The Daily Challenges Faced by Public Hospitals in India

Despite the Natural Rural Health Mission being exerted over almost a decade since 2005, and continuous medical education till date, the public health system in the country is miserable.

According to the World Health Organisation (WHO), the doctor to citizens in a country ratio must be 1:1000; whereas there is?only one doctor per 1,700 citizens in India?. The Union Health Ministry claim that there are about 6-6.6 lakh doctors available in India; but we need about 4 lakh more by 2020.

The differences

The modern day hospitals are deemed as the ultimate healthcare centres by many, but the truth is that their services have become unaffordable to many common people due to the policy framework governing the medical sector in the country. Public hospitals are becoming more and more detached from the modern context in which medicine is now being operated.

source:

• The New Indian Express

For a developing country like India where there is an increase in the number of rare medical cases reported from rural areas, the public healthcare system is going to continue being important for a very long time in order to reach out to the underserved population.

According to the 12th Five Year Plan Document, the objectives set out to improve the existing conditions are:

• i. Elucidate the more important challenges facing public hospitals in India and document their enormity.

• ii. Understand the social, economic and political sources/ factors leading to the emergence of these challenges.

• iii. In accordance with the aforementioned analysis, propose solutions that are feasible within the present political and economic system.

Apart from these, the higher public healthcare facilities have been given the responsibility of providing supervision, training and technical support to facilitate smooth functioning of the low level facilities.

Major challenges faced by public hospitals

The?main challenges confronting the public hospitals? are:

1. Deficient infrastructure

The Bhore Committee Report, formed in 1946 laid down the format of the public healthcare infrastructure in the country. As per the committee's overall plan for development of health care services in India, the goal was to achieve 1.03 beds per 1000 population within ten years of implementation of the plan. The public hospitals are nowhere close to the mentioned numbers.

2. Deficient manpower

In addition to deficiency of health infrastructure, deficiency of human resources causes further harm to health. This occurs at different levels - between regions, between rural and urban areas, and between public and private sectors; because there is an increasing unwillingness of doctors and other health personnels to serve in rural areas.

The deficiency of specialist in rural healthcare is as high as 90% in Chhattisgarh, Jharkhand and Rajasthan; it is nearly 86% in Uttarakhand and Odisha.

3. Unmanageable patient load

Secondary level of public hospitals in bigger cities are experiencing a heavy rush in of patients. The sudden increase in Indian cities has resulted in urbanization of rural poverty; which has caused an exponential expansion of slums and populations starved of health and other basic health amenities. The lack of urban health infrastructure has led to overcrowding in hospitals, lack of outreach and functional referral system, standards and norms of health care delivery system being compromised, unavailability of modern health care facilities and a stupendous rise in prices of the amenities causing a lack of purchasing power.

4. Equivocal quality of services

Lack of infrastructure and patient overload is bound to undermine the quality of services being provided by the healthcare facilities. The quality of services has deteriorated over the last two decades, pursuing the neoliberal policies in general and health sectors which were created to strengthen the private healthcare sector. The growing dominance of private hospitals has led to public hospitals outsourcing most of their services like security, laundry, cleaning, kitchen services, diagnostic and curative facilities to them, forming a public-private partnership.

One of the public hospitals that is continuing to face this challenge is "Chacha Nehru Bal Chikitsalaya", which is a Delhi government run child care hospital. The hospital continues to face difficulty in arranging sufficient resources for the required expansion of infrastructure to accommodate the rush of patients.

5. High out of pocket expenditure

In 2004-05, the National Health Accounts for India stated: "Among all the sources, households contributed a significant portion at 71.13% of total health expenditure for availing health care services from different healthcare institutions. This covers expenditure on inpatient, outpatient care, family planning and immunization and so forth."

India’s current public health expenditure fails to match those of even the least developed countries and sub-Saharan Africa.

Posted by: Vanhishikha Bhargava (http://www.buzz4health.com/blog/authors.html )