The Big Question on International Health Day: Universal Health Coverage or Preventive Healthcare?

Yet again, another International Health Day is drawing closer, and we are left confronting some rather uncomfortable questions, “When will we have adequate health coverage for all the citizens of the country? What would it take to make it happen?”

Even after 70 years of independence, Indians still lack sufficient health coverage. The coverage, as anyone would understand, has two aspects: the financial means to access health facilities and the medical and hospital infrastructure itself.

The recently announced National Health Protection Scheme (NHPS), which encompasses allowance of up to Rs 5 lakh on health per family per annum, may solve the problem of financial difficulty in accessing medical and healthcare services for the masses.

The second and equally important aspect of providing healthcare services to the populace is the existence of adequate and robust healthcare infrastructure in the country where there is no paucity of manpower or physical structures to render the services.

If we look at the current availability of doctors and nurses and the actual requirement, the sheer enormity of the task of providing healthcare facilities to the population looks daunting. There is a shortage of about 20 lakh nurses in the country. The current doctor to population ratio is about 1:1674 as compared to 1: 1000 that is recommended by the World Health Organization. And these are just the statistics; they don’t even begin to reflect upon the shortcomings of the healthcare system. It is not a hidden truth that the Indian healthcare system is fraught with large-scale deficiencies, and even if we do have adequate number of doctors, nurses and paramedical staff as per the rulebook, there will still be shortage of the manpower.

Indians right now are suffering from a host of medical problems owing to poverty and as well as lifestyle changes. There is an entire gamut of diseases and ailments that are increasingly becoming epidemics.. More than 10 lakh Indians are diagnosed with cancer yearly and the number is only rising. According to a reputed medical journal, The Lancet, about 6 to 7 lakh people lost their lives in 2012 fighting cancer in our country.

India is infamous for being the world capital for cardiovascular diseases. The Global Burden of Disease reports, that heart disease claimed the lives of 1.7million Indians in 2016. Overall, more than 60 lakh people lost their lives to non-communicable diseases (NCDs) in 2016 in the country.

These numbers clearly indicate the dire need for universal health coverage for all Indians.

Now let’s look at the newly announced NHPS. It is a step in the right direction but there’s a lot of questions to be addressed before it can have any meaningful impact on the health coverage and delivery in the country.

It is not clear yet as to how the government will fund the scheme. The government may have many options and it is still to be seen how well it deploys those options to provide monetary help to needy for secondary and tertiary medical care.

The lack of awareness and knowledge among the masses for availing the financial help is another challenge for the government. Proper educative campaigns need to be rolled out in order to let people know how to avail benefits under the scheme.

Another challenge would be to avoid procedural complexities for the poor and illiterate patient who has as much right to healthcare as anyone else. The government has to ensure that the patients or their family members would get their due under the scheme.

Another important point to consider is what to do with those families that genuinely require more than Rs 5 lakh in a year to avail emergency medical services. All these scenarios have to be looked at and sorted out before we lose more lives and drain the country of the young and healthy workforce, an important resource for making a scientific, military and economic superpower.

While we look at the health coverage as one way to counter the many healthcare challenges that India faces today, it is also important to emphasize on policies and awareness that encourage preventive healthcare. It is better to mend the roof before monsoon arrives; similarly it is better to be on our toes before disease strike.

With changing lifestyles and growing incidence of infectious diseases, diagnostic tools are gaining whole new relevance. From non-communicable diseases to infectious diseases, diagnostics is playing an essential role for treatment and aftercare. Another critical aspect of diagnostics that does not get enough attention is preventive healthcare.

Today we have ample avenues of getting tested early to identify parameters which may be indicative of lurking metabolic disorders and or healthcare conditions. These may range from simple blood cell counts and cervical Pap smears to genetic tests that detect inherited conditions such as metabolic disorders and even heritable cancers. Although an allied support to healthcare services, these are growing faster than healthcare facilities in the country. We are also making gradual inroads in the interiors of India. In fact, early diagnosis of a disease is nearly as good as preventing the disease because there exists a world of difference on what can be done to prevent the disease from spreading further than what can be done at advance stages.

Prevention of non-communicable diseases can be brought about by proper education, regarding proper nutrition, healthy lifestyle changes and recognition of early symptoms by either mass communication methods or health campaigns reaching even the remote areas of the country. In the spectrum of infectious diseases such as those of lower respiratory tract and gastrointestinal tract, prevention entails some intervention by public health authorities in providing clean air and environment, easy access to clean drinking water and proper sanitation.

Unfortunately in India, health is the most compromised aspect in all walks of life, whether social, professional or personal.

Investment on health receives minimum attention whether through medical insurance or through periodic medical assessment by availing various diagnostic services. Only when one falls ill does the bell begin to ring, and people begin exploring both, timely tests and health coverage.

However, with the growing focus on preventive healthcare, India is moving towards a stronger healthier nation. Yes, we do have challenges, but days like International Health Day helps us to reflect on our shortcomings, and inspire us to keep walking, quite literally. 

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