R Srinivasan’s credible government document on healthcare in India titled ‘Health Care in India – Vision 2020’ draft published in 2004, sub-titled ‘Issues and Prospects’, has suggested four criteria that make a just healthcare system
1. Universal access, access to an adequate level, and access without excessive burden.
2. Fair distribution of financial costs for access and fair distribution of burden in rationing care and capacity and a
constant search for improvement to a more just system.
3. Training providers for competence empathy and accountability, pursuit of quality care and cost effective use of the results of relevant research.
4. Special attention to vulnerable groups such as children, women, the disabled and the aged.
Srinivasan's draft is dated; but the criteria are relevant even today as India’s healthcare system remains in a very sordid state.
A recent study by IMS Institute of Health Informatics (19 July, 2013) has revealed that 72 percent of the rural Indian population has access to just one-third of the country’s available hospital beds while 28 percent of urban Indians have access to 66 percent of the total beds. The study also notes that those living in remote pockets have to travel more than five kilometres to access an in-patient facility, 63 percent of the time.
Evidently, the country’s historical spend on healthcare, apart from immunization programmes, has not been enough. WHO statistics show the total expenditure on health is 4.4 percent of the GDP, for a population of 1.27 billion. As a result of a low healthcare spend and lack of special attention towards this sector and absence of concrete regulatory policies, India’s healthcare system is in shambles.
Here is a picture of the current healthcare scenario:
Universal Access and Financial Costs: The IMS study noted that long waiting time and absence of diagnostic equipment at public facilities has caused an increasing number of patients to rely on private healthcare facilities. Quality of treatment is also a reason why patients switch to private centres. However, this shift from public to private care is posing an affordability challenge to poor patients.
Training and distribution of Health workforce: Statistically speaking, Indian cities have four times the number of doctors and three times more nurses than in rural areas. Meanwhile, almost 80 percent of the medical colleges are located in South and West India. The direct impact is a dearth of trained professionals practicing in rural India.