The big tests of India’s healthcare ambitions

1. Creaky Infrastructure

Is India’s health infrastructure prepared and sufficient to fight the next pandemic? Consider these stats while mulling over this question. India has one of the smallest doctor-to-population and nurses-to-population ratios, implying a shortage of trained medical professionals to cater to citizens. For every 10,000 persons, India has 7.27 doctors, against the World Health Organization’s minimum recommendation of 10.

The progress on health infrastructure has been uneven with a stark rural-urban divide. A health ministry report for 2021-22 showed that community health centres—the third and top tier of public healthcare service in rural India—have an 82% shortfall in paediatricians and 80% for general physicians. The number of auxiliary nurses and midwives (ANMs) at health sub-centres—the first focal point of care—fell to 207,587 in March 2022 from 214,820 in the year before that. Moreover, fewer than half of primary health centres (the middle tier) function round the clock.

2. Organ Paucity

Organ donations are still rare in India. Just 15,561 organ transplants took place last year, led by kidney, liver and heart transplantation. This, even as 49,745 Indians are waiting for an organ replacement, according to data presented in the Rajya Sabha last month. India has an organ donation rate of about 0.52 per million population. In comparison, Spain leads the world with close to 47 donors per million population.

The Transplantation of Human Organs and Tissues Act allows two types of donor transplants—cadaveric and brain-dead transplants, and living-donor transplants through relatives. A whopping 82% of transplants in 2022 were by living donors. Experts point out that cultural and religious beliefs, low awareness, infrastructure issues and cumbersome laws are hampering deceased organ donations. Recently, the government did away with the domicile requirement for registration of patients requiring organ transplantation from deceased donors.

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3. Superbugs Threat

The tendency to pop a pill like candies to treat that minor cold or cough is a lurking threat. No doubt, effective antibiotics have enabled increased lifespans and cured deadly infections. But several bacteria, viruses, and fungi are no longer responding to existing medicines, making infections harder to treat. India has one of the highest burdens of infections driven by such antimicrobial resistance (AMR).

This has been seen in widely-prevalent diseases such as malaria, tuberculosis, pneumonia and E. coli. An Indian Council for Medical Research report last year showed that only 43% of the pneumonia samples containing one particular pathogen in India could be treated with the first line of antibiotics in 2021, lower than 65% in 2016. A similar trend was in E. coli. Tackling this threat requires investments in new class antibiotics on war footing. But India has been woefully falling short. Moreover, little data is available on the funding allocated to AMR research.

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4. Vaccine Wonders

In last four decades, India has put in place a robust public vaccine infrastructure, which not only immunized millions of people annually but has also managed to eradicate polio (2014) and maternal and neonatal tetanus (2015). India’s immunization programme vaccinates 26.7 million newborns and 29 million pregnant women annually. The programme has also been successful in bringing down the mortality rate of under-five children from 74 per 1,000 live births in 2015-16 to 41.9 in 2019-21, according to the National Family Health Survey.

A well-established vaccine infrastructure also helped to successfully produce, administer, and export covid-19 vaccines rapidly. According to a Lancet study, the immunization programme helped prevent over 4.2 million deaths in India. However, people’s trust in vaccines, and lack of trained staff, efficient logistics and cold storage have left the country short of achieving its goal of universal immunization.

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5. Ayushman Bhava?

Around 63% of all health expenses are borne out of pocket by Indian households, according to the WHO. This leaves an unjust stress on household earnings in what is still a largely poor country. Government-paid health insurance has come as a relief to many. Over a dozen state- and centrally-sponsored health insurance schemes provide financial assistance.

The Centre’s Ayushman Bharat, launched in 2018, has emerged as one of the flagship schemes, with over 370 million registered users. It has so far catered to 43.4 million hospital admissions worth ₹51,749 crore, according to the health ministry. However, a consistent, gross under-utilization of funds allocated underlines the challenges faced in implementing such a large-scale scheme. The burden of the increasing population, the concentration of health services in urban areas, and the lack of awareness about the scheme are the major roadblocks in its implementation.

View Full Image

1. Creaky Infrastructure

Is India’s health infrastructure prepared and sufficient to fight the next pandemic? Consider these stats while mulling over this question. India has one of the smallest doctor-to-population and nurses-to-population ratios, implying a shortage of trained medical professionals to cater to citizens. For every 10,000 persons, India has 7.27 doctors, against the World Health Organization’s minimum recommendation of 10.

The progress on health infrastructure has been uneven with a stark rural-urban divide. A health ministry report for 2021-22 showed that community health centres—the third and top tier of public healthcare service in rural India—have an 82% shortfall in paediatricians and 80% for general physicians. The number of auxiliary nurses and midwives (ANMs) at health sub-centres—the first focal point of care—fell to 207,587 in March 2022 from 214,820 in the year before that. Moreover, fewer than half of primary health centres (the middle tier) function round the clock.

View Full Image

2. Organ Paucity

Organ donations are still rare in India. Just 15,561 organ transplants took place last year, led by kidney, liver and heart transplantation. This, even as 49,745 Indians are waiting for an organ replacement, according to data presented in the Rajya Sabha last month. India has an organ donation rate of about 0.52 per million population. In comparison, Spain leads the world with close to 47 donors per million population.

The Transplantation of Human Organs and Tissues Act allows two types of donor transplants—cadaveric and brain-dead transplants, and living-donor transplants through relatives. A whopping 82% of transplants in 2022 were by living donors. Experts point out that cultural and religious beliefs, low awareness, infrastructure issues and cumbersome laws are hampering deceased organ donations. Recently, the government did away with the domicile requirement for registration of patients requiring organ transplantation from deceased donors.

View Full Image

3. Superbugs Threat

The tendency to pop a pill like candies to treat that minor cold or cough is a lurking threat. No doubt, effective antibiotics have enabled increased lifespans and cured deadly infections. But several bacteria, viruses, and fungi are no longer responding to existing medicines, making infections harder to treat. India has one of the highest burdens of infections driven by such antimicrobial resistance (AMR).

This has been seen in widely-prevalent diseases such as malaria, tuberculosis, pneumonia and E. coli. An Indian Council for Medical Research report last year showed that only 43% of the pneumonia samples containing one particular pathogen in India could be treated with the first line of antibiotics in 2021, lower than 65% in 2016. A similar trend was in E. coli. Tackling this threat requires investments in new class antibiotics on war footing. But India has been woefully falling short. Moreover, little data is available on the funding allocated to AMR research.

View Full Image

4. Vaccine Wonders

In last four decades, India has put in place a robust public vaccine infrastructure, which not only immunized millions of people annually but has also managed to eradicate polio (2014) and maternal and neonatal tetanus (2015). India’s immunization programme vaccinates 26.7 million newborns and 29 million pregnant women annually. The programme has also been successful in bringing down the mortality rate of under-five children from 74 per 1,000 live births in 2015-16 to 41.9 in 2019-21, according to the National Family Health Survey.

A well-established vaccine infrastructure also helped to successfully produce, administer, and export covid-19 vaccines rapidly. According to a Lancet study, the immunization programme helped prevent over 4.2 million deaths in India. However, people’s trust in vaccines, and lack of trained staff, efficient logistics and cold storage have left the country short of achieving its goal of universal immunization.

View Full Image

5. Ayushman Bhava?

Around 63% of all health expenses are borne out of pocket by Indian households, according to the WHO. This leaves an unjust stress on household earnings in what is still a largely poor country. Government-paid health insurance has come as a relief to many. Over a dozen state- and centrally-sponsored health insurance schemes provide financial assistance.

The Centre’s Ayushman Bharat, launched in 2018, has emerged as one of the flagship schemes, with over 370 million registered users. It has so far catered to 43.4 million hospital admissions worth ₹51,749 crore, according to the health ministry. However, a consistent, gross under-utilization of funds allocated underlines the challenges faced in implementing such a large-scale scheme. The burden of the increasing population, the concentration of health services in urban areas, and the lack of awareness about the scheme are the major roadblocks in its implementation.

View Full Image