Opinion

Modular Hospitals : Health Care Delivery Vital

In India, out of pocket (OOP) expenditure makes up 63 per cent or almost two-thirds of total health expenditure as per World Bank data. This is obviously quite high compared to the UK, where the government bears over 80 per cent of people’s medical expenses. In fact, France has the lowest OOP medical expenses,whereas India has the highest. In Turkey, Germany, the UK and the US, OOP expenses are around 20 per cent.

As per a study the overall medical expenses pushed 4.5 per cent of India’s population into poverty. Roughly 3.8 crore have become poor due to OOP expenses on medicines alone. The situation has worsened since 2010-12 and in the last fiscal, the number must have doubled, more so because of Covid-19. However, the year’s Economic Survey estimated that an increase in public spending on health care from one per cent to 2.5 per cent of GDP can reduce private expenditure from 65 per cent to 30 per cent of overall health care spending, bringing India closer to China’s current level

Undeniably, serious government intervention is called for in a bigger way, more so because the majority of the population belongs to the poorer or economically weaker sections. In such a situation, to quickly revamp State health infrastructure, the Centre planned to set up 50 innovative modular hospitals across the country in the next two-three months. Modular hospitals will be built adjacent to an existing hospital building as an extension of operational infrastructure. A 100-bedded modular hospital with a dedicated zone of ICUs can be set up at an estimated cost of nearly Rs 3 crore in three weeks and made fully operational in 6-7 weeks.

It is understood that any government hospital, having basic facilities such as electricity and water supply and oxygen pipeline will be eligible to have a modular hospital attached to it. The first batch of modular hospitals is expected to be commissioned in Bilaspur (Chhattisgarh), Amravati, Pune and Jalna in Maharashtra and Mohali (Punjab)along with a 20-bed hospital in Raipur (Chhattisgarh). Bengaluru will have one each of 20,50 and 100 beds in the first phase.

Though this is a welcome decision, it would have been better if these modular hospitals are set up in districts, specially which are disease-prone and need more beds. Moreover, efforts should be made to increase the figure to at least 100 with private participation in the current fiscal, if possible.

Another significant stimulus that is being worked out by the government is a package that could include a scheme to promote health infrastructure in non-metro cities for augmenting Covid-19 treatment facilities, including ramping up of hospital beds, strengthening the procumbent of essential medical equipment and drugs. Moreover, the Emergency Credit Line Guarantee Scheme ((ECLGS) is proposed to be expanded to hospitals, which can take up to Rs 100 crore in facilities at non-metros.

It is well-known that most hospitals in sub-divisions are in poor condition due to various factors. The recent Covid-19 pandemic has exposed government health initiative to a great extent though most State governments have gone out of the way to revamp health centres to the extent possible in a relatively short time. While resource constraints of States are a major reason due to increase in patient load, there are other factors also.

According to available statistics, Bihar has one doctor for every 42,000 people and Delhi one for every 2200 people but both are a far cry from WHO recommendation of one doctor for 1000 population. Lack of workforce is largely driven by attrition with 30 per cent of individuals with a medical degree not a part of the current workforce, a high proportion relocating to other countries.

A deep mistrust of the Indian healthcare system has developed in the public eye with may citizens taking multiple opinions to achieve a solution to their problems. Thus, nearly 80 per cent Indians who died of Covid had existing conditions like diabetes, heart disease and other co-morbidities. They are the most likely to have long-term complications. If these co-morbidities could be better controlled or even prevented, then these complications and deaths most likely may not have occurred. Experts believe that between 2012 and 2030, India will have had an economic loss of $4.6 trillion due to non-communicable diseases, if these are not controlled.

It would have been better if a section of experts’suggestion of appointing para medical staff with one or two years’ medical training and posting them to rural areas would have been encouraged as it would help serve the rural populace in a better way. The inadequate number of doctors and healthcare workers may have been compensated by appointment of such staff and help fight diseases effectively in remote areas of the country.

The Union Health Ministry’s rural health statistics show that over 2900 posts of doctors in district hospitals were vacant in five States in March 2020, with shortfalls of 676 in Bihar, 637 in Uttar Pradesh, 1106 in Bengal 377 in Maharashtra and 171 in Punjab. But opposition from doctors’ organisations may have possibly been the reason for the government not accepting the suggestion.

As per Rural Health Statistics 2019-20, “compared to requirement for existing infrastructure, there is a shortage of 78.9 per cent of surgeons, 69.7 per cent obstetricians and gynaecologists, 78.2 per cent of physicians and 78.2 per cent paediatricians” Among the States with significant shortfalls are Gujarat lacking 996 specialists against a requirement of 1088, Madhya Pradesh with a requirement of 916 is short of 867 and Bengal which requires 380 specialists but has fewer 247 specialists

Uttar Pradesh, the site of a grand Ram Mandir, has one of the worst healthcare systems in India. The biggest State has among the lowest doctor-patient ratios in the country. There’s a 23 per cent shortfall of dotcoms in PHCs in rural areas. Against the sanctioned strength of 3578, there are 2579 doctors. Mandirs, masjids, memorials and monuments have been built everywhere. Some experts have suggested that it would be a novel idea if a hospital within the compound of the big structures could have considered. Historically, India’s budgetary allocation to healthcare has been pathetic, hovering at around 1 per cent of GDP.

In the current scenario, the need for developing the rural health infrastructure has been somewhat realised and with scarce resources both the Centre and States are trying to do more though the steps should have initiated right after the first wave. It is a great pity that over decades, successive governments have not cared to develop health infrastructure in rural areas, specially in the backward districts, though promises are oft heard.

It is imperative that modular hospitals and other such facilities be taken up to strengthen the health infrastructure, to aid the deprived sections. Right to health and fair treatment is obviously a part of Article 21 of the Constitution and the government has the responsibility to ensure this right. Governments cannot avoid their duty to provide adequate medical services merely because of financial constraints. Plus, a well-designed plan alone shall not do, creation of structure and infrastructure must be made top priority. Action and not words are needed.

 

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About the author

Dr Oishee Mukherjee

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