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Ayushman Bharat Health Infrastructure Mission

• The Ayushman Bharat Health Infrastructure Mission is a scheme that aims to improve the healthcare infrastructure in India by addressing gaps in critical care and primary care facilities in both urban and rural areas.
• The objective is to make critical care services available in all districts of the country with a population of more than five lakh through exclusive critical care hospital blocks. The remaining districts will be covered through referral services.
• The scheme also aims to provide people with access to a full range of diagnostic services in the public healthcare system through a network of laboratories across the country. Additionally, integrated public health labs will be set up in all districts, and an IT-enabled disease surveillance system will be established through a network of surveillance laboratories at different levels.
• The Integrated Health Information Portal will be expanded to all states and union territories, connecting all public health labs.

Current state of India's health infrastructure - World Bank data

• According to World Bank data, India had 85.7 physicians per 1,00,000 people in 2017, which is lower than other countries like Pakistan, Sri Lanka, and Japan. Similarly, the number of hospital beds per 1,00,000 people in India is lower than in countries such as Pakistan, Bangladesh, Sri Lanka, and Japan. India also has a lower number of nurses and midwives per 1,00,000 people compared to countries like Sri Lanka, Pakistan, and Japan.
• Moreover, India has one of the highest out-of-pocket expenditures (OOP) for healthcare in the world. OOP expenses account for 62% of the total health expenditure in India.

COVID-19 leads to rethinking of India’s Healthcare System

• Perception of the Healthcare System: The negative impact of the pandemic, including high death tolls, skyrocketing cases, economic setbacks, and social disturbances, has brought attention to the perception and treatment of the healthcare sector.
• Reports of Problems in Healthcare: The COVID-19 crisis has highlighted long-standing issues such as healthcare workers protesting against equipment shortages, patients accusing doctors and hospitals of profiteering, policymakers criticizing providers, and reports of essential medicine hoarding.
• Growing Disinterest among Healthcare Stakeholders: During the pandemic, the trust between patients and healthcare providers, as well as the broader mistrust between policymakers and the industry, deteriorated, revealing a significant lack of interest in India's healthcare system.

India's Healthcare Sector is Undergoing a Digital Transformation

• Healthcare is a major sector in India in terms of revenue and employment, encompassing hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment.
• The sector is growing rapidly due to increased coverage, services, and expenditure by public and private players. 
• The healthcare system is divided into two components: public and private, with the government providing basic healthcare through primary healthcare centres in rural areas, and the private sector providing secondary, tertiary, and quaternary care in major cities. 
• India's healthcare sector boasts a large pool of well-trained medical professionals and is cost-competitive with other countries in Asia and the West, with surgery costs about one-tenth of those in the US or Western Europe. 
• However, the country ranks 145 out of 195 countries in terms of healthcare quality and accessibility.

Reasons and causes for this

• Low public health expenditure– In 2013-14, India's public health expenditure was only 1% of GDP, which increased to 1.28% in 2017-18. This includes expenditure by the Centre, all States and Union Territories.
• Centre is the key player in public health management because the main bodies with technical expertise are under central control. In contrast, the States lack corresponding expert bodies such as the National Centre for Disease Control or the Indian Council of Medical Research.
• Due to the wide variation in per capita health expenditure, states differ greatly in terms of the fiscal space to deal with the novel coronavirus pandemic.

Inter-State variation in per capita health-care expenditure (between 2010-11 to 2019-20):

• Kerala and Delhi have consistently ranked close to the top in all the years in terms of per capita health expenditure.
• On the other hand, Bihar, Jharkhand, and Uttar Pradesh have consistently ranked towards the bottom of the ranking in all years.
• Odisha is notable as it had the same per capita health expenditure as Uttar Pradesh in 2010, but now has more than double that of Uttar Pradesh.

Measures needed to strengthen the existing state of Health infrastructure in the country are:

• In order to achieve a comprehensive wellness system for all, it is imperative to increase public spending on healthcare to 2.5% of GDP, despite this being lower than the global average of 5.4%. The performance of health and wellness centers is critical in reducing the burden of out-of-pocket expenses on healthcare. There is a need to depart from the current trend of inadequate and erratic increases in healthcare spending and make significant and sustained investments in public health over the next decade.
• The development of a National Health Regulatory and Development Framework is necessary to improve healthcare delivery across the country by enhancing quality, performance, equity, efficacy, and accountability, including the registration of health practitioners. Public-private partnerships should be increased to extend healthcare services to the last mile. Jan Aushadi Kendras and generic drugs should be expanded to make medication more affordable and reduce out-of-pocket expenses.
• The National Innovation Council should foster a culture of innovation in India's healthcare sector and help develop policy on innovations that will focus on an Indian model for inclusive growth. India should learn from developing countries like Thailand to work towards providing Universal Health Coverage, which includes population coverage, disease coverage, and cost coverage. Information technology, such as computer and mobile-phone-based e-health and m-health initiatives, can be leveraged to improve the quality of healthcare service delivery. Start-ups investing in the healthcare sector from process automation to diagnostics to low-cost innovations should be provided policy and regulatory support to make healthcare more accessible and affordable.

Conclusion

India requires a comprehensive strategy to address issues in the healthcare sector, which involves the participation of all stakeholders including the public, private sector, and individuals. A more energetic and forward-looking approach is required to manage the challenge of the dual disease burden. Providing universal access to healthcare will make the population healthier, ultimately contributing to the achievement of the demographic dividend.