Opinion

Making India healthier

Sanjaya Mariwala | Updated on July 21, 2021

Preventive and primary healthcare must be scaled up

The Economic Survey 2020-21 ranked India 179 out of 189 countries in priority given to health in public spending. And such a low ranking comes at a time when the world is moving towards Life Science 4.0. After the success in tackling the first wave of Covid, the country badly faltered in handling the second wave. And, now, the risk of a third wave looms large.

When the number of people falling sick spikes suddenly, the healthcare system is bound to break down. Everything from the availability of doctors to supplies of medicines and other essentials are optimised for normal loads.

While it is important to be cognisant of the number of beds, doctors and paramedic staff in the country, what is equally crucial is to ensure that abnormal loads do not arise. And for that, good protocols, discipline and, most importantly, robust preventive and primary healthcare services are a must.

Acting as a gatekeeper to ensure limited pressure on secondary and tertiary services, preventive and primary healthcare are the first line of defence. There is a need to strengthen primary facilities as the access to tertiary services is limited to those living in the metros and Tier-II cities.

Covid in rural areas

According to SBI Research, the share of rural districts in new Covid cases rose from 46 per cent at the end-April to 53 per cent by end-May. In Bihar and Uttar Pradesh, which have inadequate public healthcare, the share of rural cases in May was as high as 79 per cent and 67 per cent, respectively. This was also one of the reasons why the second wave became a concern for India.

Another dimension is affordability. According to the WHO, about 930 million people worldwide are at risk of falling into poverty due to rising out-of-pocket health spending. Scaling up primary healthcare interventions across low and middle-income countries could save 60 million lives and increase the average life expectancy by 3.7 years by 2030.

The two big challenges of the healthcare industry — access and affordability — can be easily addressed through preventive care that promotes wellness, reduces the chances of lifestyle disorders and related illnesses, and restricts complications arising out of diseases. There is much talk about immunity being a natural vaccine against Covid. People have included preventive-care solutions such as Ayurveda and dietary supplements in their routine.

But immunity cannot be built in a day. It requires guidance and a systematic approach, for which the required infrastructure must be created, nurtured and amplified.

A third dimension to be considered is acceptability. Ayurveda as a theory is the trademark of India, but its application has been limited. Ayurvedic clinics and doctors are still struggling to get recognition. Unfortunately, in people’s minds Ayurveda means retreats, spas and massages, while the fact is it has the potential to provide an effective and inexpensive cure for many chronic conditions. So is the case with other Nature-based sciences like nutraceuticals.

The Indian healthcare industry was valued at $194 billion at end-2020, of which, primary services accounted for $13 billion. According to the Rural Health Statistics 2018-19, the number of primary healthcare centres (PHCs) increased by only 1,619 to 24,855 during the 15 years from 2005 to 2019, with 60 per cent having only one doctor. Also, an average PHC covers 35,567 people and 120 sq. km in rural India.

A report released by the Centre for Policy Research last year shows that in 15 States not a single one of these facilities met the standards set by the Ministry of Health and Family Welfare.

The WHO has pointed out that PHCs are critical to making health systems more resilient and in detecting early signs of epidemics. There is, therefore, a need to strengthen and wisely use the first line of defence to protect the country from public health crises such as Covid-19.

The current healthcare delivery models are skewed in favour of multi-speciality hospitals and restricted to big cities while much of the population lives in smaller towns and villages. There is a need to innovate new delivery models, and both preventive and primary healthcare services can potentially bridge this gap.

The writer is Founder President of the Association of Herbal and Nutraceuticals Manufacturers of India

Published on July 20, 2021

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