Striking at the Roots- Structural Reforms for Improving Accessibility

The Covid-19 Pandemic shed light onto the structural weaknesses in the healthcare systems worldwide. In India these issues were found to be rooted in regional disparity, behavioural patterns and structural inefficiencies. While existing schemes such as Ayushman Bharat were introduced to make healthcare accessible, there is still a lot of room for improvement. There is a dire need for structural reforms as the system is plagued by issues like basic necessities like healthcare difficult to access and the system calls for solutions that strike at the root of these.

What are the Issues Faced by the Healthcare System?
During the Covid-19 Pandemic, India invested heavily in healthcare-- direct benefit transfers and its famous vaccine drive all the while recognising the structural weaknesses in the healthcare ecosystem. However, it is now essential to recognise and address these weaknesses to strengthen the system for not just future crises but enhancement of day to day healthcare delivery, which is why it is essential to navigate the basic issues existing in the system.

The majority of the Indian population struggles to access healthcare due to urban-rural disparities. A study revealed that 80% of experts live in metropolitan regions. Rural residents struggle not just to access expertise but even the primary healthcare centers(PMCs). This is in spite of the fact that a major chunk of the population continues to reside in rural areas and thus struggles to access healthcare services as compared to their urban counterparts.

Those who do have access to healthcare facilities have to face the brunt of inefficiencies. A research undertaken to understand the quality of primary healthcare found that only 37% of PMCs were efficient. This suggests that often those who are able to access government hospitals face issues with accessibility, waiting time and general patient dissatisfaction.

Poor healthcare has consequences greater than itself. It can keep individuals stuck in a poverty trap. The book, ‘Poor Economics’ highlights that health affects income generation negatively. Sick mothers give birth to sick babies, these sick babies grow up to do poorly at school and thus continue to live in poverty. This shows that individuals who do not get sufficient care in their early years are bound by the limitations of their environment, making them unable to achieve their full potential.

Another addition to these state of affairs is the fact that often preventive measures are not taken seriously by individuals living in poverty. This is another issue observed rampantly that people are not taking simple preventive measures that could save lives. This is not a structural issue at first glance, it comes off as a behavioral pattern, however behaviour is not just determined by inherent genes, but also the environment inclusive of the socio-economic factors. Lack of awareness, strong beliefs, social norms, distrust towards the healthcare system lie at the core of these behaviours.

Government’s Efforts for Healthcare
The government quite naturally is also aware of these issues and therefore has introduced schemes like the Ayushman Bharat Scheme. The scheme has undertaken the obligation of running vaccination drives through its Health and Wellness Centres (HWCs). The government has even expanded the budget for healthcare estimating to a 9.46 percent increase from the 2025’s budget estimates. This increase is expected to improve infrastructure, strengthen existing programs and focus on maternal and child healthcare. But this is just one part of the solution. The healthcare industry of India needs systematic changes in order to better its accessibility.
However, the aforementioned increase which boils down to the amount of INR 95,957.87 crore still accounts for only 1.94 percent of the total budget, which reflects a declining proportion when compared to the previous years and has been a cause of concern.

Striking at the Roots- Policy Recommendations

To address the core structural weaknesses of the healthcare system in India, a holistic approach needs to be adopted, one that involves all stakeholders and all facets of the system including doctors, nurses, PMCs, patients etc. Following are some measures that can be implemented-

Train individuals from rural areas to become doctors- Increasing the number of medical schools and providing incentives to doctors to move their practice to rural areas are essential to bridge the regional disparity. Skilling of locals and incentivising professionals to volunteer or base themselves in rural areas can enhance the access to quality of healthcare provided.

Make Primary Healthcare Centers accountable- Conduct regular checks on the functioning and outcomes of the PMCs. Mobile health teams should regularly engage with PMCs. More autonomy on administrative and financial powers of PMCs must be given to local committees.

Training government hospital staff for better caregiving- Personnel in government hospitals can be trained to ensure these principles are being followed to improve the patient satisfaction level. Deloitte mentions five key elements in patient satisfaction- personalised, simple, efficient, consistent and proactive engagement. Each of these can be worked upon.

Involving community in healthcare drives- Community engagement programs can be run to generate awareness, understand the needs of the people and localise solutions catering to those very needs. By decentralising the administrative and financial power and giving more power to the local communities to make their own decisions can greatly improve primary healthcare delivery.

Effective monitoring and evaluation of schemes and sharing of data on public platforms for transparency- Effectively monitoring and regular evaluation of the performance of schemes with quick implementations of adaptations needed can yield better results for the schemes. Data regarding the schemes can be published publicly to ensure greater transparency, while keeping personal details of citizens availing the schemes hidden to ensure privacy.

Promoting preventive measures: By taking means to make preventive actions seem worthwhile to people, more lives can be saved, suffering can be lessened and healthcare outcomes can be improved.

Conclusion
Covid-19 pandemic served as an eye opener to the inherent weaknesses in the existing healthcare systems across the world. Post pandemic it is necessary to address these to strengthen the system and enhance the quality of healthcare and the first step is ensuring accessibility. The government needs more manpower and dedicated efforts to strike the roots of the issue. By improving the efficiency of the existing schemes, infrastructure, educating more healthcare workers can yield better results from it and further contribute to the cause. By keeping patients in the center of the approach to improving healthcare by working on increasing patient satisfaction can make government hospitals more accessible. These measures, if implemented, can improve the quality and accessibility of healthcare for a huge section of the population. Action drives change, and change is the need of the hour!