World Health Day: 5 health challenges facing India

World Health Day, observed every year on April 7, commemorates the founding of the World Health Organization and the commitment made by countries worldwide to promote health and well-being. The day has a specific theme each year to address the various health challenges faced by people across continents. This year, on the 75th anniversary of the WHO, World Health Day is dedicated to reflecting on the public health challenges and achievements that have improved the quality of life over the past seven decades. It is a unique opportunity to inspire action to tackle current and future health challenges on another World Health Day.

Health Challenges from India’s Perspective

India has potentially overtaken China as the world’s most populous country, according to projections by the World Population Review (WPR). The WPR says that as of the end of 2022, India’s population was estimated to be 1.417 billion, surpassing China’s reported population of 1.412 billion on January 17th. 

This marks a significant shift in global population trends.

Apart from many other problems, a large population poses a serious challenge in ensuring the equitable delivery of health services. The geographical diversity and population distribution make this challenge even more significant. Although there have been efforts to strengthen health services across the country, India’s health infrastructure faces several challenges. On World Health Day, we reflect on some of them.

The Covid-19 pandemic marked a pivotal moment in global healthcare delivery evolution, with India no exception. Governments worldwide were compelled to prioritize health-related problems and rapidly fill service delivery gaps. In India, this response led to the expansion and strengthening of the district and primary health centers, while also boosting the pharmaceutical sector. As a result, the pandemic catalyzed significant improvements in the Indian healthcare system. But India still has a long way to go.

On World Health Day, here are five major health challenges India faces today and how they could be addressed:

1) Gaping holes in health insurance coverage

According to a 2021 report of the NITI Aayog ‘Health Insurance for India’s ‘Missing Middles,’ Ayushman Bharat scheme covers almost 50% of the population. Ayushman Bharat is a flagship health insurance scheme launched by the Government of India in 2018. The scheme aims to provide financial protection to poor and vulnerable families against high healthcare costs and to improve access to quality healthcare services. Under the Ayushman Bharat scheme, beneficiaries are entitled to receive an insurance cover of up to Rs. 5 lakhs per family per year for secondary and tertiary hospitalization care.

Social insurance and private voluntary health insurance cover about 20% of the population. The remaining 30% of the population lacks any financial support for medical care; this group is known as the “missing middle” since it is neither too wealthy nor too poor to qualify, for government-sponsored health insurance programmes. Due to the Ayushman Bharat scheme’s current coverage gap, the actual number of uninsured people is substantially larger.

Although the Ayushman Bharat scheme has made huge strides towards providing a safety net for the country’s large population and is considered to be the largest health public health insurance scheme in the world, it still has miles to go to extend services to the missing middles.

2) Affordability of healthcare  

India, a nation of over 1.3 billion people, has historically had one of the lowest healthcare expenditure rates in the world as a portion of total GDP. However, with the onset of Covid-19 the healthcare expenditure which stood at 1.6 percent in financial year 2020-21 increased to 2.1% by FY 2022-23. This number is expected to further rise to 2.5% in the next two years. However, when the deficit in healthcare financing accumulated over several decades is brought into the picture the need for funds becomes larger. 

The lack of adequate health infrastructure in rural areas and urban slums means those worse affected by inflation and financial hardships must make out-of-pocket payments. 

3) Access to quality healthcare

The government’s vast healthcare network covers over 70% of total OPD (outpatient) needs.This is true even in remote villages, but many of these centres are understaffed and ill-equipped. As far as the private healthcare sector is concerned, it is concentrated in cities and often too expensive for those living below the poverty line. The need of the hour remains to strengthen the district and primary health centres. The aim should be that the rural populace should not have to travel to cities for even basic treatment.

4) Rise in population and urban migration

Although India has achieved the World Health Organization-recommended ratio of 1 doctor for every 1,000 citizens, the rise in population and urban migration is stressing the existing healthcare systems in slums and backward urban settlements. Moreover, as it is with population, urban migration is also on a steep rise. This problem if not addressed at the earliest, would only worsen.

5) Lack of focus on preventive medicine 

India has been reeling under a sharp rise in lifestyle diseases such as diabetes and cardiovascular diseases (CVD). The country has started to be referred to as the diabetes capital of the world. WHO data suggests around 77 million people suffer from type-2 diabetes in India, whereas there could be over 25 million in the prediabetic stage. The case with CVDs is quite similar, with India accounting for a fifth of deaths caused by heart-related problems.

Keeping this in view, there exists an enormous need for preventive medicine in the country, which can slow down the rapid rise of noncommunicable and lifestyle diseases. 

The National Health Policy 2017 stands as a road map for improving India’s standard and quality of healthcare services. It emphasizes the need for a comprehensive approach to healthcare, focusing on preventive and promotive healthcare and curative and rehabilitative services. On World Health Day, the government and others can reiterate that India needs a holistic and integrated approach focusing on improving health outcomes and achieving universal health coverage.

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