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Hazards of a poor healthcare system
Unsatisfactory health coverage and inadequate budget allocations are the primary reasons for growing rift between doctors and patients
Universal Health Coverage (UHC) is one of the major ambitious healthcare agendas of the Narendra Modi Government. The 12th Five Year Plan targeted a long-term goal of UHC where “each individual would have assured access to a defined essential range of medicines and treatment at an affordable price, which would be entirely free for a large percentage of the population”.
However, when this is going to be realised in its letter and spirit, only time will tell. A recent spate of violence against medical staff, particularly doctors, by the patients and their relatives in the country speaks volume of the gaps that need immediate attention to be filled before such protests escalate to become a routine affair.
According to a study carried out last year by the Indian Medical Association at a large hospital in New Delhi, 40 per cent of the medical residents had been exposed to violence in the previous 12 months. It said that 75 per cent of Indian doctors have been attacked either physically of verbally by patients' families at some point.
Vivekanand Jha, executive director of the George Institute for Global Health feels that, such cases certainly raise troublesome questions and doubts in the mind of the people about the Government's plan to achieve the UHC objective. The attack incidents need to be seen in the context of the general resentment in the minds of the public against the healthcare system.
While the Government is, on the face of it, raising expectations of the people by making big promises under the UHC through plethora of publicity media at the ground level much is yet to be done: Neither the technology nor the resources are available for it. Patients are being seen as adversary, or a consumers while doctors are under the lens of suspiciousness. Needless to say, challenges to achieve the UHC are huge, given the dismal current health scenario plagued with shortage of doctors, inadequate facilities and medicines and equipment in the public sector.
India is short of nearly 500,000 doctors, based on the World Health Organization norm of 1:1,000 population. Absence of facilities has led to huge out of pocket expenditure which leaves the patient's and their relatives quite frustrated, inflamed by apathy of the overburdened doctors. One of the major reasons for overflow of patients in hospitals in metropolitan cities is because of the absence of adequate basic medical facilities at their door steps. In contrasts, private hospitals where facilities exist treatments are far too expensive and patients are looked as consumers and clients with communication and empathy missing on the part of the administration and medical professionals.
The string of attacks has also drawn the attention of the President Pranab Mukherjee who during the inauguration of the Indian Institute of Liver and Digestive Sciences, set up by the Liver Foundation West Bengal in Kolkata rued that the concept of ‘service’ was now taking the backseat in the medical profession.
Member of the Alliance of Doctors for Ethical Healthcare, G S Grewal said that doctors are being used as a tool in this environment of medical corruption because 90 per cent of them don't know who's fixing what prices and in Government's sector, it's lack of proper facilities for which doctors are not responsible but have to take ire of the angry patients and their relative.
According to the Niti Aayog, health-related issues push 39 million people every year into poverty; 47 per cent and 31 per cent of hospital admissions in rural and urban India respectively are financed by loans and asset sales; and 30 per cent in rural India and 20 per cent in urban areas go untreated due to financial constraints.
What's worrisome is that India spends just 1.4 per cent of gross domestic product on healthcare — well below the six per cent world average and the 3.1 per cent spent in China, its more affluent rival.
Clearly, India has a long way to go before it can claim to achieve UHC. In fact, in what could be indication of what lies ahead, Naresh Trehan, a leading cardiac surgeon says: “The National Health Policy missed outlining the need to protect medical professionals, the most important part of the healthcare delivery ecosystem. Recent events of growing mistrust and violence against medical professionals will halt the growth of the sector.” However, Sumit Ray, a senior consultant, Critical Care Medicine feels that doctors should too, fight for patients' rights and better access to healthcare. “Why do our representative bodies talk of patients in terms of us versus them? If we do not stand up for patients' rights as a profession, patients will never see us as their advocates. We shall, unfortunately, remain adversaries and the violence will be difficult to stop”, he notes.
(The writer is Special Correspondent, The Pioneer)
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