Protection of patients, stronger regulations and right to healthcare were among the focus areas of general elections. With the new government in power, we are yet to see how many of those will see the light of day.
By NK Ganguly
Protection of patients, stronger regulations and right to healthcare were among the focus areas of general elections. With the new government in power, we are yet to see how many of those will see the light of day. In a country spending only 1.15% of GDP on its people’s health, the appetite for better healthcare initiatives is voracious. In what could be a step in this direction, the Indian Council of Medical Research (ICMR) collaborated with the ministry of health and family welfare and some experts to release the final draft of the National Essential Diagnostics List (NEDL), in the coming months (according to sources). As the government plans to launch pathology labs at more than 500 Jan Aushadhi outlets, it appears we are inching closer to finalising NEDL.
What does it mean to the people? If all goes as planned, the government will make a set of quality diagnostic tests available at every healthcare centre, and the move could make more than 100 diagnostic tests accessible to people.
While the move is laudable, India has healthcare battles to win on many fronts, failing which NEDL could fall flat. We need a more structured approach to address the growing challenges of the healthcare industry.
The skill development challenge
There is only one government allopathic doctor per 11,082 people—as per last year’s data, India has about 10 lakh allopathy doctors to treat its entire population. Also, the number of clinicians to conduct tests falls short of requirement, and there is a lack of awareness on diagnostics. The access to diagnostics in remote areas and even in tier-2 and tier-3 cities is a challenge. NEDL caters to one side of the story, and accessibility to equipment cannot ensure better health unless there is an existing capacity of professionals who can perform these tests in a suitable infrastructure. The government should consider using NEDL to also mandate and ensure covering the gaps in this area.
Finding enough doctors and physicians to treat patients and training them well should be the first step before ensuring availability of products and services. Our hospitals are understaffed, overburdened and ill-equipped. For India to build better infrastructure, we not only need qualified doctors, but also high-quality equipment and trained professionals—microbiologists, pathologists, trained lab technicians. Without skilled professionals or advanced technology, achieving accurate diagnosis and effective prognosis will be a challenge. A step in this direction could be a partnership between the government and the medical device industry. Together, they can run diagnostic awareness campaigns and camps to support the cause, similar to what is being initiated in Andhra Pradesh and Telangana.
Limping healthcare infrastructure
In 2018, the health ministry, under the National Health Profile, revealed there is one government hospital bed per 1,844 people and one state-run hospital for 55,591 people. When I think about what NEDL could possibly do for India, my first doubt is where are the hospitals for this equipment and where are the professionals?
A recent report noted that, of the 1.5 lakh Health and Wellness Centres (HWCs) planned by 2022, only about 3,000 (2%) have been completed. Of these, 2,800 are in aspirational (economically-backward) districts. This entails building at least 50,000 HWCs every year in the next three years.
If implemented in a phased manner, NEDL could potentially improve access to safe and effective diagnostic tests for patients. However, this needs a streamlined approach in synchrony with other changes being proposed, such as revision of Indian Public Health Standards (IPHS), HWCs and free diagnostic service initiative of the government. (IPHS are a set of standards envisaged to improve the quality of healthcare delivery in the country under the National Rural Health Mission.) Even as claims by political parties seem reassuring, we cannot achieve anything unless the challenges of skill building and infrastructure are met. Without the provision of necessities like laboratory capacity, these ideas will crumble. With elections in the rear-view mirror, we are hoping for a future where the new economic vision will have a clear focus on healthcare.
(The author is former head, Indian Council of Medical Research)