Saturday, 25 June 2022

How the world's largest Democracy stack up against international standards of WHO

11 December 2019 | Views | By Manish Chhabra

Healthcare around the world is thriving in countries like Malaysia, France, Sweden, Finland, Norway, Germany, Switzerland, especially in the public health sector

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A woman in Choudwar [Choudwar is a city and a municipality in Cuttack district in the state of Odisha, India population 42,000], was refused to take custody of her newborn baby girl because she couldn’t pay her medical bills. She was discharged but without her baby! All because she was poor and couldn’t afford the delivery of her baby. Then, in a hospital in Gorakhpur [Gorakhpur is a city along the banks of the Rapti river in the north-eastern part of the Purvanchal region of the Indian state of Uttar Pradesh, population 673,000], 70 children died due to negligence and corruption. The tragedy was due to less supply of oxygen, which the hospital blamed on unpaid payments that were to be made by the state government. This is the state of our healthcare systems in India! And, these are just a few among the millions of cases. 

Unfortunately, India, which is the seventh-largest country and the second most populated country, ranks 145th among 195 countries in healthcare in terms of access and quality by the Global Burden of Disease study. 

According to the Multidimensional Poverty Index (MPI) 2019, released by the United Nations Development Programme (UNDP), India has the second-highest stunting rate after Pakistan. Out of 100 children born in India, only 43 survive under the age of five. Adding Malaria, Tuberculosis and other diseases to the mix, India is one of the sickest countries! Out of every 1000 people living in India, 18.8 are in peril to it. For every 1457 people in India, there is only one doctor available making it a 1:1457 ratio which does not align with the 1:1000 doctor to patient ratio of WHO. This assumption is made keeping in mind that 80 percent of the doctors will be available. 

India has a population of 1.35 billion as of 2018 and the GDP estimated to be $2.972 trillion in 2019. We are nowhere behind in numbers but somehow in healthcare, we are just not matching the required demand and supply. Why? The answer lies within our system- the lack of education and required skill sets, the infrastructure of hospitals, availability of healthcare professionals as well as the responsiveness of stakeholders. 

In rural parts of the country, people are still hesitant to use modern care due to less awareness because of the trust factor. Also, the rising costs and rate of unemployment adds to the healthcare burden on the economy, whether it’s to do with an ailing person in a rural or an urban city. The fact is that a well-reputed doctor takes a minimum sum of INR 700 to INR 1,000 for just one consultation! 

Besides, doctors refuse to admit patients in private hospitals that are very ill to avoid backlash in case of worsening conditions. Hospital corporatisation has resulted in an increase in unethical practices such as unnecessary investigations, specialist opinions (sometimes when unnecessary), prolonging patient stay in hospital et al, which has made people wary of medical practitioners. 

Whereas in countries such as the United Kingdom and the United States, doctors are subject to strict standards and can legally be sued for even the smallest transgression and negligence. Patients residing in India have lost the trust in doctors as they are hardly ever punished for negligence.

The lack of doctors and access to proper healthcare is what makes India backward in terms of healthcare. People don’t have access to prescribed medicines at the right time and even if they do, it comes heavy on their pockets; amazingly, the doctors prescribe the most expensive pharmacy brands carrying the same salts as any affordable one. India spends a total of 3.9% of GDP on health (including public and private spending), which is the second-lowest in the middle-income group relative to other Asian countries. Whereas Myanmar is spending 4.9% of GDP, Nepal is spending 6.9% and Pakistan is spending 2.7%. So the country’s healthcare stakeholders need to give serious thoughts here. 


What can we expect in the future - The system becoming better and worse?

Healthcare around the world is thriving in countries like Malaysia, France, Sweden, Finland, Norway, Germany, Switzerland, especially in the public health sector. France has been ranked number one in terms of healthcare by WHO because it is accessible to all and is very affordable. The prescription medicines are heavily subsidized by the government plus people diagnosed with critical and long term illnesses such as cancer, heart disease, etc. have free access to healthcare and medicines! Malaysia has 13 Joint Commission International approved hospitals, which is considered the gold standard of assessment in healthcare. Healthcare is extremely affordable in Malaysia and the cherry on top is that there is no requirement of appointment to see a specialist or a referral by a general practitioner.

Countries like Ecuador in North America are rising in the quality of healthcare index because of their easy and affordable healthcare. The cost of healthcare there is almost 80 percent of the cost of healthcare in the US! 

We can definitely expect a similar healthcare ecosystem in India, especially if we could leverage technology to its optimum potential. Healthcare apps can do wonders, here. 

Many are already showcasing results worldwide. For instance, 3D Human Anatomy Atlas (Visible Body) App offers physicians and healthcare professionals, a comprehensive 3 D, gross anatomy, of the human body, with a 3D model of MRI scans and movement of the bones and joints. Apps like CarePassport act as platforms to compile data from different healthcare providers. CarePassport stores data on one common platform including lab results, dental records, clinical reports, medical images, health forms, surgical recommendations, surgical reports, etc and helps you keep track of all these under one roof. 

The launch of Indian Digital Health Policy is surely going to contribute to making the healthcare of India better by providing a healthcare ecosystem. And here, the mobile healthcare industry will prove to be a boon. Amazingly, the industry is expected to be 86.6 billion over the world by 2020 with an anticipated growth of 20.8 percent!

The need of the hour in India in terms of healthcare is for applications that perform all the basic healthcare functions and go the extra mile to reduce the gap between rural rungs of the country and urban cities. In the coming time, patients from rural areas should be able to access city doctors through medical apps and their video calling feature, for better and preventive care.

The idea behind any responsible healthcare app in the near future should be to provide the best medical care possible to people with the ease of sitting at home. They must break-down geographical barriers and language too. They must offer accountability and reduce the chances of malpractices with patients. Patients should be able to review doctors online to make it easier for other patients to choose the best doctor. The apps should have a record-keeping feature that records all the interactions, diagnosis, medical reports, appointments, and consultations. And with all this, we would see a sea-change in the healthcare system and coordination, which would prove to be a great benefit to the economy as well!   


Manish Chhabra, CEO and Founder, Shifa Care


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