The healthcare and clinical sector in India is witnessing a major transition. Both at the government and private level, organizations are continuously involved in capacity building, upgrading themselves with advanced and sophisticated state of the art medical technology. However they are not able to reach the expected mark and have fallen short in addressing the growing disease burden of the country. This is despite the fact that apart from service sector, manufacturing and agriculture, the healthcare and pharmaceutical segments too have emerged as the new entities playing a major role in driving the country’s economic growth.
The health of the healthcare segment has not matched India’s economic growth. Equally with economic growth the challenges facing the hospital industry too have increased in the country. While the disease burden in the country is growing at a rapid pace, the same speed is not seen in enhancing the healthcare capacity and delivery system. The public sector healthcare systems or the government hospitals have failed miserably in providing expected quality healthcare to the large emerging pool of patients both in urban and rural areas.
It was expected that the fruits of economic growth would help in annulling the healthcare problems of the country, but despite pumping in huge sums of money by state and central governments for improving the healthcare indicators like MMR (maternal mortality rate), IMR (infant mortality rate) India has miserably failed to achieve its goals. India’s health sector was allocated Rs 37,330 crore in budget estimates for 2013-14. This is a meagre hike of 8.24 per cent from budget estimates of 2012-13.
The funds crunch had forced the Finance Ministry to reduce the budget estimates for the health sector for the current financial year by over 15 per cent during the year - down from the budget estimates of Rs 34,488 crore to revised estimates of Rs 29,272.56 crore.
Today the challenges of the Indian healthcare are many folds. While the public sector organizations have failed in providing facilities and equipment for quality healthcare in the country, the private sector too is far lagging behind struggling to build its required capacity to meet the growing demand as they are marred by lack of funds and resources. And those few who have managed to establish world class hospitals have made healthcare unaffordable to the common man.
Keeping all these factors in mind, the Government of India at large, and the state of Andhra Pradesh in particular, have brought in many new initiatives and innovative schemes and policy changes in the healthcare to make quality healthcare available to the lowest earner of the society. Among them the National Rural healthcare Mission (NRHM) by government of India, Rajiv Aarogyasri Health insurance scheme for BPL families in Andhra Pradesh are major highlights of the Central and state governments.
Recently the Union health ministry’s initiative to release new Drug Price Control Order, wherein about 348 essential drugs will come under price control to make available these drugs at cost effective and affordable prices to the common man, is also a major step in enhancing the healthcare in the country.
In addition to government’s initiatives, many non-government organizations are also playing their role in improving the healthcare. Among them organizations like FOGSI are taking a lead in imitating programmes to lower the MMR rate in India.
“In spite of many initiatives taken up to improve the maternal and child healthcare, India is lagging far behind in improving the healthcare indicators. Though there is a lot of improvement in lowering MMR below 150/100000 in the southern states of Andhra Pradesh, Tamil Nadu and Kerala, the northern states have fared very bad and moving upwards from 500 to touching 1000/100000 in some states of Uttar Pradesh and Bihar. The total healthcare delivery system in these states is pathetic” said Dr. Hema Divarkar President Federation of Gynaecologists Society of India (FOGSI).
As a part of FOGSI’s initiative to push up the women and child healthcare segment in India, FOGSI has joined hands with the US based international non-profit organization PATH (Programme for Appropriate Technology in Health), to reduce maternal deaths across Karnataka. As part of the agreement FOGSI will campaign for safe and appropriate use of Uterotonics, a drug used to augment labour, through obstetricians, gynaecologists and medical officers by imparting training and hands-on experience.
Talking more on the PATH programme, Dr Hema said, “The Oxytocin initiative project at PATH conducted a review, looking at Uterotonic use at or around birth, and the quality of injectable Uterotonics across the state. The review created awareness on critical issues related to Uterotonic use and misuse during labour and delivery.”
Growth drivers of healthcare in India
Currently the healthcare sector, in India, is at an inflection point and is poised for rapid growth in the medium term. However, Indian healthcare expenditure is still amongst the lowest globally and there are significant challenges to be addressed both in terms of accessibility of healthcare service and quality of patient care. While this represents significant opportunity for the private sector, the Government can also play an important role in facilitating this evolution.
If we look at the size of the healthcare industry, the Indian healthcare sector currently represents about $80 billion industry. As per the 2009 statistics the hospital sector contributes 50 per cent, pharma industry contributes 25 per cent, diagnostics contribute 10 per cent and insurance and medical equipment contribute 15 per cent of its share for the total healthcare sector in the country.
Comparatively India’s healthcare spend is significantly low when compared to western world and other economies across the globe. The Indian healthcare spend is less than half the global average in percentage terms when compared on a “percent of GDP” basis. Today India spends about only 4.10 per cent of its GDP (Gross Domestic Product) on public health where as the global average is around nine per cent.
Among the major healthcare spends, USA is leading with 15.70 per cent of its GDP followed by Brazil and United Kingdom with about 8.40 per cent of their GDP.
The healthcare spend, when compared on the basis of public-private contribution, also depicts a skewed picture. It is noted that private sector contribution to the healthcare sector in India is about 75 per cent which is highest in the world. Public spending, on the other hand, is amongst the lowest in the world which accounts to about 25 per cent, lower than the global average.
Despite the headwinds the healthcare industry is expected to grow to approximately $ 280 billion by 2020 with an average CAGR of 21 per cent for the next 10 years. The drivers of growth for healthcare sector in India include a combination of demographic and economic factors which are all expected to boost the healthcare in the country.
Demographic factors
Increase in population: Expected increase in population from about 1.1 billion in 2009-2010 to 1.4 billion by 2026 is expected to give a major boost to the healthcare growth in the country.
Shift in demographics: Today India has 60 per cent of the population in the younger age bracket and an expected increase of geriatric population from current 96 million to around 168 million by 2026. This represents a huge patient base and creates a market for preventive, curative and geriatric care opportunities.
Rise in disposable income: Households in the above Rs 200,000 per annum bracket can benefit from an increase in disposable income from 14 per cent in 2009-2010E to 26 per cent in 2014-2015 making healthcare more affordable
Increase in incidence of lifestyle-related diseases: There is likely to be a marked increase in the incidence of lifestyle-related diseases, such as cardiovascular, oncology and diabetes, when compared to the communicable and infectious diseases.
Rising literacy: Rising literacy levels is growing general awareness about illness among the population; patient preferences and better utilization of institutionalized care are some of the major aspects driven by literacy.
Economic factors
Tax benefits: Lower direct taxes, higher depreciation on medical equipment, income tax exemption for five years to hospitals in rural areas etc. are being provided by the Government to the sector.
Medical tourism: India emerging as a major medical tourist destination with medical tourism market expected to reach more than $ 2 billion by 2014.
Challenges
Indian healthcare has many challenges. Inadequate number of doctors, lack of availability of well trained healthcare staff at the rural areas, insufficient transport infrastructure, lack of hospital infrastructure such as advanced technological medical instruments and drugs, over-dependence on imports of advanced medicines and medical equipment, lack of research in the areas of innovative drug discovery, lack of funding for research and overall insensitiveness of the local governments to build a robust healthcare delivery system are the major challenges.
Majority of the population in the country are lacking awareness about the diseases and availability of advanced treatment facilities. Even today many in the rural areas prefer to go to a magician for cure rather than a doctor.
Today India needs about six lakh doctors and more than 10 lakh paramedical staff to cater to the healthcare services of the country adequately. At present the government set up has only about 2000 gynaecologists’ who are taking care of women healthcare in the country. Altogether 27000 gynaecologists are serving a population of more than 27 million in India which is accounts to one doctor per every 1000 patients which is far inadequate. As training the lower level staff like ANMS, Nurses is vital in ensuring better results, FOGSI is entering into a memorandum of understanding with government of India to give training to the nurses and ANMS in the country.
Lifestyle diseases, emerging threat to India’s healthcare
Lifestyle diseases have been of late emerging as India’s major healthcare threat. With economic liberalization, open markets have given huge scope for earning and at the same time the pressures at work areas have also increased because of which many diseases related to lifestyle have emerged. Diabetes among them is the most dangerous and mother of many illnesses.
Basically lifestyle diseases are characterized based on the daily habits of people and are a result of an inappropriate relationship of people with their environment.
The main factors contributing to lifestyle diseases include bad food habits, physical inactivity, wrong body posture, and disturbed biological clock. A report, jointly prepared by the World Health Organization (WHO) and the World Economic Forum, says India will incur an accumulated loss of $236.6 billion by 2015 on account of unhealthy lifestyles and faulty diet.
According to the report, 60 per cent of all deaths worldwide in 2005 (35 million) resulted from no communicable diseases and accounted for 44 per cent of premature deaths. What's worse, around 80 per cent of these deaths will occur in low and middle-income countries like India which are also crippled by an ever increasing burden of infectious diseases, poor maternal and perinatal conditions and nutritional deficiencies.
“Type-2 diabetes is emerging as a major threat among the Indian population. Diabetes itself is a worldwide problem. Globally 366 million people are suffering with diabetes as per 2011 statistics. By 2030 it is expected to double. While China is leading in diabetic population with about 97 million, India is second only to China with about 77 million diabetic patients. And Hyderabad is emerging as the diabetic capital of India which is a matter of big concern,” said Dr. Saxena, Chief advisor, Kareus Therapeutics, SA, during a symposium at DRILS in Hyderabad Central University.
According to a survey conducted by the Associated Chamber of Commerce and Industry (Assocham), 68 per cent of working women in the age bracket of 21-52 years were found to be afflicted with lifestyle ailments such as obesity, depression, chronic backache, diabetes and hypertension.
The study ‘Preventive Healthcare and Corporate Female Workforce’ also said that long hours and working under strict deadlines cause up to 75 per cent of working women to suffer from depression or general anxiety disorder, compared to women with lesser levels of psychological demand at work.
The study cited scientific evidence that healthy diet and adequate physical activity - at least 30 minutes of moderate activity at least five days a week - helped prevent NCDs. In India, 10 per cent of adults suffer from hypertension while the country is home to 25-30 million diabetics. Three out of every 1,000 people suffer a stroke. The number of deaths due to heart attack was projected as 1.2 million to two million in 2010.
The diet [or lifestyle] of different populations might partly determine their rates of cancer, and the basis for this hypothesis was strengthened by results of studies showing that people who migrate from one country to another generally acquire the cancer rates of the new host country, suggesting that environmental [or lifestyle factors] rather than genetic factors are the key determinants of the international variation in cancer rates. Some of the common diseases encountered because of occupational lifestyle are Alzheimer's disease, arteriosclerosis, cancer, chronic liver disease/cirrhosis, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, heart disease, nephritis/CRF, and stroke.
Occupational lifestyle diseases include those caused by the factors present in the vicinity like heat, sound, dust, fumes, smoke, cold and other pollutants. These factors are responsible for allergy, respiratory and hearing problems, and heat or cold shock. So, a healthy lifestyle must be adopted to combat these diseases with a proper balanced diet, physical activity and by giving due respect to biological clock.
Kids spending too much time slouched in front of the TV or PCs, should be encouraged to find a physical sport or activity they enjoy. Fun exercises should be encouraged in family outings. A pizza-and-video evening should be replaced for a hike and picnic. Kids who do participate in sport, especially at a high competitive level, can find the pressure to succeed very stressful. To decrease the ailments caused by occupational postures, one should avoid long sitting hours and should take frequent breaks for stretching or for other works involving physical movements.