Health in India is in the Intensive Care Unit. Not because of the quality of care or qualification of professionals but ecosystem factors which keep the system ill.
Corruption in healthcare in India is rampant, both in the public and private sector. Needless procurement, unnecessary tests, over prescription of medicines, blatant favours to vendors, cash for service, kick-backs to other doctors,
recruitment scandals, each one small or big is keeping the system on the ventilator. If there is one thing which should be fixed first, it is making corruption disappear in health. Greater transparency will direct the investments already in place in the right direction and bring the right service to the right patient.
Overinvestment in new infrastructure, underinvested in service delivery monitoring and accountability
Billions of dollars are wasted every year by the government into building new hospitals, facilities, ordering equipment and other capital expenditure. We need to first make sure what we invested in, is really working before investing again. I have written about this earlier here.
Lack of Nurse Practitioners who can provide primary and preventive care
India will never have enough doctors to meet the international guidelines. On the other hand, most primary care doesn’t need specialized medical degrees, particularly for NCDs. Our lack of Nurse practitioners who can practice and prescribe for most common illnesses is really unfortunate. We are using high cost resources like doctors to provide basic services and underutilizing a large army of trained nursing personnel
Ignoring nutrition at our own peril
We have focused all our efforts in the past on medical care and ignored food and nutrition. Particularly micronutrients in the food. Most of us are deficient in minerals and vitamins, because of our dietary habits and the type of staples, vegetables and fruits we have access too. A concerted effort to focus on locally grown, nutrient rich foods, particularly in the school age population is the single biggest investment we can make for the future. Read more about Ashoka’s efforts on Nourishing Schoolshere.
Overmedication, Overspecialisation and Overreliance on diagnostics
A longer term solution to get out of the ICU and keep out of it is to focus on primary care. But we are focused on going the other way – over specialisation. Instead of clinical tools, we have become over dependent on diagnostic tools, which is also linked to the corruption issue above. And most disturbingly, the rampant use of antibiotics and other medications without considering side effects and long term impact. Clearly, our priorities are misdirected, as primary care doesnt provide enough incentives for doctors and hospitals. However, unless we build our capacity in primary care, the system will continue to be in the ICU.
So if we are serious about taking healthcare out of the ICU, we have to create the environment of transparency by cutting out corruption, build immunity by focus on nutrition, keep people from getting back into ICU by focusing on primary care and leverage our monies better by focusing on service delivery rather than infrastructure. And get Nurse Practitioners to the forefront, if we want to do all of this on a war footing.