Health care system needs radical transformation

India’s health care delivery system needs a radical transformation if the country is to achieve the government’s vision of assuring health for all, according to new research published in The Lancet.

The study documents not only India’s progress on major health indicators in the past decade, but also its many deficiencies.

It identifies the structural problems with the healthcare system, and reasserts the recommendations of previous expert groups on the need for a radical new vision for India’s healthcare delivery system.

The most disturbing indicator of the deficiencies of the Indian health care system is the observation that health care costs are driving millions into poverty, Vikram Patel of Public Health Foundation of India and London School of Hygiene and Tropical Medicine and colleagues wrote in the journal.

The study records the considerable efforts being made in the health sector, with national and local governments investing in targeted disease control programmes and the National Health Mission focusing on maternal and child health.

Despite this, a variety of structural weaknesses have led to a situation where India’s health system performance is unable to cope with the enormous demands placed on it by the country’s growing population, researchers said.

India continues to lag behind regional neighbours especially on health indicators like mortality rates for children aged under five years, with the country recording 27 per cent of all neonatal deaths and 21 per cent of all child deaths in the world, they said.

Chronic nutrition deficiency manifesting as stunting continues to affect a third of children under five years.

Compounding this burden is the large and rapidly rising burden of non-communicable and chronic conditions.

“Suicide is now a leading cause of death of young Indians, and an Indian is likely to suffer from a heart attack at least ten years earlier than in developed countries and yet the health care system has barely responded to these urgent health crises,” Patel said.

Patel said that there are “widespread inequities in health outcomes that are apparent in the large morbidity and mortality differentials across socio-economic status, caste, class, sex, and geographic location”.

According to the researchers, an important cause of this large and inequitably distributed burden of disease in India can be attributed to social determinants beyond the conventional health care delivery sector such as urbanisation, poor access to water and sanitation, food insecurity, environmental degradation, and the pervasive caste system.

They said India's current health system needs to correct its course urgently across key challenges including strengthening the country's weak primary health system, dealing with the shortage of skilled human resources, better regulation of the private sector, increasing public spending on health, improving health information systems and dealing with the issue of weak governance and accountability.