Safety and Quality of Health

Care System in India

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Introduction

▪ Patient safety and affordable healthcare have emerged as major

concerns all over the world and more so among the developing nations
like India.
▪ India has about 9.5 million deaths a year . Cardiovascular diseases
account for nearly 27 per cent of the deaths.
▪ Infectious and parasitic diseases account for nearly 20 per cent.
Respiratory infection (pneumonia) with 11 per cent, respiratory
diseases (COPD, Asthma) with nine per cent, and cancer with eight per
cent is some of the other causes of deaths.
▪ India has more than 60 million people with diabetes and nearly 15 per
cent population has raised fasting blood sugar.
Introduction Continue

▪ Since independence, healthcare in India has been challenged by the

issues of affordability and accessibility to quality healthcare.
▪ Complying with quality and patient safety across the nation is going
to be daunting task, more so when we do not have any uniform
regulatory framework in the country.
▪ Today, Indian healthcare system stands at a cross-road. In the last
one decade, even though Indian healthcare has taken leaps in terms
of becoming a medical tourism destination, the delivery system both
public and private, continues to remain elusive to the section of
society with high healthcare needs.
Indian Healthcare Industry

▪ Healthcare has become one of India’s largest sectors - both in terms

of revenue and employment.
▪ Healthcare comprises hospitals, medical devices, clinical trials,
outsourcing, telemedicine, medical tourism, health insurance and
medical equipment.
▪ The Indian healthcare sector is growing at a brisk pace due to its
strengthening coverage, services and increasing expenditure by
public as well private players.
Indian Healthcare Industry

▪ Indian healthcare delivery system is categorised into two major

components - public and private.
▪ The Government, i.e. public healthcare system comprises limited
secondary and tertiary care institutions in key cities and focuses on
providing basic healthcare facilities in the form of primary healthcare
centres (PHCs) in rural areas.
▪ The private sector provides majority of secondary, tertiary and
quaternary care institutions with a major concentration in metros,
tier I and tier II cities.
Indian Healthcare Industry

▪ The Indian healthcare sector is expected to record a three-fold rise, growing at a

CAGR of 22% between 2016–2022 to reach US$ 372 billion in 2022 from US$ 110
billion in 2016.
▪ By FY22, Indian healthcare infrastructure is expected to reach US$ 349.1 billion.
▪ In July 2021, India made its Covid-19 vaccination platform, CoWIN, open source
for all countries. Almost 76 countries have displayed interest in leveraging the
CoWIN platform to manage their national COVID-19 vaccination drives.
▪ The hospital industry in India is forecast to increase to Rs. 8.6 trillion (US$
132.84 billion) by FY22 from Rs. 4 trillion (US$ 61.79 billion) in FY17 at a CAGR of
16–17%.
▪ The Government of India is planning to increase public health spending to 2.5%
of the country's GDP by 2025.
Types of Health Care Services

▪ Hospitals ▪ Telemedicine
▪ Pathology Clinics ▪ Naturopathy
▪ Blood Banks ▪ Yoga Centres
▪ Meditation Centres ▪ Fitness Centres
▪ Emergency services ▪ Laughter Clubs
▪ Online Medical Services ▪ Health Spas
Classification of Hospitals
Challenges of Quality Healthcare Delivery

Healthcare delivery in India is classified under three categories – primary,

secondary and tertiary care. All three levels need to work in a cohesive
manner to help delivery of quality healthcare on all the four pillars
▪ Limited services and infrastructure: Lack of robust infrastructure
coupled with limited healthcare services provided at primary
level has forced patients to seek substandard consultation and
treatment for early stage illness, which has resulted in
misdiagnosis and inappropriate treatment.
▪ Human resource challenge: Staffing is another major area of
concern as a significant amount of the healthcare workforce prefers
to work in urban areas due to higher pay and other facilities.
Challenges of Quality Healthcare Delivery

▪ Non availability of skilled workforce: Lack of specialists at primary

and secondary level especially in public hospitals force patients to
go for expensive private healthcare.
▪ Growing concerns around quality of care: Quality of healthcare
services is another growing concern that needs to be addressed.
Currently, there is need for regular measurement of the quality of
care in public hospitals.
▪ Rising cost to patient: With the cost of tertiary care increasing
rapidly, it is becoming a challenge for the poor section of the
society to access quality care.
Patient safety and Quality Healthcare Delivery

Patient safety is a growing concern in Indian healthcare system. According to

Institute of Health Management Research, India accounts for 40 per cent of unsafe
patient practices 6 . There are only 22 Joint Commission International (JCI)
accredited healthcare facilities in India 7 , reflecting the gap in following high
quality standards across hospitals in India.
Patient safety practices:
▪ Adopting quality culture and patient safety practices could bring
down the medication errors, hospital related infections and help
prevent wrong diagnosis.
▪ Adhering to basic patient care measures such as hand hygiene can
improve the quality of healthcare services in India.
Patient safety and Quality Healthcare Delivery

Quality accreditations
▪ Private hospitals are taking various initiatives to improve and
maintain existing quality standards by adopting internal
governance, structuring teams and processes, carrying internal
audits and creating separate governance for clinical quality.
▪ The introduction of NABH standards has provided a quality
framework of global standards. So far, around 300 facilities 8 have
adopted NABH standards and there are still a large number of
hospitals that needs to be encouraged to adopt these standards.
▪ Government setups also need to be encouraged to adopt quality
audits or accreditations to attract patients. .
Healthcare Quality and Safety in India - NABH

▪ National Accreditation Board for Hospitals & Healthcare Providers

(NABH) is a constituent board of Quality Council of India (QCI), set
up to establish and operate accreditation programme for
healthcare organizations.
▪ The board while being supported by all stakeholders including
industry, consumers, government, have full functional autonomy in
its operation.
▪ A public recognition of the achievement of accreditation standards
by a healthcare organization, demonstrated through an
independent external peer assessment of that organization's level
of performance in relation to the standards.
Finding of Study

▪ Shortage of healthcare delivery infrastructure at almost all levels

▪ Regulatory hurdles and lack of fiscal and tax incentives to establish
centres
▪ High cost of infrastructure can lead to high delivery cost in private
▪ Lack of PPP models at almost all levels
▪ Lack of proper implementation of quality standards
▪ No incentives to maintain quality in both public or private setups
▪ Insufficient doctor, nurse and medical support staffing especially at
primary level
Finding of Study Continue

▪ Lack of use of technology tools at almost all levels to deliver and

monitor healthcare delivery to increase access and acceptability of
healthcare
▪ Limited medical services at primary level
▪ Interrupted supply of free drugs and diagnostic services in public
hospitals
▪ Absence of national health insurance policy for all to attempt
decreasing OPP expenditure, Government policies announced so
far have not reached full potential due to poor implementation
Suggestions

▪ Need to increase focus on addition of more new infrastructure and

beds
▪ Steps to ease the regulatory regime and tax incentives for private
need to be laid out clearly
▪ Need for clear policy envisioning PPP models at primary and
secondary level
▪ Plans and procedures to maintain safety and quality in healthcare
facilities need to be revealed in a detailed manner
▪ Concrete steps need to be identified for improvement in availability
of doctors/nurses/para-medics at PHC
Conclusion

▪ Despite differences in how healthcare is organized, financed, and resourced, our

cross sectional data suggested that both types of hospitals studied face problems
of hospital quality, safety, and medical staff burnout and dissatisfaction.
▪ Medical staffing and the quality of the hospital work environment (managerial
support for care, good doctor-nurse relations, nurse participation in decision
making, and organisational priorities on care quality) were significantly associated
with patient satisfaction, quality and safety of care, and nurse workforce outcomes.
▪ With growing population and healthcare cost, India is facing a challenge of
affordability and accessibility to provide quality healthcare services for masses.
Allocating higher budget to national healthcare expenditure can help in solving
many issues related to infrastructure building and strengthening the existing ones.
To match the healthcare spending of other nation, India needs to develop a long
term vision for healthcare sector and NHP 2015 is a right step in that direction
Thank You !!