For the entirety of my childhood, I had been raised in a small township in a small district of Assam called Golaghat. Much like the fears of anyone from a semi-urban/rural set-up, one of the biggest fears I had as a child was about the limited medical infrastructure in my locality. My locality had a small hospital with basic infrastructural capacities. In case of any major emergencies, or any ailment that required more advanced or specialist care, everyone had to rush to the larger cities in Assam – mainly Guwahati and Dibrugarh. As I ventured out of my home state for academic and professional purposes, I realised that this was a norm in most semi-urban and rural areas across India. This piqued my interest and made me passionate about exploring the health sector. I wanted to understand why such inaccessibility exists, and how one can work towards improving the situation.
The AIF Fellowship allowed me to explore this interest area, allowing me to dive deep into the nuances of the health sector. As an AIF Fellow, my project involved strategizing and implementing my host organization’s programs on Tuberculosis (TB) and COVID-19 on the ground by working in tandem with the local public health centre (PHC). Much like most public health centres across rural areas in India, the local PHC faces many challenges, ranging across broken infrastructure, lack of hygiene, overcrowding, medical staff absenteeism, etc. As the local PHC is the lone medical centre that caters to the entire population of the block, overcrowding is bound to happen. However, ironically, there are days when one can find the facility empty during peak hours, highlighting the trust issues the locals have towards the facility. On inquiring further, I could gauge that the long bureaucratic processes in government health facilities, where one is made to run from one room to another to get even a minor work done, acts as a significant hindrance for the locals. The slow process leads one to spend one’s entire day in a hospital, resulting in the loss of a day’s wages. Moreover, a considerable section of the medical staff prefers traveling to work from the nearby larger cities, while many female workers have maternal duties to attend at home. These external factors push one to leave for their homes early, making it unfeasible to stay for some extra time or an extra shift, resulting in absenteeism. Through further interactions, I realized that the same scenarios existed elsewhere, too. Previously, I would question the commitment levels of the health workers. But, after hearing their sides of the story, I managed to get a broader and more holistic perspective of the absenteeism issue.
After gaining awareness of the issues mentioned above, the question that I have been pondering for some time now is: “How can we solve this health puzzle given these constraints?” The following are some of my thoughts:
Strengthening the Medical Infrastructure and Taking Medical Care Mobile
Bihar alone has a shortfall of 18,992 sub-centres, 2,792 primary health centres and 798 community health centres. Authorities and policymakers need to understand the severity of this data and work towards improving it. With that said, the meager construction of medical facilities is not enough. Ensuring the regular availability of properly functioning medical equipment and facilities in hospitals is equally essential. On a highly positive note, things are looking bright at my host location. The authorities have realised the need for a revamp of the existing PHC. They are now constructing a larger PHC right across from the present PHC. Authorities expect that the new facility should be up and running in the next 6-7 months.
Keeping in mind the population of our country and the time it takes to sanction and construct medical facilities, we shouldn’t only remain dependent on accessing healthcare through medical facilities. If people can’t come to health facilities, why not take healthcare to them? Concepts like that of mobile medical vans, organizing regular medical camps in villages with specialists, etc., can significantly improve the rates of access to quality healthcare. Treatment of significant ailments may remain a challenge. Most importantly, disease identification would happen at an early stage, which is vital in saving lives. Healthcare delivery through “telemedicine” is a great way to move forward, and it has the potential to revolutionize the Indian health sector. The process makes consultation and following up with patients, locating health information, and communicating with practitioners easier. As a result, reducing the amount of potential travel for both physicians and patients.
Cell phones (either a handset or a smartphone) and network connectivity have reached significant parts of our country, highlighting this field’s immense potential. The ongoing pandemic has highlighted the importance of telemedicine, more so than ever. Hopefully, we can further improve the infrastructure needed to strengthen telemedicine services and take this forward even after the pandemic ends.
Fortunately, at my host organization, we are following a similar model. To identify potential TB cases, the local team, in association with the ASHAs, goes door to door and looks for symptomatic patients. If they find such cases, they do the initial screening, and only if the results of the initial screening suggest that someone may have TB, the local team calls that particular person to a medical facility for further tests. Once diagnosed with TB, the further treatment and counseling support that the person requires, is provided by the local team over the phone, or by going to their homes, to the extent that is possible.
The Golden Piece of the Health Puzzle: Equal Spatial Distribution of Medical Professionals
The semi-urban and rural health infrastructure needs an increase in the number of medical professionals on the ground, especially specialists. One way to achieve this would be by making such areas more lucrative to serve, especially for the younger generation. In India, becoming a doctor is a tough ask. A lot of investment goes into acquiring a medical degree – both financially and in terms of human labor. Naturally, one would expect a higher return once one graduates – both in terms of quality of life wise and economically.
Therefore, policymakers and bureaucrats need to ensure higher pay for all medical professionals on the ground – from doctors to nurses to lab technicians. Having an aesthetic office to work from, a clean workspace, a day-care centre, etc., are some of the many factors that can make the sector more attractive. These help in one feeling optimistic, which in turn increases one’s efficiency and productivity. A more optimistic and efficient workforce in medical facilities would mean better services, which can, in turn, increase the trust of the general population towards such facilitates. Many of my networks in the medical field expressed their concern about not having access to a quality social life if they serve in such areas. Therefore, bringing a few of the spaces and services that are usually considered urban into such rural and semi-urban areas has become the need of the hour—for example – gyms, recreational parks, market centres, sports centres, e-commerce facilities, etc.
The more the equivalent distribution of quality medical resources, the lesser the movement of people from small towns to big cities for treatment purposes, saving a considerable amount of someone’s out-of-pocket medical expenditure while simultaneously reducing the stress on the medical infrastructures of big cities.
In 2018–19, India’s spending on public health was 1.29% of its GDP, which is extremely low. Both the union and state government’s need to enhance their expenditure on public health. The ongoing pandemic has highlighted the importance of it, more so than ever. As a country, it is also high time to shift our focus from the “numbers” approach to the “quality” approach. Even though the medical facility in my hometown was small/primary, the limited services provided by it; had an element of quality in it.
While bringing in change through the policy route takes times, various entities of the society, such as businesses and their CSRs, non-profits, architects, doctors, etc. need to join hands and work towards improving the already existing health system/infrastructures and making them more accessible for the everyday person. Lastly, and most importantly, discussions and dialogue surrounding public health and the importance of spending more on public health need to happen right from the school level. The more we as everyday citizens speak up about our health system’s issues, the more we can hope to accelerate change in the sector.
“Welcome to State Health Society-Bihar”. http://statehealthsocietybihar.org/healthinfra.html. Accessed 21 May 2021.