Tag Archives: state of healthcare in India

How Google is influencing Healthcare in India

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Google today announced that it will make available access to more than 400 health conditions on their search site in English and Hindi for the India’s population. This feature is already available in the US and recently they have also started in Brazil.
In India Google will do a check of the condition and symptoms partnering with Apollo Hospitals and Columbia Asia.
Google being the go-to site for search, Google wants to bring Health education to the finger tips of its users. With mobile subscriptions crossing over 800 Million and phone based search reaching more than half a billion users, this will definitely help users to be more aware of themselves and the symptoms they have.
I wrote about educating the Healthcare consumer few days ago and this is one way of educating the consumer. I am sure that over the period of time, Google may start suggesting the Doctors / Hospitals / Clinics you can visit for the kind of symptom you have searched including providing finger tip taxi booking along with medicine delivery.
Is this not what the future is?

What has changed in Indian Healthcare landscape?

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According to the World Economic Form and Harvard Public School, the probability of during the most productive years – 30 Years to 70 Years is predominantly because of non-communicable diseases like Heart stroke, heart diseases, pulmonary diseases, and diabetes. This is accounting to 26% of death’s in India in this age group.
India struggled to bring down the Infant Mortality Rate (IMR), Maternal Mortality Ratio (MMR) which have been the key metrics. However, over the last two decades, this has significantly come down and it is on a positive note.
While we are improving on the metrics, due to the changes in lifestyle, there are non-communicable diseases which are increasing leading to disparities in the Healthcare in the country. The Government’s spending on Healthcare has also has been reducing.
Private Healthcare services is on the rise. This calls for out-of-pocket expenditure on Healthcare. Since India has a good number of people living below the Above Poverty Line, the affordability for quality Health services is also one of the primary reason for the rise in non-communicable disease not being addressed at the appropriate time. Most of the out-of-pocket expenses are for medicines.
With startup’s focusing on bringing Healthcare to all (even though the predominant acceptance is in Tire 1 and 2 Cities), I look at this as a possible approach to bridge the gap between Doctor and the Patient. Looking at the mobile penetration rate which has crossed over 800 Million today, I personally see that technology can help bridge the gap.
What we need at this time is the education of the consumer on how to use the services.

How can Big Data change Healthcare?

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How can Big Data change or transform Healthcare? We capture Insurance information, medical history and wearable devices can track the lifestyle and provide more in-depth information on how the person actually is.
Have you noticed how a couple’s who have been together for longer periods communicate? They talk with their eyes many times. Whereas younger couple speak and share their thoughts and opinions. What happens over a period of time is that one gets to know the other better and mostly each one is proactively involved with each other.
In the same way, initially the data collected by the wearable devices can do a lot of talking and provide various parameters, but only over extended periods of time can the data be providing analysis. Patterns on how various lifestyle’s effect health and how to ensure quality care and take appropriate precautions are just a few things we can analyze from the data we collect. Insurance companies can use data to offer custom Insurance plans which can be more beneficial, Hospitals can provide personalized care, Individuals can themselves monitor and manage their health proactively.
Can Big Data alter the lives? To begin with, Yes. It can. All depends on how we are capturing and utilizing the data.
Do you agree?

How to build India’s HealthCare System?

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India is always compared to US, a nation which has established it’s 300 Years of Independence and quite a few times, the policies are compared and contrasted with the US. I personally feel we should not do this comparison and focus on how to build Innovative solutions to address the needs of a country like India.
India is 4 times more in population when compared to the US and we are an economy which has been struggling to establish itself in the 65 Years of Independence. I do not wish to go into history, but just a point of reference when in 1800’s, India was one of the richest land’s in the world and hence we have been invaded by quite a few people and finally ruled until 1947. There was a lot of damage done and we should take responsibility for it.
What is over is over and today, we are a nation of proud accomplishments. From the recent Mission to Mars to the complete eradication of Polio, it is not an easy task when a country has such a varied distribution of population and practices of many native medicine.
In India, the Union Government is responsible for allocating Budget for Health Services. This money is distributed to the State Government’s considering various parameters and the State Government’s are responsible for delivering Health Services to the common man.
If we go deeper into understanding how the HealthCare is structured in India, the Primary HealthCare Centre is the first point of contact for any of its 1.2 Billion Population. A PHC serves to a population of anywhere between 1,500 – 5000 people. For more information on the exact numbers and categorisation, please refer to my earlier blog post on HealthCare Infrastructure in India and my other posts under HealthCare in India category.
Today, the need of the hour is for us to push for some strong amendments to the HealthCare Law in India. Here are few of my thoughts on how we can work on building the foundations for a stronger HealthCare system in India.
1. On-line or Centralised Drug Database – This might look naive, however, this plays a very crucial role in building up a strong Health Delivery System. For technology to play a bigger role in building up India’s Health System, having a central Drug database is a must and the first step.
2. Fee Regulations for Private HealthCare – We hear the economic distribution of Private Vs. Public Health in almost all the case studies on HealthCare in India. 70% is still out of pocket. We need to have a law to regulate the cost of basic Health Services across the country. For example, for a first / basic consultation, the Doctor fee or the Hospital charge should be same across the country. This will help in more people approaching bigger/better facilities to ensure they receive the best consultation and there is no competition among Hospitals or for Doctors. My argument here is that the first point of contact for any consultation should be regulated.
3. Common Health Practices across the nation – We do not have a strong law in the country where the Hospital Workflow’s remain constant. Each hospital has it’s own rule and patients are bound to abide by them. If I need to fight out, i should take time out to go to the Court. We need to establish common rules of how Hospitals treat patients and the rights patients have to access their Health data.
4. Common Registration System – Each Hospital has their own rule of how they treat the Patient registration System. This has to be regulated to ensure the basic Patient demographic data is always constant and can be carried by the individual. Use of Adhaar like system to enforce this is very practical and brings ease of managing this aspect.
Last but not the least, we should encourage initiatives which bring in a stronger Health Law.

Indian HealthCare Education – How is it distributed?

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India ranks 112 in the World Health Organisation (WHO) Ranking of The World’s Health Systems. When it comes to per-capita spending on Health Care, India spends a little over 6% of GDP on HealthCare.

These are the common statistics which we see every day. What I wish to share are the other aspects of Indian HealthCare system which provide a strong support.

Imagine this, India is the World’s Second Largest Populated country and it is projected that we will overtake China by 2050 and the reality of data according to WHO is that India has about 0.49 Doctors and 0.80 Beds for every 1,000 Population in the country. When you hear/see these numbers, it does sound alarming! How are we going to put up with the Population Growth, provide basic HealthCare and create an Ecosystem for building robust Health Services across the country?

If the situation is bad when compared to other developed economies, then how is our Average Life Expectancy has been steadily increasing over the years? In 1947, when India got Independent, Life Expectancy was 47 Years and today, after 65 Years of Independence, we are at 65 Years. By 2025, it is projected that Life Expectancy would be 72 Years.

All the Health data which we see is primarily considering the English Medicine System or Allopathy. India and also other countries offer alternatives to the English Medicine. What we will look into here is how the HealthCare is structured and Health Education along with fundamental understanding on how Government spends its 6% on HealthCare along with what reaches the population living Below the Poverty Line (BPL).

HealthCare Systems in India

India has the most number of HealthCare systems when compared to any country in the world. Below are the five most known systems.

  • Allopathy (English Medicine)
  • Homeopathy
  • Ayurveda (Traditional Indian)
  • Unani
  • Naturopathy & Herbal Medicine

Formal Education for Doctors

India offers education in Allopathy, Homeopathy, Ayurveda, Unani and Naturopathy & Herbal Medicine. All education is recognised and Doctors who pass out of colleges are given license to practice any where in the country.

The below graph shows the admission trend to Graduate Allopathic Medicine Course over the last 20 Years. If we carefully observe, there has been a decline in admissions in the last two years when compared to earlier. Interesting.

MBBS Admissions

 

The Dental Education has quite picked up in the mean time. However, it is a poor state where the enrolments to Post Graduate Programs has been less than 10% of the actual Graduates. There are certain strong reasons as to why this happens and we will look at it later.

BDS/MDS Admissions 1991 – 2011

 

Now, let us have a look at how the Medical Education System is structured in India.

Medical College Distributions

 

Allopathy accounts to only 39%, which is around 314 Medical Colleges. in the remaining 71%, Ayurveda has 31% (249 Colleges), Homeopathy has 23% (186 Colleges) and Unani has 39 Colleges, Siddha has 8 Colleges and Naturopathy has 10 Colleges.

 

 

Issues with HealthCare IT in India

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Over the last few years, have been fortunate enough to be working with the HealthCare sector in India.

In the due course of time, I have been interacting with IT Departments of various Hospitals (Very Large and Large and to some extent at the Primary Health level too). What I have been trying to understand is the key reasons as to why the IT penetration has been at a distant in the Indian Hospitals. There are quite a few valid reasons and I also encountered one other not-too valid reason, but will have to give it a benefit of doubt.

Time factor – One of the key factor why Hospitals see resistance from Doctors to use IT systems is because of the number of clients (patients) they need to see. On an average, a Doctor in any Hospital in India see’s an average of one client every two minutes (the raw data might be even more). In these two minutes, the Doctor has to understand his client problem, establish a connection (Important in the Indian Context), provide guidelines for the analysis and prescribe. The complete process takes definitely more than two minutes, and if the Doctor tries to spend time on the computer taking notes, his/her client might not appreciate it and not return back to them. People in Cities understand the importance of technology, however, in India, as 80% of the population still lives outside Cities, it might not be practical for the Doctor/Hospital to make them understand the same.

Cost – The second most important reason which needs serious consideration. 70% of HealthCare costs are “out of pocket”. Hence, when Hospitals/Doctor’s Clinic implement the use of technology, client tends to understand that cost of treatment is “higher” and hence avoid’s those kind of Hospitals/Doctors.

There is no support for Hospitals/Doctor’s to use Technology from the Government. Hence, the cost has to be shared by the client, which directly impacts their revenue.

Technology Education – There are no initiatives by the Government to spread awareness of the benefits of using Technology to end users. Even though there might not be immediate acceptance for this, on the long run, people would definitely see the benefit.

As an illustration, Government of India spend considerable time and money on the “Eradicate Polio” initiative and this has been a success. Even though initially the message was not taken seriously, now when a child is born even in the remotest place of the Country, parents immediately inquire of the Polio Drops schedule and ensure that their child gets them. The results speak for themselves – Today, India is “Polio Free”.

Variety of HealthCare Practices – India is a very large country and has variety of HealthCare Practices – Homeopathy, Allopathy, Unani etc. People change their practice depending on the kind of ailment. I have also seen and known people who follow a certain practice sticking to the treatment in serious conditions too, but very rare.

This does not have a direct impact on the HealthCare System/Process, however, this plays a vital role when people shift their accustomed practice.

More detailed information on various practices and Infrastructure in my earlier post.

Acceptance by all Stakeholders – Even though every Individual accepts that IT is an integral part of delivering Quality HealthCare, acceptance by all stakeholders also plays a very vital role in rolling out technology solutions.

As an Illustration, Government employees need to submit manual receipts and documentation for their medical reimbursement. Also, many Insurance providers do not completely follow the approval and reimbursement process online.

In summary, a Hospital/Doctor’s office is not encouraged in all aspects to implement Technology. There are many a times when they need manual documentation. To avoid multiple process flows, Hospitals keep their Technology inquisitiveness away.

However, things are changing. With a recent success story of how the Andhra Pradesh Government implemented Aarogyasri, many states have been trying to follow the same.

There are quite a few other concerns and problems for Hospitals to implement IT, however, if we have a humble beginning, success will definitely follow.

HealthCare Infrastructure in India

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There have been many articles, research papers and writeup on this topic available on the web. As part of a research project, I managed to gather some data points for understanding the State of HealthCare in India. Thorough this post, would like to share my findings and provide some references for a better understanding on this subject.Economically, India has been consistently growing at over 8% GDP every year for the last 3 years and if the Economists prediction goes right, we will continue to grow the same way for the next few years.

HealthCare is one of the key parameters in which a country’s Development and stature are measured. To begin this discussion, let us first understand the structure of HealthCare in the Indian Context.

Primary Health Care is essential health care; based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and self-determination (WHO & UNICEF, 1978).
The World Health Organization (WHO) has identified five key elements to achieving this objective:
  • Reducing exclusion and social disparities in health (universal coverage reforms)
  • Organizing health services around people’s needs and expectations (service delivery reforms)
  • Integrating health into all sectors (public policy reforms)
  • Pursuing collaborative models of policy dialogue (leadership reforms); and
  • Increasing stakeholder participation.

Primary HealthCare in India

In 1947, the year of India’s independence, average life expectancy was 29 years and today, in just 63 years, it has reached 65 years. According to estimates, it will reach 74 Years by 2025. There are many reasons for this impressive progress in life expectancy in India and one of the key reasons is the maturity of the Primary Health Care facilities and services in India.

PHC was conceptualized in 1946, three decades before the Alma Ata declaration, with the recommendations of the Bhore committee, that laid emphasis on social orientation of medical practice and high level of public participation. The government followed it up with setting the Community Development Plan in the 1st 5 year plan (1951-55) and Health Survey and Planning Committee in the 2nd 5 year plan.

Primary HealthCare as a key initiative has been an Objective only in the 9th 5 Year Plan (1997-2002).

  • Department of Women and Child Welfare (DoWCW) is responsible for the overall implementation of HealthCare schemes in India.
  • The Central Government is responsible for providing funds for HealthCare infrastructure across the country.
  • The State Government is responsible for allocation of funds to respective regions and building up the personnel and HealthCare facilities across the state.
  • At times of emergency, the Central Government is responsible for collecting and distributing Medicine’s and required support to the state/region.
  • The Government provides a three-tier (Primary, Tertiary and Secondary) support structure for addressing the HealthCare needs across the country.
Structure of Indian Public HealthCare System
The Indian HealthCare system is a three-tire structure which focus’s on delivering care at the individual level. This structure is designed according to the population norms.

Population

Urban

Hilly/Tribal/Rural
Sub Center

5000

3000
Primary Health Center

30,000

20,000
Community Health Center

1,20,000

80,000
Sub Center
The Sub Center is the closest to the common man and becomes the first point of contact in the three tire system.
  • Each Sub Center is managed by an Auxiliary Nurse Midwife (ANM) and one Male Health Worker.
  • One Female Health Assistant and One Male Health Assistant manage 6 Sub Centers.
As of 2008,
  • There are 1,58,792 Sub Centers.
  • 53,390 ANM’s
  • 1,46,036 Male Health Workers
  • 23,458 Female Health Workers
  • 23,458 Male Health Workers.
Primary HealthCare Center (PHC)

Primary HealthCare Center’s form the second tire in the system (Secondary Care) and each PHC is a hub for 6 Sub-Center’s. A PHC typically has a 4-6 beds for addressing immediate and basic Health Care necessities.

Community Health Center (CHC)

CHC forms the third tier in the system.

  • A CHC has 1 Surgeon, 1 Physician, 1 Gynecologist and 1 Pediatrician along with 21 Paramedical Staff.
  • CHC is a 30 bed facility.
  • 1 CHC for 4 PHC’s.

Now, let us look at the core data of HealthCare Infrastructure in India.

Personnel Availability

Required In Position Shortfall
CHC 6491 4276 2337
PHC 26022 23458 4477
Sub-Center 158792 146036 20486
Doctors at PHC 23458 24380 3537
Multipurpose Worker (Female) at PHC & SC 169494 153537 21066
Nurse MidWife 53390 44940 18017
Only ANM 19385 21313 1841
Health Assistant (Female) 23458 17599 6481
Health Assistant (Male) 23458 17972 8827
Health Worker (Male) 146036 60247 79322
Laboratory Technician 27734 12885 14135
Obstetricians and Gynecologists (PHC) 4042 1029 2576
Obstetricians and Gynecologists (Other Location) 219 143 115
Peadiatrician (PHC) 4042 791 2814
Peadiatrician (Other Location) 219 73 146
Pharmacists 27734 20964 7017
Physicians (PHC) 4042 1043 2562
Physicians (Other Location) 219 81 138
Radiographers 4276 1695 2280
Surgeons 234 81 142
All Specialists at PHCs 17104 4279 11033
Total 739849 556822 209349

Infrastructure – (District Hospitals, Ayurvedic Dispensaries & Hospitals, Family Welfare Center and Referral Hospitals)

State District Hospitals Ayurvedic Dispensaries Ayuevedic Hospitals City Family Welface Center Referral Hospitals
Andhra Pradesh 16 557 9 0
Assam 22 380 1 0
Arunachal Pradesh 14 2 1 0
Bihar 25 311 11 12 70
Chhattisgarh 16 634 8 0
Goa 2 77 1 0
Gujarat 23 493 48 106 409
Haryana 21 472 8 0
Himachal Pradesh 12 1109 25 0
Jammu & Kashmir 14 273 2 0
Jharkhand 24 122 1 0
Karnataka 27 589 122 2 57
Kerala 14 740 124 0
Madhya Pradesh 50 1427 34 0
Maharastra 23 469 55 0
Manipur 7 0 0 4 8
Meghalaya 5 12 1 0
Mizoram 8 0 0 0
Nagaland 11 85 0 0
Orissa 32 624 8 0
Punjab 20 507 15 0
Rajasthan 33 3539 100 0
Sikkim 4 1 1 0
Tamil Nadu 27 35 7 104 100
Tripura 2 55 1 0
Uttar Pradesh 71 340 1771 0
Uttaranchal 18 467 7 0
West Bengal 16 295 4 0
Andaman & Nicobar 3 5 1 0
Chandigarh 1 6 1 0
Dadra and Nagar Haveli 1 3 0 0 1
Daman and Diu 2 1 0 0
Lakshadweep 1 2 0 0
New Delhi 9 148 10 0
Pondicherry 4 16 1 0
Total 578 13796 2378 228 645

Infrastructure – Homeopathic Dispensary & Hospitals, Medical Colleges, Unani Dispensaries/Hospitals

State Homeopathic Dispensary Homeopathic Hospitals Medical Colleage Rural Dispensaries Unani Dispensaries Unani Hospitals
Andhra Pradesh 286 6 32 196 6
Assam 75 3 3 1 –
Arunachal Pradesh 44 2 – –
Bihar 179 11 8 366 144 4
Chhattisgarh 52 3 3 6 1
Goa 59 1 1 – –
Gujarat 216 14 13 8347 – –
Haryana 20 1 3 19 1
Himachal Pradesh 14 1 2 3 –
Jammu & Kashmir 0 0 4 235 2
Jharkhand 54 2 3 30 –
Karnataka 42 20 36 176 51 13
Kerala 580 33 18 1 –
Madhya Pradesh 146 22 8 50 2
Maharastra 0 45 39 25 5
Manipur 9 1 1 42 – –
Meghalaya 10 7 – –
Mizoram 1 0 – –
Nagaland 115 1 – –
Orissa 603 6 4 9 –
Punjab 107 5 7 35 –
Rajasthan 178 9 8 102 3
Sikkim 1 0 1 – –
Tamil Nadu 46 9 25 1421 21 1
Tripura 93 1 2 – –
Uttar Pradesh 1482 8 16 49 210
Uttaranchal 60 1 3 3 2
West Bengal 1220 12 9 3 1
Andaman & Nicobar 15 1 – 1
Chandigarh 5 1 1 – –
Dadra and Nagar Haveli 1 0 3 – –
Daman and Diu 0 0 – –
Lakshadweep 1 0 – –
New Delhi 98 2 5 25 2
Pondicherry 7 0 8 – –
Total 5819 228 263 10355 1008 254

State wise Population to Infrastructure availability

State Population Sub Center PHC CHC Doctor
Andaman & Nicobar Islands* 356,265 3,125 18,751 89,066 4,880
Andhra Pradesh 75,727,541 6,048 48,234 453,458 34,204
Arunachal Pradesh 1,091,117 1,843 9,406 24,798 12,542
Assam 26,638,407 5,801 31,562 258,625 65,290
Bihar 82,878,796 9,356 50,505 1,183,983 52,958
Chandigarh* 900,914 64,351 450,457
Chhatisgarh 20,795,956 4,386 28,843 152,911 24,125
Dadra & Nagar Haveli* 220,451 5,801 36,742 220,451 36,742
Daman & Diu* 158,059 7,185 52,686 158,059 26,343
Delhi* 13,782,976 336,170 1,722,872 599,260
Goa 1,343,998 7,814 70,737 268,800 30,545
Gujarat 50,596,992 6,956 47,155 185,337 49,654
Haryana 21,082,989 8,665 50,198 245,151 60,237
Himachal Pradesh 6,077,248 2,934 13,535 83,250 14,932
Jammu & Kashmir 10,069,917 5,281 26,853 118,470 22,328
Jharkhand 26,909,428 6,799 81,544 138,708 81,544
Karnataka 52,733,958 6,476 24,025 163,263 18,562
Kerala 31,838,619 6,250 35,026 297,557 18,383
Lakshadweep* 60,595 4,328 15,149 20,198 10,099
Madhya Pradesh 60,385,118 6,836 52,554 223,649 57,951
Maharashtra 96,752,247 9,146 53,278 237,721 81,236
Manipur 2,388,634 5,687 33,175 149,290 20,771
Meghalaya 2,306,069 5,751 22,389 88,695 21,755
Mizoram 891,058 2,435 15,633 99,006 17,136
Nagaland 1,988,636 5,009 23,124 94,697 25,173
Orissa 36,706,920 5,488 28,700 158,904 27,130
Pondicherry* 973,829 12,647 24,970 243,457 14,321
Punjab 24,289,296 8,499 50,184 192,772 120,842
Rajasthan 56,473,122 5,257 37,574 161,814 36,623
Sikkim 540,493 3,677 22,521 135,123 12,869
Tamil Nadu 62,110,839 7,134 51,120 301,509 27,483
Tripura 3,191,168 5,512 41,989 290,106 12,514
Uttar Pradesh 166,052,859 8,092 45,001 322,433 82,985
Uttaranchal 8,479,562 4,804 35,479 154,174 9,792
West Bengal 80,221,171 7,746 86,819 229,860 99,038
Total 1,027,015,247 7,033 2,988,332 7,595,753 1,830,246

I will append more information as I get to learn more.

Most of the data was taken from Ministry of Family and Child Welfare (http://www.mohfw.nic.in) and also from search, papers and other websites. I ensured that I do not violate any copyright information.