"Prime Minister Narendra Modi rolled out the Centre's flagship Ayushman Bharat-National Health Protection Mission from Jharkhand on Sunday. The programme, also called Pradhan Mantri Jan Arogya Abhiyan, aims to provide coverage of Rs. 500,000 to 100 million economically backward families involving 500 million individuals, a population larger than the whole of Europe or USA, Canada and Mexico combined"
This news item caught my attention for a number of reasons. It was launched from my birthplace Ranchi and the first beneficiary was a lady who was able to have a caesarian section with no out-of-pocket expense. This is a huge initiative by the Government and will impact millions of lives for the better if and when it is implemented efficiently.
I, like many healthcare professionals, however have certain reservations.
Infrastructure for diagnosis and treatment for acute cases like gall stones, appendix etc. at one end and stroke, poly trauma and heart attack at the other should be provided at the district level hospital, at least. Then, there are cases such as cataract surgery, glaucoma surgery and chronic kidney diseases requiring dialysis for which the poor patient cannot go far from home on a regular basis. Patients with back and leg pain, or those needing rehabilitation & regular physiotherapy from old-age related diseases, stroke, head injuries, disc disease etc. cannot travel far from home. Hence, facilities have to be created at peripheral hospitals.
There is no doubt that one of the major hurdles in the Indian healthcare system is the lack of infrastructure and the disparity between the rural and urban healthcare facilities. Urban cities have a higher density of hospitals and hospital beds than rural towns. Data from the Health Ministry (June 2018) states that there is 1 government bed per 1,844 people and 1 state-run hospital per 55,591 people. Stories of patients having to share hospital beds are, unfortunately, very common. Capital expenditure should have been done primarily before launching this scheme or at least simultaneously.
Another important factor is the human capital. Effort should have been put in recruiting extra doctors, nurses and paramedics and training them for the extra demands, for which they may or may not have been trained. The current medical professionals will face a huge surge in patients seeking medical advice and treatment, which would make even triaging an arduous process solely due to human resource mismanagement.
There is a huge shortage of doctors and nurses, which needs to be addressed urgently by the government. According to the government’s own statistics, there is 1 allopathic doctor for every 11,082 people. To put this in perspective, WHO recommends a ratio of 1 doctor to 1000 people. For those in Bihar, the figures are even more abysmal. There, we’re looking at 1 government allopathic doctor per 28,391 people. How are medical professionals supposed to be ready for this influx of patients when we’re already understaffed, overworked and, quite frankly, worriedly reading about abuse against doctors on a daily basis?
We could take a page out of the western world by creating a cadre of "Nurse practitioners". Upgrading the skills of the present nurses so that they can prescribe medicines, suture wounds and even give anaesthesia, could go a long way in helping manage patients.
Lastly, another change that can be made, that will have a huge impact, is to emphasise the prevention of non- communicable diseases like head and spine injuries. 200,000 people die every year following a head injury and five times as many need rehab for months on end. Reducing the number of these injuries through public awareness programs on helmets and seat belts will reduce the strain on the medical facilities and reduce the costs to the state running into millions of rupees.
These are some of the steps which when taken will help make this groundbreaking scheme a success. I am excited that at last I will not turn away a patient who needs my expertise but does not have the funds to pay the hospital bills or buy drugs, even if I provided my services free, which my colleagues and I have done on many occasions.