impact-of-covid-on-rural-healthcare-system

Context: The consecutive waves of Covid-19 and Mucormycosis have left the country shattered. During the second wave of the pandemic, the rural people are struggling the most.

Background:

  • The health care facilities in rural areas have to provide regular and comprehensive health-care needs as guided by the WHO’s  principle of Universal Health Coverage.
  • The rural people should have access to needed health services of sufficient quality to be effective while also ensuring that these services do not expose their financial hardship.
  • The pandemic has exposed the inadequate and poor health infrastructure in the rural areas.
  • India has 1 PHC for 25 villages. But in this fast changing health scenario, India should have 1 expanded PHC for every 10 villages with the provision of some beds and other minimum necessary facilities.
  • India has 5624 CHCs against the requirement of 7322 and there is 81.8% shortfall of specialists at CHCs.
  • As per Human Development Report 2020, India has 8 hospital beds for 10000 population whereas China has 40 beds for the same number of people.
  • It is utmost important that governments everywhere engage with all kinds of rural community organisations such as Panchayats, Gram Sabha, Notified Area Committees, municipal bodies and NGOs to minimise the effects of the pandemic.
  • The diseases must be treated at the primary level in its first stage to create a healthy India. It will also reduce burden at the secondary and tertiary care.
  • It will help to save a lot of money and the resources being spent.
  • There should have been healthcare data of the people in their respective areas which will enable them to identify those who are going to slip to secondary or tertiary care.
  • Regular health camps will help to identify those on verge of developing TB, hypertension, diabetes etc.
  • All stakeholders must revisit and refurbish health infrastructure in rural areas and build them in a better manner as 65% of our population resides in rural areas.

Challenges in rural healthcare system:

  • Weak Governance and Accountability: Over the past 5 years, the government has introduced several new laws to strengthen the governance of the health system, but many of these laws have not been widely implemented, “said Lancet. In some instances,” (some ) Is still the scope of the rules. It is unclear, and there are apprehensions that these laws have hindered public health testing led by non-commercial entities. “
  • Insufficient Funding: In 2019, the total net government spending on healthcare was $36 million or 1.23% of its GDP, far less than some of the poorest countries of the world. We are ahead of only a few countries like Myanmar, Pakistan, Sudan and Cambodia.
  • Public health expenditure remains very low in India. Even though real state expenditure on health has increased by 7% annually in recent years, central government expenditure has plateaued. Economically weaker states are particularly susceptible to low public health investments. The 14th finance commission recommendations, which will transfer a greater share of central taxes to states, offers an opportunity for the latter to increase investments in health.
  • Cost of Healthcare: It is common knowledge that the private sector is a major player in the health sector in India. Private hospital charges are so high that more than 40% of all hospitalized patients have to borrow money or sell their assets, and about 25% of the farmers are pushed below the poverty line because They make healthcare expenses out of pocket.
  • Rural-Urban Disparity: Access to healthcare is very high between rural and urban India. While urban residents have a choice between public or private providers, rural residents face very few options. India has a large public health network with community-level sub-centres. The health sub-centres are primarily run by barefoot health workers and serve as a bridge between the community and primary health centres (PHC).
  • Overlapping Jurisdiction: There is no single authority responsible for public health that is legally empowered to issue guidelines and enforce compliance with health standards.
  • Sub-optimal Public Health System: Due to this, it is challenging to deal with non-communicable diseases, which is about prevention and early detection. It reduces preparedness and effective management for new and emerging threats such as epidemics like Covid-19.
  • Weak Primary Health Care: India has made progress in expanding public services. For example, in 2015, there was one government hospital bed for every 1,833 people, compared to 2,336 individuals a decade earlier. However, as the Lancet points out, it is unevenly distributed. For example, there is one government hospital bed for every 614 people in Goa compared to every 8,789 people in Bihar. The care provided in these facilities is also not up to the mark.
  • Low Penetration of Health Insurance: When the public health system fails, people are forced to turn to private healthcare facilities to avail treatment. Private health facilities work to make a profit. There is a clear demand-supply gap and they use low supply to raise their own prices. 
  • Low-quality control: Remember the lag on the supply side? This healthcare service is a profitable venture for private players. There is no compulsion for a small new entrant to gain recognition. People also neither know about the quality standards nor are they upset about it. They go to whatever is cheaper. And so small, mushrooms everywhere, with very little monitoring from private clinics, hospitals, diagnostic and imaging central government. 

How to improve rural healthcare system:

  • Government Must spend more on Health care: this achieves the following –
  1. With more funding, the government can provide free treatment to the poor through the public health system. In addition to free treatment, the government can provide health insurance to the poor so that they can avail treatment in private hospitals as well.
  2. Higher wages would attract skilled doctors and manpower to stay in India.
  3. Higher spending will enable public hospitals to acquire medicines and supplies, receive uninterrupted water and electricity supply, maintain the premises and keep it clean and safe, maintain equipment and ambulances so that they’re functional and available when required.
  4. More funding on medical and nursing colleges and technical training centres would help increase the existing number of seats or open new colleges in more locations. This would produce more skilled medical manpower to cater to the huge demands of our population.
  • Need Innovation in Health care System: The government will have to innovate to make public healthcare more efficient so that it is as optimal as possible for a given investment. Technology will help automate many processes, thus making health-related tasks less frequent and more accurate than human errors. Technology such as telemedicine can increase the reach of public healthcare, and techniques such as EMR and big data analytics can provide important insights to governments, policymakers, doctors, and all stakeholders to improve public health and combat epidemics and disease outbreaks. Again, Technology and Innovation needs funds.
  • Stringent Regulation: The government will have to tighten its rules regarding healthcare. Strict rules about quality and an efficient monitoring mechanism will ensure that fake doctors and cubs do not operate. And also that the smallest medical facility, say a lab, provides the minimum assured quality of service at affordable prices.
  • Need to strengthen Primary Health care: Attainment of health care as a primary objective is essential. There is a need to create financially viable and sustainable PHCs based on rational principles to meet the goals of providing quality health services on an affordable and equitable basis and to ensure fiscal prudence.
  • Women and girls are able to take care whenever needed: Gender discrimination in India begins when a girl is born. The biological benefit reflected in lower infant mortality among female infants compared to men is offset by social and cultural preferences for male children, and consequently, many more girls die in childhood than boys. This old trend continued in 2018-19 as well.
  • Mobile clinics were sent to nearby rural hospitals to test for heart disease and refer potential customers. They also offer government-supported micro-insurance programs, which provide coverage to three million poor customers for extremely low monthly premiums.

Way Forward:

India has made significant progress in health standards in the post-independence era. Nevertheless, many feel that budgetary resources should be increased for the health sector. International development in information technology needs to be used at the national level in an effort to document health data. Continued efforts to control the country’s population and political will towards the Millennium Development Goals in Health will help India make a significant impact in the international health scene

Source- IE