Fixing Rural Healthcare In India

The Indian healthcare market is close to about USD 50 billion today and is expected to grow to USD 70 billion in another two years time.  Changing demographics, rising income levels (& consequently shifts from chronic to lifestyle diseases) and medical tourism is driving the boom in this industry. There also has been a huge increase in insurance companies issuing medical insurance policies (it is still estimated that 75% of the healthcare costs in India are borne by the consumer directly).

There is still a huge shortage of adequate healthcare in rural India and India definitely needs a lot of investment in this sector. The number of beds per 1000 population is at a 0.7 against a global average of almost 4. There is a serious shortage of staff and doctors and a good number of them of them go abroad every year. Government infrastructure is defunct in most areas. Often, there are no doctors, staff or even medicines available, the infrastructure is inadequate and the hospitals/health-centers are poorly located resulting in a lot of patient travel.  Private hospitals that provide better healthcare are either too expensive or much too far away for the typical villager.

But will having enough doctors and adequate infrastructure solve the problem completely? Well, for one, we know for sure that we need have this is in place at a minimum. However, there are other real issues here. Firstly, there needs to be a lot of private participation in the healthcare sector. Government by itself cannot solve the problem as the scale of the problem is massive and the government doesn’t seem to get the incentive structure of the staff and doctors right. Secondly, the private hospitals will need to charge at rates that are affordable & yet not make losses and so they will have to get their pricing right. When some markets may not be viable to the private sector at all, public private partnerships may make more sense. Thirdly and more importantly, the staff will have to be such that they feel a sense of ownership in being associated with the healthcare center and therefore more local people will have to be trained and deployed accordingly.  There is little point in forcing a doctor/staff to travel 4 hours to and fro to work at a rural center every day.  It is simply un-sustainable.  You also don’t need high skilled doctors to serve at a rural center that will cater to mostly primary healthcare. For this one can have medical school undergraduates (tie-up with city colleges for an assured steam of junior doctors). And as far as the staff is concerned, employ, train and deploy locally.

Uttarakhand has devised a system that seems to be working well. They have trained the local women and assigned them to villages in their districts. These women bond well with other women in the village and serve as the first point of contact in the healthcare system. They arrange for local transport in case of emergencies and ferry patients across to the health centers. They also act as enforcers and in case of errant hospital staff, have the authority to directly complain to higher developmental authorities.  Maternity mortality rates especially have gone down rather sharply as a consequence over the last few years.