While we can proudly say that we fared better than most developed nations with regards to the pandemic in the first wave, in the current surge, it has exposed our weak healthcare system, of course, along with it our grit and resourcefulness as well to get things done! Nevertheless, it is time to spruce up our health systems, and very specifically we need to start with the primary care. And we need to start at the grassroots in the rural areas. For, this is where will lie our prosperity—health wise as well as cost wise. Our primary systems need to be enabled to nip the evil in the bud.
India has one of the largest primary healthcare set-ups in the world, from an infrastructure perspective. With our three-tiered primary health system, each sub-centre covers a population of three-to-five thousand people, each Primary Health Centre (PHC) covers a population of twenty-to-thirty thousand, and a Community Centre around eighty thousand to a lac. This three-tiered system covers every nook and corner of the country. Fact is, however, that despite this large spread across the length and breadth of the country, the health coverage remains scarce, especially in the rural areas. Eighty percent of health coverage is still provided by private players. However, this is also unevenly distributed with a concentration in large cities.
The moot question is that when we do have the basic infrastructure available for good primary healthcare services funded by the government, why is there still a lag in such a life critical service? The answer lies in the low doctor-patient and the nurse-patient ratios in our country. And this could be attributed to a considerable brain drain as well as owing to lack of opportunities. While the capacity for education in these streams has been increasing over the last few years, owing to the lack of quality of faculty and other resources, this is impacting the speed and quality of student output.
The private sector has lately seen the advent of the primary healthcare services or retail healthcare over the last few years. However, there are few success stories in primary care, or, rather the story in this sector is still evolving. The cost of the offering is high, profits low and thus few takers from the investment standpoint for the traditional brick and mortar models. And with the evolving needs for home healthcare and other specialised models, primary healthcare is taking a backseat.
The key concerns for availability of primary healthcare services, with this background, remain – accessibility, quality and cost. All three challenges because of the uneven distribution of available skillset outside of the urban areas. And the outcome of these challenges is the increased chronic disease burden, increased mortality, eventual higher cost of treatment and disability as a result of delayed treatment. Each of these aspects affect economic productivity and output apart from the cost burden of the public healthcare services through public health institutions or the public health instruments offering free treatment through the private sector.
Thus, it is imperative that to reduce the cost of provision of healthcare and the disease burden itself, good primary care as well as wellness be promoted and early diagnosis be done – nip the evil in the bud. This is only possible through provision of good primary healthcare services. Come to think of it, many lives have been lost in the pandemic itself because of delayed diagnosis and treatment, not just because of the disease itself.
It is time to infuse digital support to the basic rung of our healthcare system. With the scarcity of doctors in general and doubly so for specialists and super specialists, this is one way to overcome the challenge of non-availability of physicians in the rural setups. A support system of physician assistants can greatly aid the system and the community.
It is also time to recognise benefits of Point of Care (PoC) diagnostics. With these, the early diagnosis in the primary facilities is eased and made possible because they do away with the need of elaborate lab setups. Also, these do not require the presence of specialised skillset of laboratory technicians and physicians.
The evolution of connected devices is another area that can help in overcoming accessibility and availability challenges in the rural regions. This is supportive of regular monitoring of health conditions of patients suffering from chronic diseases leading to early interventions. These early interventions prevent serious health deterioration episodes and of course lowers the cost of treatment eventually. There are a lot of our youth who are engaged in innovation of such devices and applications. It is indeed time to put these to use.
The primary healthcare system also needs to take a positive step towards wellness and prevention of diseases. Here again a lot of these PoC diagnostics and connected devices can be very useful for regular health checks. Digitisation can help through health trackers. A lot of these are now being deployed by insurance companies. An application of similar trackers at the PHC levels can be useful for promoting wellness and disease prevention.
Simple interventions can help in not only modernising our clinics but also enhancing the scope of disease management through digital mode. Artificial Intelligence (AI) can also support in decision making on one hand as well as supporting population health management at the community level. At the disease management level, AI can support not only simple decision making but also reducing judgment errors while also enriching the diagnosis with data showing evidence of various treatment modalities. At the community level, data collected through these modalities can help in disease profiling and early pick up of signs of any mass illness / epidemic events more easily.
In a nutshell, the solution to our challenges of skill availability, quality and cost can all be overcome through the modern-day tools supporting and working in sync with the traditional models. They cannot for sure be seen as competition. The very possible solutions have been pushed aside in the past only because of the seemingly competitive positioning of these models. It is time for these to actually sync in with the rudimentary models offering them a boost. Digital health management is definitely in but the final solution comes only through these boosting the traditional models to start with. The delivery of primary healthcare services can contribute to the national health statistics way more effectively through digitisation. While digitisation has been adopted way more successfully over the past years at the tertiary level, the similar application can bring a boost to the neglected rural sectors.
There is a solution for each of the cited challenges, through varying modes of partnership, and, methodology of service provision. There also remains a good business promise with lowered cost. And at the top of this will be a healthy community and a healthy nation.
