into this mission. As of February 6, 2024, the Ministry of Health has issued over 9 crore Ayushman Cards.

ASSESSING ITS SUCCESS

A recent study conducted by a team of researchers from Europe revealed that PMJAY has enhanced access to secondary and tertiary care services for socio-economically disadvantaged groups in India.

Another study from 2023 concluded that due to PM-JAY, access to the healthcare system increased by 11.7 and 8 percentage points in rural and urban India, respectively. It also succeeded in narrowing the gap between the rich and the poor in rural areas.

PMJAY has undoubtedly been a success story for the Indian government and a blessing for hundreds of millions of people. However, there is always room for improvement and the development of a more robust healthcare policy.

BALANCING ACT OF BUDGET AND IMPLEMENTATION

The government continues to rely on data from the 2011 census for the implementation of PMJAY. Just as the government has been integrating various horizontal and vertical components into this mission, there is undoubtedly a need for further expansion.

India's demographics have undergone significant changes since 2011 in all aspects. Relying on outdated data could pose challenges in the logistics and execution of this mission.

For the financial year 2024, the Union Government allocated Rs 88,956 crore to PM-JAY. Even a small misallocation of this substantial sum would constitute a significant waste of public resources.

SCOPE OF INNOVATION IN HEALTH AND FINANCIAL RISK MITIGATION

The Ministry of Health (MoH) can certainly incorporate the latest technology into upcoming health-based surveys. The government should prioritise investment in gene-testing technology for nationwide surveys in India. Gene testing represents a cutting-edge technology capable of conducting predictive analyses of an individual's future health. For instance, if an individual carries a mutation such as Presenilin-1, they are at a heightened risk of developing dementia later in life.

The majority of these mutations are hereditary, meaning individuals from common communities and groups in India will generally share similar risks of developing certain medical disorders.

Conducting a comprehensive survey with representative samples from the population can assist policymakers in making future predictions regarding the potential number of patients with specific diseases in the near future.

Gene testing can also be utilized to devise optimum nutritional plans, as different bodies harbour various mutations tailored to their nutritional intake. According to a research paper from 2012, certain groups of India exhibit a higher frequency of lactose tolerance mutations, suggesting that these groups may derive more nutritional benefit from milk compared to others.

Integrating a nutritional plan for the general population alongside the public healthcare mission can also assist the government in optimizing the burden on their healthcare infrastructure, as individuals with improved nutrition are inclined to possess better immunity.

In addition to this, there is a definite necessity for enhanced financial risk modelling for vulnerable groups in India. A study conducted in 2021 emphasized the importance of improving the assessment of vulnerable individuals who require access to the insurance coverage provided by PM-JAY.

Numerous organisations have begun employing state-of-the-art machine learning and deep learning algorithms and methodologies for predictive purposes. The Indian government has incorporated numerous digital features into PM-JAY; thus, it would be advantageous for them to consider integrating these advanced methods as well.

However, we also need many such innovations and upgrades at various federal levels of government. Many states, like Haryana and Rajasthan have had huge incremental increases in their healthcare infrastructure over the years. At the provincial level, states must strive to integrate their policies with those of the Union Government. This endeavour will enhance healthcare accessibility even in the most remote regions of the country.

Many states can also learn from others, such as Kerala, which has already developed a robust healthcare system. They can glean insights from the challenges Kerala faced during its development.

Crafting healthcare policy for a nation as vast as India is undoubtedly challenging, yet with meticulous planning and execution, the government can certainly implement a more versatile healthcare mission that optimally strikes a balance between allocation of resources and improved health outcomes.

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BY DAKSH MEHLA

TEAM GEOSTRATA

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