As the COVID-19 Pandemic ravaged India, it swept away the mud of complacency that had wedged itself into the psyche of many people. In a country ranked 160th in the world in terms of number of hospital beds per 1000 people with 0.5 hospital beds, and 116th in the world in terms of physicians per 1000 people with 0.86 physicians, the perturbing statistics made themselves glaringly apparent during the second wave of the COVID-19 Pandemic from March-May 2021. Horrifying images of wailing sons and daughters grappling for oxygen cylinders to treat their parents piled on with the endless billows of smoke that blacked out the sky on cremation sites. When interspersed with mega election rallies held simultaneously that became super-spreader events, the Indian healthcare system saw its backbone shattered. This all begs us to ask the question: Has healthcare in India evolved enough since its inception?
I shall explore the answer through 3 major facets: Healthcare Schemes, Infrastructure, and Research. I will delve into how these have changed and how in line with global trends these changes are.
Healthcare Schemes
1947 saw the Indian Government face great uncertainty over healthcare; mass migration of people to and from its borders as a symptom of the Partition threw available statistics into disarray. Additionally, although the figures above offer some semblance of order, it is important to understand that allopathic medicine was the conventional treatment in India at the time: Homeopathy, Ayurveda, and Naturopathy were trusted more greatly, and as a result the figures above could be seen as an undercount of the actual number of healthcare centres available to citizens.
Consequently, the first Five Year Plan aimed to remedy this by gathering more information through the actions of the Bhore Committee. As part of the Bhore Committee’s fact-finding efforts, a slew of measures was introduced:
· The creation of a standardised course for all medical students called the “Bachelor of Medicine and Bachelor of Surgery (MBBS)” Degree. This aimed to centralize the pathway for medical practitioners and increase the number of doctors in the country by providing an uncomplicated and straightforward road to become one.
· The institution of a central institution for medical aspirants called the All-India Institute of Medical Sciences (AIIMS) that aimed to bolster medical research and ensure reputed centres existed in the country for the dispensing of a prestigious medical education
· The development of Primary Health Care Centres (PHCs) across the country to provide allopathic medicine to patients and increase the physician to population ratio
· The integration of preventative and curative medicine into the same centre to prevent patient delays and reduce the mortality rate from communicable and non-communicable diseases.
As evidenced by the schemes launched above, early India focused on standardising healthcare education and treatment options for its population to address the primary concern at the time of a dangerously low physician to population ratio that would be crucial to combating any pandemics and epidemics that could ravage the country at the time. The quick resolution of the 1957 Influenza Pandemic within 8 months and around 1000 deaths gives some evidence to the success of the above measures.
As the above issues became less of a concern, and as India inched closer towards a capitalist economy and not a socialist one, both public and private healthcare schemes were made available in the country. A lack of adequately funded public healthcare services meant many citizens had to pay from their own pockets to get treatments as was the case with medicine that had to imported by patients from abroad because of a lack of availability in India. Current trends in healthcare schemes have focused on improving the affordability of healthcare as a result. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana launched in September 2018 is symptomatic of this shift away from infrastructure development to affordability inclusivity. Aiming to provide free insurance coverage to the bottom 50% of India’s Population, it provides a coverage of $6600 per family per year for medical treatment in both public and private hospitals. The Janshree Bima Yojana and the Pradhan Mantri Suraksha Bima Yojana are other similar policies implemented in recent years that primarily focus on insurance schemes.
Current global trends have reflected a shift in government policies towards a focus on making healthcare more inclusive and affordable. The United States of America saw the implementation of Patient Protection and Affordable Care Act or “Obamacare”, and countries like the United Kingdom, Italy, Spain, Denmark, Sweden, Norway, and New Zealand implemented Beveridge models of affordable healthcare where income taxes from citizens was used to fund public healthcare. In this regard, the recent directives of Indian Healthcare in this space can be seen as lining up with recent global trends in healthcare schemes, but they still fall short of the universal healthcare coverage provided by these Beveridge model countries.
Healthcare Research
1951 witnessed the establishment of the Indian Institute of Technology (IIT) in Kharagpur that was conceived as a way of developing engineers who would then go on to develop technologies that would benefit a wide array of fields including medicine. However, inspite of four more IITs being set up in the next ten years distributed throughout the country, India primarily relied on the Soviet Union and its scientists for new technologies.
Primarily, healthcare research in India early on focused on solving endemic diseases at the time that cost the economy upwards of $1.2 billion. Working with the World Health Organization, vaccine distributions channels were established to eradicate diseases like Polio and Smallpox, and to reduce the spread of other diseases like Tuberculosis and Human Immunodeficiency Virus (HIV).
It was only in the 1980s as economic liberalisation began to take root that healthcare research began in earnest. First came the combat against Diarrhoeal Dehydration that claimed 40% of paediatric hospital beds in the country. Operational and applied research by AIIMS helped eradicate this program in many parts of the country by 1997 through the dispersal of low-cost Oral Rehydration Solutions to rural and urban areas. A Polymerase Chain Reaction (PCR) Test was developed by AIIMS against tuberculosis and leprosy too found a vaccine currently being trialled in Kanpur district. Additionally, the Universal Salt Iodization Program found its roots in India through the laboratory and field trials on its benefits conducted in the country in 1986. When coupled with the current pioneering research done by India in the study of malaria, HIV Diagnostic Tests, Hepatitis C Vaccines, and anti-fertility medicines, it becomes clear that the pace of development of healthcare research in India has been accelerating exponentially in recent years.
However, the statistics in the awards field paints a contrastingly bleak picture. No Indian Medical University is ranked in the top 150. No Indian has ever won a Nobel Prize in Physiology and Medicine since the award was instituted in 1901. The United States has 103 Nobel Laureates in this field, the United Kingdom has 31, Germany has 17, and France has 11. No Indian researcher has ever won the Lasker Award, one of the highest accolades available in the field of medicine, and no Indian surgeon has ever won the Lister Medal, the most prestigious award that can be won by surgeons. These awards are often used as a benchmark for assessing the quality of research facilities and pioneering developments, and they suggest that India is not in line with current trends in global healthcare.
Healthcare Infrastructure and Measures
Healthcare in India after it gained its independence was inadequate. Life expectancy was 32.1 years against a global average of 65.1. The infant mortality rate (IMR) was 145.6/1000 births while maternal mortality ratio (MMR) in 1947 was 2000/100,000 births. There were only 61800 doctors across the country and only 9209 primary healthcare centres covered an area of over 3,287,263 square kilometres. Healthcare had significantly developed from the 1200 hospitals India hosted in 1880, but there was still a long distance to cover to exceed contemporary healthcare trends.
Today, the life expectancy for Indians Is 70.19 years against a global average of 72.74 years. The infant mortality rate in India today is 30 per 1000 births against a global average of 29 per 1000 births. The maternal mortality rate is 113 per 1000 births against a global average of 211 per 1000 births. However, there are only 675,000 doctors in India today with a physician to population ratio of 0.86 per 1000 against a global average of 3.37 in developed countries and 714,00 hospital beds with a ratio of 0.5 hospital beds for every 1000 people against a global average 4.64 for developed countries.
The statistics clearly show how India today is in line with and even exceeds conventional health measures; however, it does lag developed countries in terms of infrastructure. These infrastructural problems compounded and exacerbated the problems initiated by the. COVID-19 Pandemic as evidenced by patients thronging the streets during the second wave owing to a severe dearth in the number of hospital beds available.
Conclusion
Having read about all the benefits and criticisms of the development and changes brought about in the Indian Healthcare System, the onus is now on you. The end of each of the sections on evaluating aspects of the Indian Healthcare System includes a question: Consider the question and answer the question posed to you in the title of this essay- Has the Indian Healthcare System Evolved Enough Since Its Inception?
References
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18. Kalita, Anuska et al. “Public health research in India in the new millennium: a bibliometric analysis.” Global health action vol. 8 27576. 14 Aug. 2015, doi:10.3402/gha.v8.27576
22. Narain, Jai Prakash. “Public Health Challenges in India: Seizing the Opportunities.” Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine vol. 41,2 (2016): 85-8. doi:10.4103/0970-0218.177507
23. Anshu. and A Supe. “Evolution of medical education in India: The impact of colonialism.” Journal of postgraduate medicine vol. 62,4 (2016): 255-259. doi:10.4103/0022-3859.191011
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