The COVID-19 pandemic, while posing a significant global health challenge, has underscored the critical need for increased investments in public health. Currently, India allocates just over 1.5 percent of its Gross Domestic Product (GDP) to public healthcare, and it is imperative to raise this figure to a minimum of 3.5 percent in the near future. Notably, several developed nations already allocate over 10 percent of their GDP to public health expenditures.
To fortify India’s healthcare system, a strategy should be adopted, with a particular focus on bolstering primary healthcare centers. These centers can meet approximately 90 percent of the demand for medical treatment, with only a small fraction of patients necessitating referral to higher tiers of healthcare facilities. This approach hinges on the provision of comprehensive health education and awareness, particularly concerning common lifestyle diseases and infections, at the primary care level. Strengthening primary healthcare is key to ensuring universal access to healthcare services for the entire population.
The United Nations High-Level Political Declaration on Universal Health Coverage underscores the need for accessible and equitable healthcare services for all and emphasises the importance of primary healthcare. Improving primary healthcare should begin with sub-centers, the initial healthcare points for communities. By staffing these centers with well-trained non-physician healthcare providers, facility-based and outreach services can be rendered without heavy reliance on doctors. Sub-district hospitals should also be reinforced to deliver high-quality secondary care, essential tertiary care, and training for various healthcare providers, alleviating overcrowding in tertiary care hospitals.
The next priority is enhancing the quantity and quality of the healthcare workforce. Without this, the goal of achieving Universal Health Coverage remains an empty promise. Given that primary healthcare is of paramount importance, resources should be allocated to produce competent and dedicated community health workers for the frontline, mid-level health workers or AYUSH doctors for sub-centers, and general and specialist nurses, along with non-specialist doctors, for primary health centers. More specialists are required for advanced healthcare levels, including district hospitals. The establishment of new nursing and medical colleges in districts with limited facilities should be prioritized, establishing strong links with tertiary care hospitals. While it’s encouraging to witness the government setting up new medical colleges at the district level, more must be done to ensure sufficient staff recruitment, reinforce all specialties, establish infrastructure for facilities, enhance emergency care, and upgrade patient care and management in the newly established medical colleges. Public health competencies should be enhanced through interdisciplinary education that aligns with health system requirements. Improved management of all these human resources necessitates enhanced incentives for recruitment and retention, cadre reviews, and the creation of well-defined career paths.
Another area of focus should be the provision of essential medicines and diagnostics free of cost at all public healthcare facilities. Simultaneously, referral linkages and patient transport services need improvement to integrate primary, secondary, and tertiary healthcare within the public system. The difficult-to-reach areas and vulnerable population groups should receive special attention, while the principle of universality must guide the design of healthcare services.
The healthcare regulatory systems require strengthening, from hospital accreditation to health professional education, and from drug licensing to the mandatory adoption of standard management guidelines for the diagnosis and treatment of various health conditions at each level of healthcare.
The establishment of a district-wise interoperable Health Information Network is essential to enhance governance, accountability, portability, health records storage, and management. Furthermore, community participation should be actively promoted to engage people in the design, delivery, monitoring, and evaluation of health programs.
Finally, increased healthcare investments and budget allocation should be directed toward health promotion programs in other sectors such as water, sanitation, nutrition, environment, urban design, and livelihood generation.
Dr. Tasaduk Hussain Itoo is a Physician & Diabetologist/Columnist, Member, Research Society for the Study of Diabetes in India(RSSDI)