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What are the problems and solutions of Indian Public Health Care(PHC) System?

• Hi, I presume that every Indian citizen had seen the conditions of Indian Government Hospitals and their staff behavior. So my question needs a discussion on what are the various problems in Indian PHCs and what can be the solutions to resolve these problems. Some of the problems I am going list down My mother recently required some tests to be done for a viral fever. Luckily, we knew one Doctor who is employed in the Government hospital and after 2 hour journey to various medical departments (I think total journey of 2 km distance) ; my mom finally succeeded to give all the tests with his help. I was wondering if there was no help; then I got no choice but to spend large amount of money in any of the Private hospitals as I do not want to waste my time in long queues of OPDs, Pharmacy and Blood test dept. During my journey, I have seen lot of crowd just waiting, quarreling with peers and the skinny guards at the rickety door of the Doctor room over their turn.Some people just made the place as their bedroom taking rests over a smelly carpet. Thus, I gave a thought ,this problem occurred , just because we got lot of unhealthy population? The answers is simply NO  . Many factors contribute to this pitiful conditions of PHC systems in India. Lack of good and less greedy doctors: According to the statistics, India got 1 doctor per 1000 people. That is rather shocking, what promotes this condition is less growth prospectus of doctors, unhygienic conditions and poor pay package from the Government. Moreover our Medical institutes  makes 45,000 graduating doctors annually or 2.22  percent of the total number of doctors India produces every year! The situation worsened when approx 3000 Doctors in last 3 years which went to study abroad did not come back as they get good environment to practice in US rather than in India. The ministry should focus on the larger picture, the 97.78 students who  stay in India. Incentivise their work and give them benefits for  choosing to stay behind instead of penalizing the few who go abroad. courtesy: http://bit.ly/1cmGZ0X Lack of Government Hospitals and necessary staff and equipments: Coming back to my experience, during my Mom is waiting for the Doctor to fill up her OPD form (via privilege means) I hear a large loud on one tone from a group of people. Out of curiosity, me and other idle patient's kins see that few group of nurses and hospital staff were making slogans in loud voices. After a small talk I came to know that due to lack of nurses, some of the patient's kin fight with other nurses due to their unavailability. Hence causes the strike in OPD department by nurses and other staff (Phew!!). This is not something new, treatment of illiterate patients and their relatives is the most cumbersome job and that too is handled by meager staff. If we count on number of beds, I stumble upon a statistics which shows that intoto bed capacity of government hospital in India  is five lakhs forty  thousand .(5,40,000). With population of One twenty one crores , 540000  beds is quite low figure. For more details follow the link : http://bit.ly/1bauZ3L. Statistics on other equipments and basic features in a Hospitals were never revealed. Imbalance of Government Funding in PHC as compared to other countries: This may be the most important point which promote ill treatment of poor and common people in Public Hospitals. It should be noted that most of the Central Government Funding towards the PHC system go to National Rural Health Mission (NRHM).A total of Rs 71,880 crore (out of the total Budget Estimates during  this period) has been budgeted for NRHM since its launch in 2008-09. But all in vain as NRHM fails to maintain a healthy ratio between people and doctors and the hospital bed capacity. I wonder where all money goes?? Apart from that If we see total spending by various elements like Private+Public elements, Private only and Public only towards the Public Health then a shocking pictures come. This simply suggests that why Private hospitals and clinics   market is on boon in India.Other countries like China maintains a healthy comparison for their spending with private players.This will simply cause people like me and other who can pay (though not willingly) will go to Private hospitals.The government should look methods to increase the funding for the Public Health Care as well as increase awareness to promote Generic Medicines. Lack of research in medicinal field: At the free medicine counter in the hospital, I heard one counter guy scolding the poor patient "Take it or leave, this medicine will cause you 20 per tablet from outside!". And I heard that the guy is taking medicines for Heart Problem. Next I wonder why the medicines are so expensive, since I knew that our Ayurveda has solutions to all of the problem. Why we always rely on foreign generated and innovated medicines? Ofcourse they will cost you a hefty price since directly or indirectly we pay royality to the Patented companies. Then I googled for the Research firms initiated by our beloved Government to innovate new methods and research in Medicinal areas. And guess what I found nothing... It is shame that almost every health issue is notified in Ayurveda and a medicine is always available. For example, the Use of Giloy is widely used by common people to treat depleting blood platelets. If illiterate people knew about that why does our Research Firm used this method to make tablets or syrup to treat Dengue?Why we rely much on Foreign firms? Points are infinite but space is limited :) But I will ask from you guys that what are the ways in which we can resolve above issues.

• Answer:

  Sorry to hear about painful experience your mother has to go through. Not all indians are unhealthy, but if recent government datasets are any indication, then this it is and will become very serious concern. I did some basic analysis and published here. Its very specific to CVD, but its still relevant to get a feel . http://www.sensoryhealthsystems.com/2013/10/30/women-and-heart-diseases-its-not-a-myth/ http://www.sensoryhealthsystems.com/2013/10/21/cvd-burden-in-india-who-needs-to-be-engaged/ http://www.sensoryhealthsystems.com/2013/10/23/indian-men-living-in-cities-are-you-investing-your-health-dollars-in-right-direction/ I haven't published yet (planning to do so in next couple of days) , but I did some analysis on PHC vs healthcare burden and its bad. But in a country like India where more than 70% of population lives in Tier-II,Tier-III cities/towns and villages, they are out of reach of Private hospitals. 90% of the patients live outside our primary care system and so it requires lot of investments from Govt in improving care model and make it economically viable. When compared to decade vs not, it improved, but its not sufficient and has long way to go. Currently everyone wants to talk about over hyped words like patient engagement, HIT etc, but they are all far off from ground realities when it comes to emerging countries like India. Like India has leap frogged in telecommunications by skipping the landline and embraced mobile/wireless technologies , same should happen in healthcare. This is one of goals I have with my current startup Sensory health systems  ( http://www.sensoryhealthsystems.com ) which is to improve care delivery models with initial focus on patients suffering from chronic diseases. Patients and elderly like your mother can  significantly benefit from this. There are other exciting startups like ucheck which are all trying to improve the system. But again you are right, the current system is not sufficient and there is lot of room for everyone to do innovate and help. If you are interested,I would definitely love to have a conversation offline with you to know more about your experience and what you think are viables alternatives that can help folks like you and your parents.