State of Indian Healthcare Accessibility: An Overview for Project XCoV19
Healthcare accessibility in India is a complex issue with many factors contributing to the problem. One of the most significant challenges is the lack of adequate infrastructure. India has a population of over 1.3 billion people, but only a fraction of those people have access to quality healthcare.
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This article is the first of a series of articles where we will compile analytical reports to provide an overview of healthcare accessibility in India. The report utilises the available Indian government healthcare data to examine various aspects related to healthcare accessibility, including availability, affordability, and quality of healthcare services across different regions of the country. The findings indicate several challenges that need to be addressed to improve healthcare accessibility in India. If you want to get the final list of data sources and references for the analytics, it will be available in the last article of this series.
Healthcare Challenges
To set the context, a lack of hospitals and clinics to meet the needs of the population and poorly equipped and staffed of the existing facilities is the driver for under-met needs of such a massive population.
Another major challenge is the high cost of healthcare. In India, the out-of-pocket expenditure on healthcare is among the highest in the world. This means that many people are unable to afford the care they need, even if they have access to it. The high cost of healthcare is due to a number of factors, including the high cost of drugs and medical equipment, as well as the low salaries of doctors and other healthcare professionals.
What are the negative consequences of this?
A high rate of preventable deaths partly due to human error or lack of proper attention due to substandard diagnostic protocols.
Highest maternal and high infant mortality rates.
A high rate of non-communicable diseases, such as heart disease, stroke, and diabetes, preventable with early diagnosis and treatment.
Lost productivity and economic growth.
A general decrease in the quality of life for many people.
We did a small survey to collect patient experiences in general to understand what they think of the entire patient care journey from finding care providers to post consultation. The survey was randomized trial run globally and specific ad runs for the survey were targeted towards Sri Lanka, Nepal, Bangladesh and India. Here are the results.
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And here are the results as of this writing.
Key observations and questions with my remarks.
As of this writing, the young population sample can sometime travel much farther upto 80 minutes to seek care than the aged segment, who prefer to stay with the 10-15 mins range of travel time for seeking care.
It is not clear what is the socio-economic strata so this is not a general conclusion. An entire segment of people from remote villages can travel 50 kilometres if they have reference to a doctor from acquaintances.
There is no doubt that getting an appointment or reference and waiting for consultation after getting an appointment seems the most common complaints. What are the reasons for this? High influx of patients, triage issues or poorly managed scheduling conflicts ? Or just logistical issue?
When people travel to far off places to seek care or wait in line, is it in time or too late?
There are a number of things that can be done to improve healthcare accessibility in India. One of the most important is to increase the number of hospitals and clinics. In addition, the quality of existing facilities needs to be improved.
It is important to educate the public about the importance of preventive care. Many people in India are not aware of the risks of certain diseases, or they do not know how to prevent them. By educating the public about the importance of preventive care, the government can help to reduce the number of preventable deaths and illnesses.
The Power of Largest ever Survey: National Family Health Survey 2019, India
Let us not stop here and look at what the data from the government shows. This data comes from the 5th National Family Health Survey. A followup article will cover the data points from the 6th published survey to understand what has changed over the last 5 years.
The results of the survey show some surprising demographic transitions, such as women outnumbering men, and some expected ones, such as fertility rates declining. They also highlight the health challenges that remain, such as moving towards addressing nutrition deficiency apart from just food adequacy. And they offer a more sobering picture of the impact of government’s schemes on access to basic amenities such as clean cooking fuel and improved sanitation.
-- Source: Big Picture: Comprehensive Discussion on NFHS - 5
How are the Indian women faring across states?
Postnatal care
As stated in the interview, due to covid pandemic and other healthcare blockers, the maternal facilities may have been delayed but not denied to mothers.
Women with High Blood Sugar Across States
Women who have ever screened for cervical cancer
Women who have ever screened for breast cancer
What were conclusive observations from survey?
Economically well to do states have had higher screenings for women. Does Higher state GDP relate to improved testing or improved health awareness due to education? Is there a correlation?
The educated south viz. Kerela, Tamil Nadu, Puducherry rank higher in number of women with high blood sugar, over 20% in a state, as well. Is it that they have persisted or is this ailment rampant across all states but not enough testing is done? Or is there not enough general awareness to get patient profiles amongst the common masses in North India?
Anaemia in women is on the rise.
Rise in C-sections.
Malnutrition persists.
Age of marriage not improving.
Increase in non-communicable diseases such as diabetes, strokes, obesity.
Schemes like Ayushman Bharat are helping but local institutional intervention is necessary. Everything cannot be centralised.
More robust health financing system is needed.
The government has already taken some steps to improve healthcare accessibility in India.
In 2005, the government launched the National Rural Health Mission (NRHM), which aimed to improve healthcare in rural areas. The NRHM has been successful in increasing the number of hospitals and clinics in rural areas, and in improving the quality of care. However, the NRHM has not been able to address the issue of the high cost of healthcare.
In 2014, the government launched the Pradhan Mantri Jan Arogya Yojana (PMJAY), which is a national health insurance scheme. The PMJAY aims to provide health insurance to over 100 million poor families. The PMJAY is a step in the right direction, but it is not enough to address the issue of the high cost of healthcare.
Although the government has shown alot of effort and progress in order to tackle issues in Indian healthcare system, as aforementioned in a vast country like India with varied demographics, it is the local intervention mechanisms that can scale which can take the local healthcare challenges head-on. Taking cue from the global state of healthcare as discussed in my prior article, robust healthcare accessibility solutions are propping in the Indian health-tech space to deal with these challenges.
In the next article in this series of State of Indian Healthcare, we will recap and look at the currently presented survey data further and the followup on what Indian healthcare policy makers, Bharat Healthstack and Indian health-tech startups are cooking up in healthcare accessibility space.
Stay tuned for an even more exciting analysis, interviews and updates in this series.