The vision and dream of Former President Dr A P J Abdul Kalam to see a developed India by 2020 has not come true, we are still far away from his vision. Due to the political leadership from 2004 till date, especially those handling the Finance Ministry and the economy, it has become too difficult for the economy to boom and exploit the complete potential of the youth and the working class in this country. We are in the last month of 2020 with high inflation and the highest ever unemployment rate in 4 decades. The global health crisis due to the outbreak of COVID-19 has made it even worse for the economy and it reflects the harsh reality of the healthcare facility in India.
When the outbreak took place in Feb-Mar 2020, the Prime Minister had no contingency plan on how to tackle it. All that he could do was lockdown in this country and then ask citizens to take up utensils and start banging them and then later on asking them to light up candles and torch lights for the frontline healthcare professionals. This just showed how important education is needed in one’s life. The poor and labour class were subjected to all sorts of harassment by the police and the administration. 1000s of labourers had to walk long distances just to reach their homes with toddlers in their hands.
Though the outbreak of the disease was in China, it was able to tackle the COVID-19 crisis because of strict lockdown norms, better healthcare infrastructure, and doctor population ratio and not to forget a healthy research environment to find antidotes.
Post the lockdown, the frontline healthcare professionals, doctors, nurses, and the staff had to bear the load of contact tracing and so many had lost their lives treating patients, the cause was simple unavailability or shortage of good quality Personal Protective Equipment (PPEs). By the time the spread of the virus had reached its peak in Aug-Sept, the urban middle class or the working class started to feel the heat, several places in the urban areas witnessed a shortage of beds and equipment such as ventilators. Several “leading” private hospitals took advantage of this scenario and charged exorbitant rates to treat patients, a broad daylight loot was taking place, and the government could do nothing.
India has lost close to 1,50,000 lives due to the virus in 2020 and the sad part of all is the loss of over 500 frontline doctors. Most of them had top-notch expertise and had been champions in their field. While we mourn their loss, it’s time for the citizens to call for an urgent revamp to the healthcare sector in India.
Currently the doctor: Population ratio stands at 1:1445, i.e. 0.62 doctors per 1000 population this is way too below the World Health Organization (WHO) prescribed norm of 1:1000. Developed countries such as the USA have 2.5 doctors per 1000 population, our neighbouring country China has 1.49 doctors per 1000 population. Though the outbreak of the disease was in China, it was able to tackle the COVID-19 crisis because of strict lockdown norms, better healthcare infrastructure, and doctor population ratio, and not to forget a healthy research environment to find antidotes. Singapore handled it even better, they have opened up their entire country by Dec 2020 because of the presence of vibrant healthcare infrastructure. India is still battling with the disease and the shoddy healthcare infrastructure shows how well India has performed.
All these calls for urgent government intervention to deal with such breakouts in the future. One can’t even imagine the magnitude of the life loss that a country like ours would witness in case the origin of the virus was in India and in a densely populated area.
IITians still dominate the startup, innovation, and patent space. This kind of push is required urgently for AIIMS as well to cater to the 1.35 billion population in this country.
All these said, we now need a bold central and state-level intervention to deal with healthcare infrastructure, just like how the national highways infrastructure had transformed the mobility in this country with massive investment pushes like Bharat Mala and Golden Quadrilateral, etc. We need a series of such scales for healthcare as well. This needs central and state cooperation as health comes under the concurrent list under the 7th schedule in the Constitution.
At the central level, the first and foremost step would be to kickstart a national ambitious program to have at least 100 new fully functional world-class hospitals and medical colleges i.e. AIIMS in every major district in this country. The reason why we need this measure is that the government’s annual spending on healthcare is less than 1.4% of our GDP which is a pathetic number. Developed countries like the US have 14% government spending on healthcare, UK and Germany have close to 10% of their spending on healthcare, our neighbour China has around 4% government spending on healthcare. We are nowhere close to those and sadly we are in the bucket with the poorest countries in the world when it comes to healthcare spending by the government.
The reason why we need a world-class health infrastructure is that it will kickstart a wave of allied services post that, a ripple effect driven by innovation and research. We have seen the case with the IITs in our country, The government started world-class engineering colleges in this country, although it mushroomed a lot of coaching services, some of the selected students were able to utilize the infrastructure to create a wave of startups and entrepreneurship across the country contributing a lot to the economy. IITs were able to bring the best minds and produce so many Unicorns. IITians still dominate the startup, innovation, and patent space. This kind of push is required urgently for AIIMS as well to cater to the 1.35 billion population in this country.
As of 2020, there are just over 1200 seats in 15 AIIMS which is appalling for a country aspiring to provide world-class healthcare. This has to be improved to at least 15000 seats by 2030 to scale the doctor per population ratio to global standards considering the projected population of 2030 without compromising the quality of service and facility. So to add 15000 more seats in AIIMS we need at least 100 new AIIMS in this country to match the number. In addition to AIIMS, a free hand should be given to the Defence Ministry as well to add more Armed Forces Medical Colleges to cater to the Army’s needs as well as for the public welfare.
This infrastructure push can be done easily without any hassles. Currently, many new AIIMS are being set up under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). Most of them are being built at a very slow pace and tardy progress has been made so far in the new AIIMS, most of which is due to land acquisition and several logistics issues. In the future, this bottleneck should be totally avoided. The best way to avoid this is to set up AIIMS inside all the large state or centrally funded universities and engineering colleges across the country. This will not just serve the urban population but also ensure that Medicine and Science/ Engineering finds a space incoherence for all research and innovation.
To give a simple example Bangalore University has over 1200 acres of land under it in the heart of the city and it requires only 100 Acres for a world-class medical college cum hospital. The government can use such lands rather than waiting for new land to be acquired and start the work. Similarly, Hyderabad Central University has over 2300 acres of land. JNU has about 1000 acres of land, IIT Madras, IIT Kharagpur, IIT Kanpur, IIT Varanasi, NIT Trichy, NIT Rourkela all have over 1000 acres of land under their administrative control and so much vacant space is still available, this can be utilized better as they are in urban areas and the urban population is in dire need of world-class healthcare facilities.
Every major district in our country has such colleges and universities and in all these places, world-class medical institutions can be easily started.
Another way to establish hospitals is to set up Armed forces medical colleges (AFMCs) inside Cantonment boards which come under Defence estates, So many places across the country have vast tracts of land for free use/ re-use, these can again be better utilized for urban healthcare infrastructure. Eg. Jalahalli Airforce station in Bangalore, Secunderabad Cantonment, Bathinda Cantonment, all has so much land for a world-class institution.
These AIIMS & AFMCs should act as the backbone of our healthcare infrastructure, a similar pattern should be followed at the state level by setting up medical colleges and hospitals at each and every Taluk along the national highways to integrate the city and rural facility.
This method can be leveraged and will work in India as well because of the demographic dividend advantage i.e. we have the largest workforce in the world who would be ready to contribute.
One can ask, where can these institutions get money for operational expenses? For that too we have an existing system that can be utilized and leveraged upon. India recently started the world largest health assurance scheme which is the Ayushmaan Bharat, “for providing a health cover of Rs.5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population.” This scheme is currently free of cost for the poor and almost 1/5th of the population have received e-health cards through this scheme.
So if a 50 crore population can be given free of cost, then the rest 85 crore people can too be covered for a charge based on their income by creating a mandatory Healthcare provident fund/ Medical savings account. In fact, Singapore follows this method to charge their citizens and all have a medical savings account and its impact is directly visible, the average life expectancy is 83 yrs, one of the best in the world. This method can be leveraged and will work in India as well because of the demographic dividend advantage i.e. we have the largest workforce in the world who would be ready to contribute.
In the next 10 years, 50-60% of the population would be in the urban areas so, therefore, we need at least 2 AIIMS in each metro city and 1 in every major district integrated with new state-level medical colleges in each and every Taluk along the national highways to form a National Healthcare grid.
1. The views expressed here are those of the author and do not necessarily represent or reflect the views of PGurus.
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