In October, a fire took 22 lives in a hospital in Odisha. Then came the report of a man carrying the body of his wife for want of an ambulance.
Will these be the haunting images of healthcare in 2016? Or, will it be the faces of aspiring doctors hopeful of a shot at merit through NEET (National Eligibility-cum-Entrance Test), the common medical entrance conducted by the Centre?
Cardiac surgeon Devi Shetty says 2016 is a “watershed” because of NEET “as merit has a voice”. Healthcare delivery suffers not because of the lack of money, he says, citing the example of Cuba that has one of the best healthcare indicators. They are a much poorer country, but have six times more doctors than they require. And this works not just for them, but they also send doctors to other countries, says Shetty, founder of the Narayana Health chain of hospitals.
Cleaning up medical eduction is one of the most significant steps of the year, he says, since 26 million babies are born every year in India. “Our children are genetically inclined to become doctors,” he says, referring to the global shortage in doctors. Indian doctors do support medical systems abroad, but they are not in the driver’s seat, as they go as hired hands and have to take an additional entrance exam. “All this will go out of the window in 10 years,” he says.
In a couple of years, healthcare is tipped to be among the largest drivers of the global economy at $7.8 trillion. And NEET will allow people with a passion and merit to become doctors, he says.
But there are some things in healthcare that have not changed over the years, for instance, the regulatory framework under which hospitals operate, says Ratan Jalan, Founder of Medium Healthcare Consulting and former head of Apollo Health and Lifestyle. Pharmaceuticals and medical technology are highly regulated, but not hospitals, he says, making a case for mandatory accreditation to make hospitals accountable. People have greater trust in their local nursing homes than a corporate hospital, he observes.
The fire in a Kolkata hospital years ago was followed by some action. There needs to be greater control of quality, curbs on pollution, handling of medical waste, etc, he adds.
Vishal Bali,co-founder and Chairman of home healthcare company Medwell Ventures, worries that the demand-supply gap is ballooning. This year, too, saw pressure on hospitals from dengue, chikungunya and so on. “We are still losing too many lives to such diseases and need to control these situations better,” says Bali, who has headed Wockhardt and Fortis hospital chains.
Echoing the call for greater regulatory governance, he focusses attention on education, infrastructure and enterprise. Clinicians should be recertified, as happens in developed countries. And though the promise to increase the government's healthcare spending to about 2.5 per cent of GDP (from about 1 per cent today) continues to hang fire, the Centre should create an environment enabling people to set up hospitals, he says.
Staying with the low public funding concern, Amit Sengupta with Jan Swasthya Abhiyan says the National Health Mission is in limbo, between the Centre's promise of an insurance rollout and the move to give more funds to the States. There is a lack of vision for public health services. And the spike in epidemics, resulting from climate change and unplanned urbanisation, will only add to the pressure on health infrastructure, he says.
NEET and the revamp of the Medical Council of India are a start, but there are rough edges to sort out, he says, apprehensive about private sector involvement in medical education. The plight of the ASHA (Accredited Social Health Activists) workers, integral to delivering healthcare, also needs to be addressed, he adds.
From hospitals to doctors and education to healthcare workers, the Government has its task cut out in the New Year. In a country where people still travel long distances to reach a doctor, healthcare is an area the political class can ill afford to drag its feet on.