Name: Chiranjib Sahoo Roll No: UR18066

Class: MBA (RM) Section: B

Assignment Type: Class Assignment-6

Healthcare issues in Rural India

1. Issue:

India has only 10 lakh physicians registered to serve 1,3 billion people. According to the
MCI allegations, half of the country's physicians are quacks (unregistered allopathy
physicians). Although metropolitan regions have 58% of skilled physicians, the amount in
rural regions is as small as 18.8%.
India is still spending about 1.2% of its GDP on the health industry far less than some of
the world's poorest nations. Only a few nations such as Myanmar, Pakistan, Sudan and
Cambodia are ahead of us.
The accessibility to public health services, however, is abysmal. There is only one state
allopathic doctor per 10,189 persons, only one government hospital bed per 2046 persons,
and one state hospital per 90,343 persons. Of the country's 1 million physicians, only 10
percent (according to the National Health Profile) operate in the public health sector.
38.2 percent of the population of India was below poverty in 2014. For their diagnosis,
these individuals rely on government hospitals. Many times they go to hospitals with one
disease and come back infected with some other illness due to improper sanitation and
inadequate quality of care provided by the staff.
The issue at the rural level is that sub-centers run by an auxiliary nurse midwife team, a
male multi-skilled health worker and health care assistants are short of employees, while
main health centers do not have enough physicians.
According to Rural Health Statistics, 2017, of the 156,231 sub-centers in India, 78,569
were without male health employees, 6,371 without auxiliary nurse midwives and 4,263
without either.
PHCs involve 25,650 physicians across India to tend to outpatient care as per Indian
Public Health Standards (IPHS) for at least 40 patients per doctor per day. If these
requirements are met, it could benefit 1 million patients every day. But there are 1,974
PHCs without physicians with a shortage of 3,027 physicians. This implies that every
day, 12 percent of patients, or 121,080, go without access to primary health care.
Healthcare in the villages of India is a three-tiered structure under the National Rural
Health Mission (NRHM)—sub-centers, primary health centers, and community health
centers.
Strengthening both PHCs and sub-centers will relieve the strain on secondary (district
hospitals and community health centers block) and tertiary health organizations (specialist
and super-specialist facilities in hospitals-cum-medical schools). Failure to find enough
doctors will also undermine universal health coverage as envisaged in the 2002 and 2017
consecutive national health policies.

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 Source: Rural Health Statistics 2017
Health professional distribution skewed in favor of towns:
In India, 70% of the population lives in villages and 30% in metropolitan regions. But health
workers ' allocation leaves rural India with little access to health care—60% of the country's
2-million-strong health workforce provides urban India with only the remaining 40% of
service villages, as reported by a World Health Organization (WHO) 2016 report.
2. Involvement of the State regarding the issue:

The government must be serious about pricing the healthcare services. In most countries
today, central government health systems do not have an ideal scheme of pricing that should
effectively be based on open tendering. Maybe fixing the price in the form of a package of
services with similar processes will be helpful In the UK and Thailand, 80% of the services
supplied are supplied by government hospitals with set wages for physicians and employees.
In Japan, in consultation with personnel owners, private physicians deliver services based on
set rates by the Ministry of Health. By imposing strict penalties, the government guarantees
that there should be no overbilling.
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We need some businesses that can bring together on one platform various healthcare
elements such as physicians, hospitals, clinics, diagnostic centres and provide home services.
Home care services are provided by startups such as PORTEA. It claims "It offers 30-40
percent fewer chemotherapy fees than the hospital fees. The price of the drug as well as
admission and nursing fees in an average private hospital is nearly Rs 25000 compared to Rs
16000 if the therapy is provided at home. Home care also reduces the risk of secondary
infection.
If the state stops looking at the bad patient as a source of income or some burden on
taxpayers ' cash, healthcare costs will fall. If a person pays Rs 1000 for healthcare facilities
then about Rs 250 goes as different taxes to the state. Hospital income tax exemption as an
incentive will not decrease the patient's healthcare costs, but will benefit the promoter.
Under Ayushman Bharat Yojana, the domestic health system introduced on September 23,
2018, the chronic shortage of skilled medical practitioners in rural India may influence the
relaunch of 150,000 health sub-centers and primary health centers (PHCs) as "health and
wellness centers.
A lesser-known portion of the health insurance program, also known as Modicare, includes
health and wellness centers that will play a critical role in managing India's increasing burden
of non-communicable diseases. They will also provide services for maternal and child health.
A significant challenge that Ayushman Bharat still faces is the retention of physicians in rural
regions. To address this issue, during postgraduate medical research, policy frameworks in
several states required mandatory rural service of 1-5 years. In addition, after postgraduate
studies, some states require medical officers to practice medicine in rural fields for a specific
period.
Suggestions:
 The healthcare spending should be increased to 2.5% of the GDP: According to the
Organization for Economic Cooperation and Development, the Indian government
currently spends about 1 percent of its gross domestic product on health care. Mr.
Reddy wants it to invest 2.5% of GDP by 2017.
 Paying with taxes rather than user fees: To pay for this scheme, the state should use
current tax revenues. As the tax base widened, the government could also consider
levying a particular income tax to promote the national healthcare program, in which
case user fees on individuals above certain revenue would be twice as much as
charged.
 More spending on primary care: Additional funds should not go solely to preserve the
current health system, with its skewed choice of expenditure. Like in education,
Indian health expenditure has often favoured therapy in hospitals in big towns over
fundamental and preventive care more commonly accessible. The medical skills of the
attending doctors and the sophistication of the equipment required to provide it
distinguish primary care from other levels of care. For instance, pre-natal check-ups
and periodic deliveries would be primary care, while secondary care would be a
caesarean delivery.

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  All India public health service: More medical and nursing schools will need to be set
up and millions of more fundamental health employees will be needed, especially in
villages, to create a domestic health system that operates.
 The drugs should be bought in bulk: Tamil Nadu, who buys drugs in bulk and offers
many free medicines to patients, could be taken up by the Indian government. This
would mean a significant increase in public expenditure on drugs.

3. Future Implications:

Improving the rural healthcare system will definitely not have negative implications on the
society. Moreover, the increase in expenditure to invest in healthcare systems can create a
wave of dissatisfaction among the middle class section. Because it will decrease the
contribution in other funding. Rural population also remains unaware of these facts which are
taken at the union level. Hence, they are unaware of these policies that will be undertaken by
the government. The government should create enough events and campaigns to give proper
knowledge about the policies that will be enacted. Moreover, the middle-class section do not
care about the lower section of the country if they are getting proper access to healthcare
services. They are more concerned about their own expenditures which will increase if due to
taxes.

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