Public Health in India. Part 1 . Understanding the Problem

I was attending a recent event organized by NASSCOM and IBM Watson Health focused on Public Healthcare. The speakers are solving some of the biggest issues facing healthcare right now, especially in India. Several metrics got pointed out but the first metric which everyone agrees on is the Doctors to Population Ratio. I am sure we all agree to the following numbers:

One doctor for every 1,700 people or 4.2 doctors for every 10,000 people. This metric is compared with industrialized nations where on an average there are 20 doctors for every 10,000 people. Another interesting fact brought up was that India produces 50,000 doctors every year. It looks simple at the outset that if we can somehow bring up the doctor to people ratio, we should improve our healthcare system. I am intentionally ignoring infrastructure for the sake of this argument. An eminent speaker pointed out an even more important number. Out of all the doctors available in India, only 30% are available to an 830 million rural segment.

Here is what we are missing. What is the health index of western countries? Definitely higher or much higher than India in general. And if we segregate the health index of those 830 million people who have only 30% of available doctors, their health index is much lower than the national average. We will be at the bottom of the list when compared to the top 10 countries by GDP. We all know the 30% doctor population who serve in rural India are mandatory postings and they are generally junior doctors. The quality of care available is far less than what is available in tier II or III towns. What I am implying here is that even if we increase the number of doctors available to 20 per 10,000, say in rural India, we will not be able to serve all those in need. Also it is impossible to achieve such numbers as it will take decades.

To add insult to injury, our policy makers take decisions based on the data that gets curated at the highest levels. My fellow panelists threw some important facts about the data. The data being collected at the grassroots level is “erroneous” , “fabricated”, etc.  The data I am talking about is collected from grassroots health workers like ANMs, ASHAs,  and to an extent PHCs , CHCs and DHs. If I remember the numbers mentioned by my fellow panelist correctly, out of the 2 billion health transactions in the US, 80% are digitized, hence close to reality. Whereas India does 6.3 billion transactions and only 6.5% are digitized.  So, our policies are made based on the these numbers ?

Are we closer to providing proper healthcare in our country? We take pride in Indian doctors being visible across the world and also talk about medical tourism that India is attracting. What about the basic primary health care for our own people who actually till our land and provide food and are the back bone of our country? When are we going to get our act right? What I wrote above should give a decent idea about the problem statement.

Now, organizers wanted startups to address Public Health System in India and see if we can connect to existing proven solutions and platforms. Thoughts are in perfect direction. But , how are these startups can actually have a sustainable businesses? 

We all know there are almost two startups coming up every day in this segment. I am not sure how many cater to public or primary Health. Still, let’s take it at face value. All the solutions being offered to rural India and generally for public health are funded, paid,  controlled by the Government of India and to a small extent NGOs and CSR activities. The government and NASCOMM are doing a phenomenal job in promoting Startup India. Due to our age old transparency laws (I love them actually), we do have a tendering process and contracts are awarded based on number of years in business, past history and eligibility criteria and at the end the lowest bid wins the tender.

My questions is a simple and straight one. While our startups are doing a fantastic job in solving India centric problems, how is that we can solve this “Monumental Problem” which has “Huge Business Potential”  are we doing enough to create conducive market place for startups? Won’t it be a WIN – WIN situation if we not only succeed in improving the health index of the country but also enable the cascading effect of these startups selling the solutions out of India and improve the country as a whole?

In my Part 2 , will try to address the issues Public Health System in India is facing , at grass-root level .

The author Balaji Krishnammagaru is Co founder of MedOnGo which focuses on Primary and Public health and has served about 4.5 million consultations to date.

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