Healthcare is an essential need of every society and everybody is entitled to medical services on tap to enable preventive and curative streams for a healthy society. Health and well-being for all ages lie at the heart of Sustainability Development Goals 2030 (SDG), which identifies health status of the population, health infrastructure, access to health insurance, etc. as being key drivers/objectives.
SDG Health Goal 3 focusses on a few key levers such as reducing maternal & infant mortality, achieving universal health coverage; making essential medicines and vaccines affordable; ending preventable deaths of children.
India’s ranking: India ranks 130 among 189 countries on health care access and quality as per the latest Human Development Index ranking (Source: UNDP HDI statistical Update 2018). As per the Human Capital Index (HCI), a first-ever report by the World Bank, India ranks 115 out of 157 countries. Human Capital is an offshoot of Development Economics and embodies the idea that health, knowledge, training, and judgment all combine to give people the ability to provide and create economic value. Hence, the need to track simple inputs such as quality education, affordable health care etc.
As per the United Nations SDG 2030, India ranks 112 out of 156 countries.
Irrespective of whichever index is used, the moot point is that India ranks abysmally low in all parameters under healthcare. Maternal, Infant and neonatal mortality and low universal health coverage are some the common indicators under healthcare across all Indices. The table below shows India’s rating on each parameter alongside a possible trend – such trend is crucial to assess if India is on the right path to achieving the sustainability goals in 2030.
Performance of some indicators of SDG Goals: 2018
*Maternal mortality: Deaths per 1 lac live births
** Infant and Neonatal: Deaths per 1000 live births.
Source: Open Government Data (OGD) India Platform and WHO, 2016.
According to the health goals of SDG, by 2030, the maternal mortality rate is expected to be less than 70 per 1 lac live births, under-5 mortality to be at least as low as 25 per 1,000 live births; neonatal mortality to at least 12 per 1,000 live births. (Neonatal mortality is death under 28 days of birth.)
As evidenced by the table we are far from our targets of 2030, but given the upward trend there is a possibility that we may reach the target – however, this presupposes that the major challenges are addressed on a war footing.
Healthcare infrastructure and systems form a foundational basis for access to health care services for all. Universal health coverage trend shows that we have major challenges and the current infrastructure is not sufficient to reach the goals. The availability of health facilities in India is comparatively much lower (about 1:1000 – bed: population ratio) than in the developed nations (about 7:1000). The number of allopathic doctors, nurses, and midwives in India is less than a fourth of the World Health Organisation (WHO) requirement; when adjusted for qualification, the ratio of nurses to doctors is about 0.6:1 in India, while in many developed countries this ratio is about 3:1.
To achieve the goals for Universal Health coverage, Prime Minister Narendra Modi recently launched the world’s biggest health insurance scheme Ayushman Bharat, which is expected to cover at least 40% of India’s population which is deprived of secondary and tertiary care services. As the scheme has come to effect recently, the effect and impact on implementation are yet to be seen.
CSR contribution to Health Care: Education and Healthcare are the two most preferred thematic areas when it comes to the implementation of CSR projects by companies. Under Healthcare, much of the CSR funds are spent on health camps and building hospitals in the cities.
Some Corporates in India, as part of their CSR activities, are doing their bit in buttressing the existing health facilities. Avaya is one such corporate which has chosen health as a focus area in their CSR strategy and has partnered with “Save the Children” (NGO) to improve skills of the nurses and staff by providing practical on the job training at the hospitals.
Urbanization has led to large-scale migration resulting in a proliferation of slums which are characterized by poverty, high mortality and fertility rates making it difficult for the city infrastructure and social services to cope with health issues of this population.
Project Kushal involves transforming Medical Colleges as collaborative centres for mentoring, by exchange of technical know-how, supportive supervision through video conferencing and bridge building between academia and health program managers. This initiative is intended to improve the prenatal care of the newborn and the mother. The ICT network connects 16 primary and secondary health care centres to the tertiary health care facilities i.e. 2 Government hospitals. This was done in collaboration with Pune Municipal Corporation as part of the smart city health plan. Mentoring through connectivity is also expected to improve health care at primary health care centres; as well as reduce the referral cases and taking the load off the secondary and tertiary health care centres and hospitals. The target audience is mothers and newborn.
Expected Outcome of the project:
- Reduction in maternal and infant mortality rate.
- Improvement in knowledge and skills of nurses and midwives in the maternity wards.
- Enhance healthcare access at primary health care centres by providing mentoring guidance through practical training.
The Government spend on health care is estimated to be about 1.02% of the GDP, which is significantly lower in comparison to other countries. Advanced nations spend anywhere between 5 to 8 % of their GDP on Health. (Source: National Health Profile data 2016) For the implementation of SDGs, every country needs to judiciously prioritize, and adapt the goals and targets in accordance with local challenges, capacities, and resources available. Financial resources are a key driver to various other capital and human resources.
To achieve its health goals under SDG, India will need to reach a Health Index of 0.9. India is estimated to require around INR 55 lakh crores (USD 763 billion) till 2030 to achieve the targeted Health Index. A gap of around INR 19 lakh crores (USD 264 billion) is estimated. Improving the Health Index would mean improving the health status of the population, quality of healthcare institutions and access to health care (insurance, etc.)
However, future status of health care in India would rest on the overall changes in its political economy – on progress made in poverty mitigation (healthcare to the poor), in reduction of inequalities (access to health care for all), in generation of employment / income streams (to facilitate capacity to pay and to accept individual responsibility for one’s health), in public information and development communication (to promote preventive self-care and risk reduction through conducive lifestyles).
(Article submitted by SoStakes)