This article was first published in Business Today on January 25, 2017;
http://www.businesstoday.in/union-budget-2017-18/expectations/what-healthcare-sector-is-expecting-from-union-budget-2017/story/244957.html
It takes a healthy nation to build a wealthy nation. Focus
on ease of doing business, creating jobs, building houses, putting more
disposable income in the hands of people are all appreciated and needed. Yet,
the importance of health cannot be undermined because all of the above will be
meaningful only when the people who reap the benefits of such reforms are
healthy enough to enjoy the benefits. Healthy citizens also improve the
efficiency and effectiveness in the economy, thereby contributing much more to
the nation.
The author
asked a few renowned doctors in the city of Hyderabad, one of the major
healthcare hubs of the country, regarding their expectation from the
forthcoming union budget.
Budget Allocation
Dr. V.P. Jyotsna, Obstetrician, Expert in Gynecological
Endoscopy and High Risk Pregnancy, the Birthplace, says that the first step
should be to substantially increase the budget for healthcare. “In the last two
budgets, while the absolute amounts have gone up, as a percentage of GDP, the
expenditure has remained more or less stagnant”, she said.
Spending of the budget effectively
Dr Lavanya Kannaiyan, Consultant Paediatric Surgeon,
Continental Hospital, says that even the budget that is allocated is poorly
spent. “There are hospitals which
build the infrastructure with the budget allocated to them but not enough
thought goes into aspects like sanitation and staffing. While the number of
beds increases, the care providers do not. The backbone of any health system is
not the doctors but the nursing staff and technicians”.
Dr. Jyotsna suggested that all Community Health Centres
(CHCs) in the country should be upgraded. She said that every small scale
hospital, nursing home and clinic should have a basic level of facilities.
“There are instances of a cesarean being undertaken without an Ambu bag and resuscitation
kit for emergency. Accountability mechanism in the event of negligence or
procedural lapses has to go up”.
Dr. Lavanya also points out that the number of government
funded institutions has not kept pace with the rising population. “The backbone
of our health infrastructure dates to the colonial period and the immediate
post-independence period. There is only one government children's hospital per
state while ideally there should be one or more per district”, she said.
Education
Dr Tarjani Vivek Dave, Consultant, Oculoplasty, Ocular
Oncology, Orbit, Facial Aesthetics, L V Prasad Eye Institute adds that access
to healthcare in India is severely limited by inadequate infrastructure.
“Inadequacy is not only in terms of equipment but also manpower”, she said.
Dr. Jyotsna felt that the budget should focus on specific
allocation for continuous updating of skills and knowledge not just for doctors
but nurses and paramedical workers too. “We need more well trained nurses and
paramedical staff. Improving medical education for all categories of medical
staff will probably help the country a generation later, but it must be
undertaken now!” Dr. Tarjani further emphasized the need for improvement in the
quality of medical care that's provided. “Continuous medical education and
certification of doctors is definitely the need of the hour”, she added.
Dr. Nitasha Bagga, Paediatrician and Neonatologist, Rainbow Children’s
Hospitals said, “Medical teaching is the most important aspect to nurturing a
good healthcare system. If the government is serious about improving healthcare
in India, it must strengthen the government hospitals and the medical colleges,
in terms of equipment, trained doctors and retaining trained doctors and staff”.
Dr. Jyotsna added that manpower was needed not just for
providing healthcare services, but for analytics, administration and increasing
the reach of services! Budget allocations should keep all these in mind. To
attract good talent, the hospitals need to pay at par with the market rates.
Urban Rural Divide
Dr Lavanya said, “Most health professionals are in the urban
centres. They shun rural areas because of the poor pay and hardships. Doctors
must be incentivized to serve in remote areas. Government doctors’ pay has not
increased proportionally compared to inflation”.
Dr. Jyotsna adds that by the time Doctors finish their
post-graduation, they have a family. Accepting a rural posting, where access to
good schools and basic facilities may not be available, is a difficult
proposition. The only way out is for the rural areas to be well connected and
sanitary conditions to improve. And maybe fixed period contract jobs where
doctors have to show up actually and not just sign attendance once a week. That
way doctors wouldn't mind a temporary stint for a few months in rotation.
In Australia and USA doctors posted in rural areas get paid
a lot more than their urban colleagues. The Christian mission hospitals pay for
the children's education at some of the best boarding schools.
Dr. Nitasha said that if government hospitals or health
centers, especially in the rural areas, have ambulances with transport
ventilators, it will be very useful for the rural population. The sick people
can be taken to the nearest well equipped hospital with minimum casualty.
Dr. Saumya Dikshit, Radiologist, Tesla Diagnostics, said
that awareness about healthcare is the key to improving healthcare in India,
especially in rural and suburban areas.
Rising costs
Rising healthcare costs is a big challenge for the patients.
Dr. Saumya said, “a significant cost is the cost of medical equipment and
implants which ultimately get transferred to the patients. Most of the medical
equipment and implants are manufactured abroad. There should be a huge
incentive, either in terms of taxes, subsidies or grants to promote “Make in
India” of medical devices”.
She adds that generic medicines are highly underrated at
times and doctors sometime prescribe expensive imported medicines. Even though
in the previous budget, it was announced that the government would open
pharmacies to enable the public to access cheaper drugs, the effect has been
negligible.
Even though the Indian pharma industry is a large player in
the generics business, they still need to step up the value chain and endeavor
to be a significant player in drugs discovery. The budget should encourage the
pharma companies to increase their efforts towards research activities.
Dr. Nitasha points out that while there are many state and
centre sponsored health insurance schemes, there are still many poor people who
are either not covered or are not aware of the schemes. As a result, they are
devoid of the treatment. Each and every Indian should have an equal right to be
treated irrespective of their social and economic standing. Till the gap between
the private and government sector remains as wide as it is now, in terms of
quality of treatment, health cannot be universal. A universal health cover must
be worked out by the government sooner rather than later!
Concluding remarks
All the five doctors that the author spoke to also concluded
that in the end every penny that goes into laying roads, highways, sanitation,
clean drinking water and food subsidies, contribute to improving healthcare in
some way or the other.
Sufficient allocation of funds and its effective utilization;
impetus to education and ‘effective’ training; investments in quality
assurance; building infrastructure; containing rising costs and bridging the
urban rural divide should be foundations on which Mr. Jaitley should base the health
budget for a healthy India!
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