Following the Covid-19 pandemic, a key portfolio decision that healthcare policy must make is about the relative importance placed on communicable versus non-communicable diseases (NCDs), stated the survey authored by chief economic advisor Krishnamurthy Subramanian.
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“As the next health crisis could possibly be drastically different from Covid-19, the focus must be on building the healthcare system generally rather than a specific focus on communicable diseases,” the economic survey report said.
The report highlighted that 71% of global deaths and about 65% of deaths in India are caused by NCDs. Between 1990 and 2016, the contribution of NCDs increased 37% to 61% of all deaths. Further, preventing communicable diseases requires focus on better sanitation and drinking water, which the Swachh Bharat and the Har Ghar Jal Abhiyan campaigns are focusing on, the survey report recommended.
As pandemics represent rare events, healthcare policy can become a victim of “saliency bias”, which involves over-weighting recent phenomena, the economic survey report said.
The report highlighted that despite improvements in healthcare access and quality (healthcare access and quality scored at 41.2 in 2016, up from 24.7 in 1990), India continues to underperform in comparison to other Low and Lower Middle Income (LMIC) countries.
On quality and access of healthcare, India was ranked 145th out of 180 countries according to the Global Burden of Disease Study 2016. Only few sub-Saharan countries, some pacific islands, Nepal and Pakistan were ranked below India, the report pointed out.
“India still needs to improve significantly on metrics of maternal mortality ratio (MMR) and infant mortality rate (IMR). Countries such as China, Bangladesh, Bhutan, Cambodia, etc. have improved much more on these metrics than India,” the economic survey said.
The survey indicated that in India there is lower utilisation and access to healthcare in the country.
“At 3-4%, the hospitalisation rates in India are among the lowest in the world; the average for middle-income countries is 8-9% and 13-17% for Organisation for Economic Co-operation and Development (OECD) countries,” the report said.
“Given the increasing burden of NCD, lower life expectancy, higher MMR and IMR, the low hospitalisation rates are unlikely to reflect a more healthy population as compared to middle income or OECD countries. Thus, the low hospitalisation rates reflect lower access and utilisation of healthcare in India,” it said.
World Health Organization (WHO) identified an aggregate density of health workers to be 44.5 per 10,000 population and an adequate skill-mix of health workers to achieve composite SDG tracer indicators index by 2030.
Although aggregate human resources for health density in India is close to the lower threshold of 23, the distribution of health workforce across states is lop-sided. Also, the skill mix (doctor/nurse-midwives ratio) is far from adequate, the report said.
According to the report, the State-level variations in the density of health workers and the skill mix reflects that while Kerala and Jammu and Kashmir have a high density of doctors, states like Punjab, Himachal Pradesh and Chhattisgarh have a larger number of nurses and midwives but a very low density of doctors. Andhra Pradesh, Delhi and Tamil Nadu reflect a better balance of doctors and nurses and midwives, the report said.
The economic survey recommended that every hospital may be equipped so that at least one ward in the hospital can be quickly modified to respond to a national health emergency while caring for the normal diseases in usual times.
Research in building such health infrastructure can guide how to build such flexible wards, the survey further recommended. The ongoing covid-19 pandemic has helped showcase the role of technology-enabled platforms as an alternate distribution channel for remote delivery of healthcare services.
“These technology-enabled platforms offer a promising new avenue to address India’s last-mile healthcare access and delivery challenges. These technology platforms coupled with digitisation and the promise of artificial intelligence at-scale, have led to a drastic uptake in the utilisation of telemedicine for primary care and mental health,” the report said.
“Given India’s unique last mile challenges, such technology-enabled solutions need to be harnessed to the fullest. As we show, telemedicine depends crucially on internet connectivity and health infrastructure. Therefore, both Central and the State governments need to invest in telemedicine on a mission mode to complement the government’s digital health mission and thereby enable greater access to the masses,” the report further said.