CHALLENGES OF

HEADING SUB HEADING Healthcare in India Maternal Healthcare Geriatric Healthcare Primary Healthcare Non Communicable Diseases Public Healthcare
1. high OOPE (50%)- world avg. 20% 1. high OOPE despite govt 1. low/no pension and insurance 1. affordability - 5cr individuals fall 1. 60% burden of NCD - chronic diseases 1. high OOPE due to medicines - 70%
2. affordability - 5cr indiv fall into sponsored 2 trimesters cover for old age people into poverty annually due to lead to multiple drain of wealth cost
Affordability & OOP
poverty annually due to catastrophic 2. high cost of nutritious foods 2. feminisation of old age- low/no catastrophic health expenditure 2. 85% deaths due to NCD in low and 2.
Expenditure
health expenditure income middle incone class - WHO
3. affluence linked healthcare 3. Only 7% people in India can afford
PATIENTS mental health treatment
1. Urban areas have 4X more 1. unsafe abortions & deliveries 1. diagnostic tools outdated, 1. <50% Primary Health Centres 1. lack of customised and directly, (44%
personalised 1. only 10% (540/5800) community
doctors than rural areas 2. poor awareness- eg. First milk 2. shortages of essentials - oxygen (PHC) function 24×7 healthcare for NCD healthcare centres have all 4
Service Quality 2. only 10% (540/5800) community (colostrum)feeding 3. missing medical history/reports 2. timely golden hour interventions 2. lack digital interoperability of records specialists
healthcare centres have all 4 lacking 2. shortage of essentials- medicine,
specialists- Rural Health Statistics 3. 40% lack access to basic oxygen
2021-22 (RHS) people- Ind-2, WHO-
1. nurses/1000 1. nurses/1000 people- Ind-2, WHO- 1. less focus on geriatric healthcare
1. Urban PHC face shortage of ~20% 1. PHC lack exertise in NCD care 3.
1. fire breakoutspeople-
nurses/1000 - disasters
Ind-2, WHO-
3, 3, specialisation in medical courses staff -RHS(2021-22) 2. Need 3 psychiatrists per lakh (India-0.7) 3,
Shortfall of Personels 2. 80% shortfall of all 4 specialist in 2. 80% shortfall of all 4 specialist in 2. no geriatric specialisation in Old 2. 80% shortfall of all 4 specialist in 2. 80% shortfall of all 4 specialist in
rural healthcare - surgeons, rural healthcare - surgeons, age homes. rural healthcare - surgeons, rural healthcare - surgeons,
obstetricians and gynaecologists, obstetricians and gynaecologists, obstetricians and gynaecologists, obstetricians and gynaecologists,
physicians,
1. beds/1000paediatricians- RuralWHO- physicians,
people India-0.6, paediatricians
1. unsafe institutional delivery 1. not old age friendly- reduced physicians,
1. shortage paediatricians-
of PHC= 1PHC on Rural 1. poor diagnostic tools for NCD. physicians, paediatricians
1. overcrowded OPD- unhygeinic
5 rooms- (LAQSHYA Scheme) mobility, average per number of villages Unaffordable for smaller PHC and District open spaces
DOCTOR +
Health Infrastructure 2. dilapidated infrastructure in PHC 2. diagnostics test ultrasound 2. import dependency on medical (India-28, UP-35, Karnataka- 15)- hospital 2. poor digital healthcare- rural
HOSPITAL
and sub centres- 1. <50% Primary machines misused unavailable in devices- disgnostic, surgery, medical
Min o H&FW 2. high import dependence on medical internet quallity,
Health Centres (PHC) function 24×7, rural PHC aid 2. Lack medicine & vaccine storge devices and implants
Lack
1. Pvtproper
sectorVaccine
focus onstorage
tertiarycold facility-
1. poor family planning, less focus on 1. over foucs on physical disabilities 1. eg. During
less attention oncovid
PHC functions of 1. focus on Lifestyle corrections missing- 1. tertiary hospitals performing
healthcare. health of girl child, early pregnancy and neglect of old age nutrition and communicable diseases, over post care of chronic illnesses (cancer, primary tasks- overcrwoded OPD
Inverted Pyramid ( Curative) 2. specialist doctors concentrated in 2. less %age of women access lifestyle 2. rural lifestyle and livelihood diabetes, CVD) 2.
urban areas in tertiary. postnatal care 2. missing doorstep medical service related curative measures not 2. focus only on curative post issue -
3. Neglect of early intervention, delivery suggested by PHC depression anxiety, not on curative mental
community
1. health
Health- state centres
subject, butand
many 1. central scheme for maternal 1. centre sponsored scheme - vaya 1. convert 1.5lakh PHC in HWC wellbeing
1. NP-NCD (2023-2030)- funding allocation 1. issues with health insurance and
national level schemes Ayushman health vs states burden on vandana yojana and medical aid under ayushman bharat and implimentation issues ayushman bharat- states vs centre
Fragmented & State List Bharat, National health mission implimentation - janani suraksha, devices - not fully implimented 2. regional disparity in PHC 2. delinked mental health from physcial 2. private focus more on urban
implimented slowly by states matru vandana 2. no holistic govt plan for availability (south+Maharashtra health tertiary care, govt allocations more
GOVERNMENT 2. rajasthan - right to health bill 2. regional disparities in states for population ageing issues more dense than north) for rural healthcare but not utilised
& issue MMR
1. total expenditure of 3.3% (target 1. support to ASHA workers and 1. longevity research lacking- 1. Underutilisation of funds for PHC 1. Government funding for mental health 2. 1. only 1.9% spent on healthcare
REGULATORS
6%)- govt expenditure of only 1.9% ANM is too low 2. Ayush focus on Old age care development. low (~1% of the total health budget) 2. private health insurance issues-
inadequate funding & R&D (OECD 9-10%) 2. few start ups in maternal health 3. limited start ups in online geriatric 2. more funds diverted to secondary 2. no standalone policy, claims
2. poor industry academia linkage and hygiene care only and tertiary healthcare settlement etc
for Biotech, pharma, medical devices 2. decline of MMR to 97(nfhs 5) 3. linking lifestyle affluence with 3. international BMGF, World bank
research
1. in india
Universal Healthcare- for all sdg from
1. 130 (2013),
continumm yet very
of care- high
from pre 1. holistic care- chronic illness, healthcare
1. (eg. promotive
current focus on curativehealthy
health 1. NCD not seen as cumulative issue of funding
1. yet tobut only in few
incorporate pockets
One health in
3.8 conception health to post natal preventive healthcare, mental care, physical disabilities. need limited nutrition, unhealthy lifestyle, lack rural area - human health, poultry-
"One Health" Concept &
2. lack preventive, promotive health health (20% of old age) Expanded- NCD, Mental health, of Yoga, contaminated water. dairy health, agro-forests health
Narrow Definition
healthcare, rehabilitative 2. childcare 2. youth and adult awareness geriatric, adolescent 2. seen as end result and not process- 2. expand public healthcare beyond
CONCEPT OF 3. Complete health- Healthcare- healthy lifestyle for future 2. ONE health- rural + Urban, requires continumm of care approach curative primary health to mental
HEALTH hygiene-WASH-Nutrition-lifestyle
1. malnourishment (25% male and 1. >50% women anemic 1. homeless and destitute old age People+animal+environment,
1. >70% population dependent(vet on 1. high stress, sedentry lifestyle health, NCD,
1. poverty preventive
induced healthmaternal
crisis-
female, 30% children) 2. meta son preference- women parents (solitude), feminisation of PHC 2. menatl health as taboo in society - malnourished, more immune to
Other Socio-Economic
2.WASH- hygiene and water health neglected elderly 2. low literacy leads to low silent pandemic diseases, filthy conditions, pollution
Parameters
contamination 3. women with no education 2. 1 extra year of life expectancy healthcare services access (kerala vs 2. education and awareness of early
3. culture of neglect towards TFR=2.8 (with 12years education = increases GDP by 4% MP) signs of illness, NCD symptoms.
healthcare, piecemeal apporach for 2.8) 3. Food and Nutritional security- (ignorant attitude- only about 25%