Indian HealthCare system

The healthCare system in the rural and sub- urban level. The functions of different departments from preventive care, treatment experience and after care services.

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The higher spending power of consumers in towns and cities the majority of Indian healthcare professionals are concentrated around urban areas, leaving rural areas under served. While India meets the global average in number of physicians, nearly 75% of dispensaries, 60% of hospitals and 80% of doctors are located in urban areas. Doctors cater to a third of the urban population, or no more than 442 million people. 

Poor Health Infrastructure

There is is one government hospital bed for every 2,046 individuals, one government doctor for every10,189 people, and one state-run hospital for every 90,343 citizens respectively. In comparison to these dismal numbers, the US has 24.5 doctors for every 10,000 people and one hospital bed for every 345 citizens. India also has a shortage of specialist doctors at rural community health centres (CHCs), according to Indian government health and family welfare statistics.

 

Preventive Care

Rather than consulting trained doctors, home remedies are often used as an effective mode of treatment, where almost every household has someone to offer healthcare advice. However, the authenticity of information offered is often debatable. To create awareness in this area, a startup called 'Myupchar'  -- meaning self treatment in Hindi --  gives users a range of information on Ayurveda --  "whole-body" holistic treatment – homeopathy and allopathy, to address various health and wellness-related issues, including obesity, pregnancy, women’s health and post-surgery care.

Low levels Of Health Insurance

Insurance Regulatory and Development Authority (IRDA) has stated that India’s per capita healthcare expenditure is one of the lowest levels of in the world.  What makes this fact more dismal is government’s contribution to insurance stands at roughly 32%, as opposed to 83.5% in the UK. 76% of Indians do not have health insurance, this results in the high out-of-pocket expenses incurred by the citizens of this country.

Paucity of Doctors, Nurses & Administrative Staff  

One of the biggest challenges faced by the healthcare industry in general and private hospitals, in particular, is of manpower shortage. There is a sheer dearth of people who have the requisite skills required by the hospitals. The shortage is most highly felt for doctors, nurses and, to some extent, other paramedical staff also.  There are a number medical schools but the course content in these schools is not so much in sync with what the industry requires. Hence the hospitals have to re-skill the doctors by providing relevant training. Pulling the doctors often from work for training is a sizeable challenge that the human resources manager of a hospital has to grapple with. Similarly, the nurses need to be trained and taught new or supplementary skill sets. There are significant time and costs involved in conducting these training. 

Health Beliefs 

Treatment and medicine mixes fluidly with religion in Indian culture. India has a variety of medical systems, of which Western medicine is only one. The medical heritage of Muslim practices, called unani tibbi, integrates Arabic medicine, homeopathic systems, and regional and local health practices. Ayurveda,roughly translated as "the science of life," is a complex medical system that emphasizes physical, mental, and spiritual health. This includes a regulated daily life, rejuvenating measures, and the practice of yoga. The most commonly practiced Ayurvedic treatments in the west are massage, dietary and herbal advice, due to the strong regulations surrounding medical practice. Ayurveda classifies patients by body types, or prakriti, which are determined by proportions of the three body humors, or doshas. Contrary to scientific understanding of germs, viruses and genetic faults, illness and disease are considered to be a matter of imbalance in the doshas. Disease is caused by an imbalance of the bodily humors, and cured by a restoration of the balance through meditation, diet, and natural medicine.

Society prefers to treat patients holistically, emphasizing prevention. The majority of Indians use herbal remedies to cure illness. Root causes for diseases are considered to include many things such as physical ailments, stress, and karma. Treatment for illness mostly involves changes in diet, herbal remedies, massage, application of oil to key areas and rest. 

Cultural Beliefs and Practices 

Beliefs and practices are intended to honor and uphold the family. Families tend to be private and do not wish to invite shame upon themselves. Modesty is highly valued. Dating is generally allowed, but traditionally only with parental consent. Inter-marriage presents great strain in an Indian family regarding cultural and religious concerns. 

Education is extremely important in Indian families. In India, education was only available for those who could pay. Immigrants often came to America for educational purposes and strongly encourage their children to excel in school. This may cause stress for some children.Women prepare and serve meals, and may take their meals separately from the males in the family. Women traditionally are forbidden to cook during their menstrual period. Eating with the fingers of the right hand is common. Hand washing before meals is a necessity. Overeating is generally discouraged because of the risk of decreased lifespa

KPMG Report: Case Study on Manpower shortage

Statistics by themselves may still not bring forth the acuteness of the challenges as perhaps the description of the ground realities can. While working as a consultant at the National Health Services Resource Center (NHSRC), the author had the opportunity to visit many health facilities in different districts of Uttar Pradesh and Uttarakhand. The following are observations from some of the visits. 

1. During a monitoring visit in June 2013 by the author to the district hospital in Pithoragarh district of Uttarakhand state, it was found that the doctors and the employees of the hospital were on strike in protest against roughing up of some hospital staff by the relatives of an 18- or 19-year-old boy who died the previous night of some complication following the operation for abdominal/inguinal hernia (a simple and routine surgery provided that there is no strangulation of the intestines at the hernia site).

At the time the boy died, there were only two nurses, one in the casualty of the hospital and the other to take care of admitted patients, in various wards, in a 120-bed hospital. After the regular working hours there is only one doctor available for all these patients, which is too in the emergency. So in the absence of doctors and nurses in the wards after routine hours, it is for the attendants to be able to locate them in the hospital in case their patient requires medical attention, provided of course that the attendants are able to judge the criticality of their patient’s discomfort.

2. Likewise, in the 100-bed district women hospital at Jhansi, after four p.m., there is only one nurse (who was working on contract basis at the time of the author’s visit) to take care of the labor room, the ward, and an occasional cesarean section that may take place. 100 beds do not mean only 100 patients, because one needs to count the babies of the delivered mothers as well, who require even greater medical attention.

 

3. The conditions at the 100 bed “Mahatma Gandhi Smarak District Hospital” at Naugarh, the district headquarter of Siddharthnagar district in UP, are even worse. The patients are pretty much on their own after 4 p.m. as the only available nurse is kept busy in the labor room, while the doctor mans the emergency. The hospital had just 5 nurses on its rolls at the time of writing to provide all the nursing care required at the hospital.

 

4. Almost similar conditions were to be found at district general and the district women hospital in Faizabad district of Uttar Pradesh. According to the information provided by the hospital authorities in February 2013, there had been 26 maternal deaths at the hospital in the last one year out of a total of 5860 deliveries that took place at the hospital. This works out to a maternal mortality rate of a whopping 443.7 per 100,000 live births.

 

5. There was just one obstetrician and gynecologist in both Pithoragarh and Siddharthnagar districts to cater to cases requiring cesarean deliveries. The specialist in Pithoragarh was putting up around 580 km away from her family in Gwalior, situated in Madhya Pradesh state. She was forthright, “had I been posted in plain areas I could have at least visited my family easily; I am only biding my time and shall leave the moment I get a more suitable job.” 

References

1. https://www.mckinsey.com/~/media/McKinsey/Featured%20Insights/India/India%20Healthcare%20Inspiring%20possibilities%20challenging%20journey/India%20Healthcare_Inspiring%20Possibilities_Challenging%20Journey.ashx

Accessed on 22 October 2019

2. https://medicaldialogues.in/80-percent-of-indian-doctors-located-in-urban-areas-says-report/

Accessed on 22 October 2019

3. https://books.google.com/books?hl=en&lr=&id=kvZ0DwAAQBAJ&oi=fnd&pg=PA210&dq=KPMG+healthcare+in+rural+india&ots=HW3tmOPByM&sig=BKSkmfceZbt_CGlz25Dw-4zQf68#v=onepage&q&f=false

Accessed on 22 October 2019