Introduction
One of the oldest civilizations in the world, since achieving its independence in 1947, India has been growing and developing in an exponential pace. Though its human capital is internationally appreciated, and the country is one of the largest customer service and hi-tech outsourcing destinations, its population and infrastructure remain lacking. To this extent, I found it interesting to examine how the Indian government, in light of this disparity, manages one of the most basic needs and service- healthcare.
This paper will begin by describing India today- its location, size, population and government. The political structure of a country is crucial in evaluating government programs and infrastructure, as it affects not only goal setting, but also the manner in which the government can implement nationwide initiatives. Following this description, the current state of health in the country will be examined, as well as the current infrastructure supporting it. Concluding, health goals and their implications on the nursing profession in the country will also be under the microscope.
The 7th largest country in the world, India covers an area of 3,287,590 sq. km on the Asian continent, with a variety of landscapes ranging from mountains to coastlines. As of March 2011, India’s population is estimated at 1,210,193,422.
Economy
The Indian Gross Domestic Product per capita is estimated at US$2700, with an unemployment rate of 7.2%, as 25% of the population is below poverty line (Mekoth et al., 2012).
Government
India’s government is based on a state-system, in which the states are responsible for most of their governing, including a constitutional decentralization of healthcare. Therefore, any government-initiated plan is executed by the state. The Indian society is comprised of a caste approach which to this day governs social interactions (Berman et al., 2010).
Healthcare system and delivery
In the 1980s, the Government of India introduced government-owned commercial health insurance, and in the beginning of 2011 roughly 20% of the population was covered by either government of private health insurance (Dhaliwal, 2011).
Within the government, the Ministry of Health and Family Welfare in responsible for administering healthcare, and it does so through three departments: Health, Family Welfare and Ayush (alternative medical systems such as Ayurveda, Homeopathy and Siddha) (Mekoth et al., 2012).
While the private health care sector comprises 82% of overall health expenditures, only 1% of the population is covered by health insurance (Bagchi, 2008). Unlike other countries, despite years of significant economic growth, India’s public health expenditures did not increase accordingly (Berman et al., 2010). In fact, India is positioned number 171 of 175 countries in terms of gross domestic product spent on healthcare (Mekoth et al., 2012).
Healthcare in India is delivered on four levels: the first is sub-centers, provided in rural centers serving about 5,000 people and staffed by one male and one female multi-purpose health workers. The second level is primary care, serving 20-30,000 people, staffed by a medical officer and two health assistants, as well as health workers and support staff. Such a center provides basic medical care, maternal and child health, family planning, disease prevention and control and implementation of national health programs. The secondary health care service consists of hospitals and community health centers, and the last level involves more specialized and skilled services (Bagchi, 2008).
In 2005, as part of a government plan to increase public spending on health from roughly 1% of the GDP to 2-3%, the government established the National Rural health Mission (NRHM), an umbrella plan supporting district and village level health services (Berman et al., 2010). Nevertheless, while the number of healthcare facilities in rural areas may increase, approximately 30% of these sub-centers do not have electricity or running water, and are therefore limited in their ability to fulfill their purpose (Bajpai& Saraya, 2012).
Culture/ traditional medicine
In general, there is a difference between north and south India in regards to tradition and world views, as this is reflected in their approach to healthcare as well. North Indians tend to support a more fatalistic world view, not regarding healthcare services as something that can determine life or death. To this extent, there is a clear preference, mainly among older people, for alternative medical systems, mainly Ayurveda, which is intertwined with ancient Indian philosophy and the Hindu way of life. In contrast, some of the country’s most renowned medical institutions are located in the south (Mekoth et al., 2012).
Healthcare personnel, education system and associations
Each year, approximately 27,000 doctors graduate from medical colleges throughout the country, 75% of whom will work in large cities and urban areas. The current doctor-population ratio is estimated at 1:1722. This shortage extends to all health professionals, including a significant deficit in nurses and practitioners (Bagchi, 2008). In rural areas, the ratio is approximated at 1:19560 (Bajpai& Saraya, 2012).
While the number of educational institutions qualifying nurses has been rising, the quality of nursing education has been declining. There are insufficient regulatory and enforcement mechanisms ensuring the quality of such educational facilities. For instance, the nationally-based Indian Nursing Council advocates for nurses’ wages and rights, but seems to lack influence on educational institutions (Nair, 2011).
The healthcare professionals’ shortage is even greater in rural areas, where people may have to walk several hundreds of kilometers to see a medical professional (Dhaliwal, 2011). In addition, the growing privatization serves to accentuate the disparity between higher and lower classes, as is reflected in the division between curative and preventative medicine, the former being centered in the large and affluent cities and constantly expanding while the latter, catering to the poorer citizens is located in rural and remote locations and is in dismal condition (Bajpai& Saraya, 2012).
Health priorities
The main health concerns for the country today are HIV and tuberculosis; nearly 3.1 million people are infected with HIV and approximately 800,000 contract an infectious form of tuberculosis annually (Mekoth et al., 2012). As weaker populations tend to be more vulnerable to contracting diseases due to poor infrastructure, lack of awareness and lack of access to clean water and basic sanitary conditions, their vulnerability is doubled if there are insufficient healthcare facilities involved in treating and preventing disease. In my eyes, the first and foremost step must be to increase the number of healthcare facilities in rural areas, maintaining high standard of care. Moreover, the government and/ or states should provide incentives for health professionals to work in rural areas.
Nursing implications
One solution could be to open a prestigious teaching hospital in a rural area, subsidizing tuition in exchange for living and working in that area for a certain number of years. Thus, not only will the area enjoy quality healthcare, but it may attract a stronger population which in turn can contribute to improving infrastructure and bridging the gap between the lower and higher socio-economic populations.
In addition, nurses working in both urban and rural areas should engage in an outreach program targeting the more remote locations or poorer population where healthcare is not established or well-recognized. Such outreach can serve two purposes; the first is detecting, treating and preventing disease. The second is increasing awareness of the benefits of medical care and its importance.
References
Bagchi, S. (2008). Growth generates health care challenges in booming India. Canadian Medical Association Journal, 178(8), 981-983.
Berman, P., Ahuja, R., Tandon, A., Sparkes, S., & Gottret, P. (2010). Government Health Financing in India: Challenges in Achieving Ambitious Goals. World Bank.
Dhaliwal, J. S. (2011). Financing Delivery of Health Care Services in India. The Journal of Global Health Care Systems, 1(4).
Mekoth, N., George, B. P., Dalvi, V., Rajanala, N., & Nizomadinov, K. (2012). Service Quality in the Public Sector Hospitals: A Study in India. Hospital topics, 90(1), 16-22.
