ICTpost Healthcare Bureau
Research has pointed out that only three out of ten people ultimately get treated in Tier II and III cities. This reflects a huge potential for investment in these markets. A report on the outlook for Indian healthcare infrastructure in the next five years reveal that against a world average of around four hospital beds per 1000 population, India lags behind at just over 0.72 clearly indicating an insufficiency.
Rising income levels, changing demographics and illness profiles with a shift from chronic to lifestyle diseases would propel the Indian healthcare industry to double in value by 2021 and quadruple by 2024. This is likely to result in considerable infrastructure challenges and opportunities which the likes of private players are looking to tap.
Private players are more likely to enter rural markets when logistical problems are taken care of by the government to some extent. A large problem that government hospitals face is lack of well trained staff. Therefore, a private player is more likely to enter into a rural area where apart from good demand, there should be supporting infrastructure such as power, transport, education and potable water. This has to come from the government.
Low operating costs, energy-efficiency, easy serviceability and support for high patient volumes, are critical to increasing healthcare access in India. The shortage of specialist physicians in smaller towns necessitates the need for hub-and-spoke technology models. Such technology can enable smaller health centres and hospitals to feed their data into Tier II and III cities, which can in turn pass it on to hospitals in metro cities.
Healthcare Opportunities and Challenges in Tier II and III cities
India was one of the pioneers in health service Planning with a focus on primary health care. In 1946, the Health Survey and Development Committee, headed by Sir Joseph Bhore recommended establishment of a well-structured and comprehensive health service with a sound primary health care infrastructure. This report not only provided a historical landmark in the development of the public health system but also laid down the blueprint of subsequent health planning and development in independent India.
Improvement in the health status of the population has been one of the major thrust areas for the social development programmes of the country. This was to be achieved through improving the access to and utilization of Health, Family Welfare and Nutrition Services with special focus on under served and under privileged segment of population.
Primary Health Care
The primary health care infrastructure provides the first level of contact between the population and health care providers upto and including primary health care physicians and forms the common pathway for implementation of all the health and family welfare programmes in the country. It provides integrated promotive, preventive, curative and rehabilitative services to the population close to their hearth and home. Majority of the health care needs of the population is taken care of by the trained health personnel at the primary health care level. Those requiring specialised care are referred to secondary or tertiary care. Thus, the three-tier system consisting of Primary, Secondary and Tertiary care facilities with adequate referral linkages will provide essential health and family welfare services to the entire population.
While computing the requirements for primary health care infrastructure for the growing population, the fact that population increase has occurred in and around the already established centres have to be kept in mind. The already established physical infrastructure cannot be shifted and it will be difficult to add additional centres to serve the population in geographically convenient locations. It might be more feasible to increase the number of functionaries required to cater to the populations need rather than increase the number of centres.
In some areas, the existing Primary Health Care Institutions (PHIs) are functioning sub-optimally because of one or more of the following factors:
i. Inappropriate location, poor access, lack of maintenance;
ii. Lack of professional and para-professional staff at the critical posts;
iii. Mismatch between the requirement and availability of health professionals especially physicians at PHC;
iv. Lack of funds for essential drugs/diagnostics
v. Lack of First Referral Units (FRUs) for linkage of referral services.
Factors responsible for sub-optimal functioning of Primary Health Care Institutions:
Inappropriate location, poor access, poor maintenance
Gaps in critical manpower
Mismatch between personnel & equipment
Lack of essential drugs/diagnostics
Poor referral linkages
Secondary Health Care
The secondary health care infrastructure at the district hospitals today functions both as primary health care infrastructure for taking care of the needs of the population in the city/town in which it is located and as secondary care Centres. This dual role dilutes its effectiveness. To remedy the situation, initiatives were taken during five year Plan to ensure that these hospitals are able to cope with the referred cases. Four States – Andhra Pradesh, Karnataka, West Bengal and Punjab – have initiated Secondary Health System Development Projects with special focus on strengthening the District Hospital and the referral services.
Priorities
Provide adequate diagnostics, consumables and drugs
Strengthen emergency services
Provide care for high risk cases
Establish effective, credible linkages with primary and tertiary care facilities in geographically delineated areas.
ICTpost View:
Primary care is the backbone of preventive health care, and a strong primary care workforce is essential to health of our country. The Affordable Care Act and Public Health Fund should be designed to help create the necessary infrastructure to prevent disease, detect it early, and manage conditions before they become severe.
India today has a vast network of governmental, voluntary and private health infrastructure manned by large number of medical and paramedical persons.
Current problems faced by the health care services include:
1.Persistent gaps in manpower and infrastructure especially at the primary health care level.
2.Suboptimal functioning of the infrastructure; poor referral services.
3.Plethora of hospitals not having appropriate manpower, diagnostic and therapeutic services and drugs, in Govt., voluntary and private sector;
4.Massive interstate/ interdistrict differences in performance as assessed by health and demographic indices; availability and utilisation of services are poorest in the most needy states/districts.
5.Sub optimal intersectoral coordination
6.Increasing dual disease burden of communicable and noncommunicable diseases because of ongoing demographic, lifestyle and environmental transitions,
7.Increasing awareness and expectations of the population regarding health care services
8.Escalating costs of health care, ever widening gaps between what is possible and what the individual or the country can afford.
Solution
Increasing the number of nurse practitioners trained: Nurse practitioners provide comprehensive primary care;
Establishing new nurse practitioner-led clinics: These clinics will be staffed by nurse practitioners, which provide comprehensive primary health care services to populations living in medically underserved communities.
Encouraging States to plan for and address health professional workforce needs
New Focus on Education and Worker Training
This effort with multi-faceted strategy will encourage and educate more physicians, nurse practitioners, and physician assistants to practice in primary care, including:
Increasing access to providers in underserved areas
Focusing on career training
Expanding tax benefits to health professionals working in underserved areas
Building primary care capacity
Making health care education more accessible: Many individuals in health professions are eligible for generous student loan forgiveness program.
