Open Forum
New Delhi, 30 June 2021
Modular Hospitals
HEALTH CARE DELIVERY VITAL
By Dr Oishee Mukherjee
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.---INFA
(Copyright, India News & Feature Alliance)
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