Biosci. Biotech. Res. Comm. 8(2):
Some problems and solutions of public health scenario in developing countries
Shaima A Miraj*
College of Health Sciences Saudi Electronic University, Riyadh, Kingdom of Saudi Arabia
Despite good intentions, health systems across the globe are unable to deliver
KEY WORDS: PROBLEMS, SOLUTIONS, PUBLIC, HEALTH, DEVELOPING, COUNTRIES.
Hospitals and health care centers are our life lines; they are temples of life, giving hope to the hopeless, life to the lifeless and as a matter of fact have become indispen- sable. During the last couple of decades with the advent of technology, the face of these life savers has changed dramatically and in developed western countries, most
*Corresponding Author: email@example.com Received 20th July, 2015
Accepted after revision 15th November, 2015 BBRC Print ISSN:
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of them have acquired new dimensions providing best of treatments to those who can afford them or their gov- ernance which can make them affordable, through sus- tained efforts. Humanity has always been dealing with its inner con#icts, while other conjectures are combating with changing moral codes and parameters set by soci- ety, our life styles are undergoing drastic changes and although there seems to be a health revolution, going
on, with health care taking at a fast speed, developing nations like India, and the below level ones which are leaping ahead economically still are not moving towards a state of balanced health.
Despite good intentions, health systems across devel- oping nations are unable to deliver
SOME OF THE EXISTING PROBLEMS IN HEALTH CARE SYSTEM
Spending on health care in India was an estimated !ve percent of gross domestic product (GDP) in 2013 and is expected to remain at that level through 2016. Total health care spending in
India’s public health care system is patchy, with underfunded and overcrowded hospitals and clinics, and inadequate rural coverage. Reduced funding by the Indian Government has been attributed to historic fail- ures on the part of the Ministry of Health and Family Welfare (MHFW) to spend its allocated budget fully. This is despite increasing demand, due, in part, to growing incidence of age- and
Shaima A Miraj
of Indian health care expenditures in 2012 came from government sources. Of the remaining private spend- ing, around 86 percent was OOP, (Indian Medical Tour- ism http://articles.economic times.indiatimes.com., IBEF Healthcare March 2014, Healthcare spending, http:// www.livemint.com).
If in a country like India with the government spend- ing thousands of crores annually on health coupled with International aids in billions of dollars, the condition of hospitals, health care centers and health providers is in tatters; one can imagine their conditions in countries like Pakistan and Bangladesh. A study on sickness revealed that around 40 to 50 million people are under medical supervision for major ailments at any given point of time and about 200 million man days are lost annually on account of sickness. The country spends about 6 per cent of its GDP on healthcare while private healthcare expend- iture is about 4.25 per cent of GDP, which has grown at the rate of 12 per cent per annum over the last few years.
Perusal of the National Health Policy,
Hospitals run by the government in developing nations almost function as white elephants and except for the below poverty lines, people do not have any faith in them as they seldom get proper treatment. It is not that there are improper facilities, quali!ed person- nel and doctors with specializations, it is rather poor state of administration, management and implementa- tion of policies and schemes, which are in plenty. The state of healthcare delivery in India is well summarized by the World Bank that reported: “a detailed survey of the knowledge of medical practitioners for treating !ve common conditions in Delhi found that the average doc- tor in a public primary health center has around a
Shaima A Miraj
On the contrary a visit to any multi specialty hos- pital in India managed by private sector, one will get an impression that it is the power of money which can buy you any health package starting from economy to deluxe, whether it is from your own pocket or from your insurer. The effective services which these private mega hospitals provide, leaves one in awe, their huge success in a short span of time is a testimony to their professional business like approach in managing them using the cutting state of the art technologies for unlim- ited pro!ts. One group soon successfully expands and a chain of hospitals is formed, with multinationals and economic giants tying up for this fast growing business. Medical tourism is on a rise, as foreigners from Middle East, Africa, Pakistan, Bangladesh , in increasing num- bers are now coming to India for private health care for complex pediatric cardiac surgery or liver transplants— procedures that are not done in their home countries. They also come from the United Kingdom, Europe, and North America for quick, ef!cient, and cheap coronary bypasses or orthopedic procedures. A shoulder operation in the UK would cost £10 000 done privately or entail several months’ wait under the NHS. In India, the same operation can be done for £1700 and within 10 days of a !rst email contact.
The recent remarkable growth of the private health sector in India has come at a time when public spending on health care at 0.9% of gross domestic product (GDP) is among the lowest in the world and ahead of only !ve
In India and the subcontinent, mega health projects by big names like Max, Fortis, Glaxo, Artemis, Apollo, Reliance, Birla, Mallaya and many others are on the rise.
Almost all metro and major cities have a very healthy competition in this newly growing health care indus- try. On the other hand most of the government hos- pitals whether in urban or rural areas have the same malady, corruption in magnanimous proportions. This single factor which has adhered to our life as an insepa- rable attribute, is taking our progress to where we had started. Whether we take the case of India, Pakistan or Bangladesh or any underdeveloped country thriving on aids from international quarters, perhaps the story is the same. It is this weak governance coupled with loss of character, morals, honesty and commitment that is giving way to alternatives which though are costly, but very effective.
Most people do not compromise on matters of life and death and are subscribing to the philosophy to pay more to get best of the services, though the costly ones are also not immune to default and may be of harrowing experience to some despite paying heftily. Private health care in India is expensive for Indian patients:
In general, the extra ordinary success of private health care sector is inversely proportional to the failure of government one. It is not that the paucity of funds which is causing the failure of these public hospitals in some places, but it is non governance, lack of aware- ness, education and non activism on our part that is responsible for the sorry state of affairs in one of the most important areas of our life. Even in India if one goes little down south, one can scale up the progress of this very upcoming sector. But in places where there is demonocracy instead of democracy , then a very huge chunk of public money, government funds via taxes, coupled with a lot of international aid goes in the drain.
There are several instances where billions of hard earned public exchequer has been criminally wasted at the cost of national health. Recently a national news- paper Dainik Bhaskar highlighted a big scam of crores of rupees in the National Rural Health Mission schemes in the state of Madhya Pradesh, where from an annual budget of Rs.765.65 crores , Rs 50 to 75 crores have been spent on seminars and workshops in which family members of health of!cials also enjoyed at 5 star hotels on public money. In a two day seminar 2 million rupees were spent in Khajuraho a tourist attraction in MP as per the report of the number one newspaper of the state and central India. Similarly 50 crores are being spent
annually on advertisements alone rather than on quality work to improve the health of the people!
Rest of money perhaps goes to other channels includ- ing the #ourishing NGOs which without accountabil- ity on percentage basis provide services which are well known. The paper has reported that as a result of such wasteful expenditures, the real issues of infant mortal- ity, health of women and children, the aged and hapless remain neglected despite huge fund at hands. (Dainik Bhaskar, 2008) This is example of one state, one can imagine what several developing nations which have a weak governance and accountability with a labyrinthine legal system do with large aids in the name of humanity. It seems that there is mostly a competition to advertise what is being done only on paper, it is happening right from the central government to the states, (Perappadan, 2005).
WHAT CAN BE DONE TO IMPROVE THE CONDITIONS OF OUR HEALTH CARE SYSTEM
It is time to restructure radically the governance for a prosperous civilization; hopefully the young generation takes the mantle in the right direction. Time has come now to repay the country what we have taken from it, let us stick to our traditions and morals which have their own values. In this context general awareness, honest and sincere media activism with private public partner- ships playing important role has to take a lead now in order to take control of the depilated conditions of our health institutions.
The existing set up of government hospitals needs total revamping with managers taking up the management and administration of hospitals rather than the physicians and doctors, who should be allowed to concentrate on their !elds and do justice to their specializations , experience and expertise other than running a hospital or health care unit. Regulation of !nances must become more stringent, as wastefulness is one of the major drawbacks of proper health management. A regulatory body at the national level must come enforce to manage the !nances of the government hospitals with central and state sharing the problems and their solutions.
We have enough of government controlled councils who have almost bled the public to death. Private admin- istrative controlling professional bodies on the lines of Western countries, have to be brought in now with transparent working. There are several doctors, physi- cians, academicians, entrepreneurs and health manag- ers of repute who can contribute to develop a work- ing model of government hospitals run without hassles. These are already working excellently in some of the smaller southern states of our country.
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In the Times of India, India’s leading news paper on the occasion of 61st Independence Day editorial, governance has been ranked as perhaps the single most important issue that needs immediate attention, (TOI, 2008). It is not merely about building institutions; it is about ensuing that these institutions are accountable to the people, while they uphold the rule of the law. Our public hospitals also need a strong accountable govern- ance with a strict vigil by honest of the honest armed with acts like right to information, speedy trials in fast track courts of special nature, a viable and just media
,otherwise the future of individuals and the nation as well will be at risk.
There is an urgent need of sweeping reforms in insur- ance !nanced programs at the national, regional, and health facility levels, with either the government !nanc- ing health programs wholly or with a strategy which will increase access to care in partnerships. The Min- istry of Health should emphasize cost sharing, with an expanded role for the private sector and health insur- ance, in this context private NGOs can play a key role in improving access to health insurance schemes through the piloting and scaling up of
Experts vary in opinion about potential size of Health Insurance market. To attain world average of Health expenditure, India needs 80 billion USD of health allo- cation. Assuming 20% of the expenditure is the poten- tial allocation for
But there is need for substantial structural changes to achieve this desirable magnitude of performance. Esti- mation suggests only 1% of the market has been tapped so far. In the medium term of three years, even with present effort the market may reach INR 15000 crores. In the past, growth of health insurance has been very slug- gish, right from its formal introduction in the eighties. But in the last few years the cumulative average growth rate attained has been 37%.
Shaima A Miraj
fraught with moral hazard.
Transparent health regulatory bodies or councils should be set up at the national, state and district levels to manage the ailing health care system of the public hospitals with both the central, state and health insur- ance companies sharing the problems and their solu- tions. In the place of already existing government health departments, private administration controlling profes- sional bodies on the lines of western countries has to be brought in now with transparent working. There are several doctors, physicians, academicians, entrepreneurs and health managers of repute who can contribute to developing, working models of government hospitals that can run without hassles, making the reach of free or economic health packages to the needy.
One way to increase India’s health care funding and access is through innovative
These are already working well in some of the smaller southern states of India, like that of Kerala and Kar- nataka.
need more encouragement, with an increasing role for government as the !nancier of healthcare rather than the provider, protecting the generic drug industry, reducing the healthcare taxes, training of more com- munity health workers and free access of healthcare to all, (Golcha,2014, Narayan, 2011, and Shaima Miraj 2014 and 2015).
Finally it can be concluded that the government has to share the burden of health care. Lack of government interest in health care in a democracy! Possible only in developing nations. Let it not be that!
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