According to the Lancet, the world-renowned medical journal air pollution can affect nearly every organ and system of the body, negatively affecting nature and humans alike. Air pollution is a huge problem in emerging and developing countries, where global environmental standards often cannot be met. Considering the only outdoor air quality and not indoor air quality, which caused an additional two million premature deaths in 2019. The World Health Organization’s recommended limit is 5 micrograms of particulate matter per cubic meter, although there are also various national guideline values, which are often much higher. Air pollution is among the biggest health problems of modern industrial society and is responsible for more than 10 percent of all deaths worldwide (nearly 4.5 million premature deaths in 2019). Unfortunately according to the data available currently, based on the air quality life index and particulate matter pollution, the modeled potential loss of life expectancy of the population, India tops the list of the 198 countries in the world, while Denmark is the least affected.
Under this background when we look into the health parameters of India, a recent study estimated that India has roughly 20 health workers per 10,000 population, with allopathic doctors comprising 31% of the workforce, nurses and midwives 30%, pharmacists 11%, AYUSH practitioners 9%, and others 9%. This workforce is not distributed optimally, with most preferring to work in areas where infrastructure and facilities for family life and growth are higher. In general, the poorer regions of Northern and Central India have lower densities of health workers compared to the Southern states. The government has increased the number of medical colleges and subsequently increased MBBS seats. There has been an increase of 82% in medical colleges from 387 before 2014 to 706 as of now 2023. Further, there is an increase of 112% in MBBS seats from 51,348 before 2014 to 1,08,940 as of now and PG seats have been increased to 127% from 31,185 before 2014 to 70,674 as of now. The State of Andhra Pradesh has almost 100% of the required Accredited Social Health Activists (ASHAs) in position under the National Rural Health Mission (NRHM) and around 82% under the National Urban Health Mission (NUHM). The doctor-to-staff nurse ratio in place is 1:2 with 3 public health providers, medical Officers, specialists, staff nurses, and ANM per 10,0000 population.
Coming to the private sector accounts for most of the health expenditures in the country, the state-run health sector still is the only option for much of the rural and surrounding urban areas of the country. The lack of a qualified person at the point of delivery, when a person has traveled a fair distance to reach, is a big discouragement to the health-seeking behavior of the population. According to the rural health statistics of the Government of India (2015), about 10.4% of the sanctioned posts of auxiliary nurse midwives are vacant, which rises to 40.7% of the posts of male health workers. Twenty-seven percent of doctor posts at PHCs were vacant, which is more than a quarter of the sanctioned posts. The status of the employment position and vacancy positions are ever-changing as per the needs.
Considering that the private sector is the major player in healthcare service delivery, there have been many programs aiming to harness private expertise to provide public healthcare services. The latest is the new nationwide scheme proposed which accredits private providers to deliver services reimbursable by the Government. In an ideal world, this should result in the improvement of coverage levels, but does it represent a transfer of responsibility and an acknowledgment of the deficiencies of the public health system? It is not out of the place to mention that the government has to slowly switch from schemes like Arogyasri where millions of funds are diverted to the private health sector. There are several cases of mismanagement of the scheme where poor and middle-class beneficiaries are not receiving the proper attention from the health management in those schemes. I would suggest the government spend that huge money to improve the infrastructure and modern facilities in the hospitals starting from primary health care centers, community health care centers, to district headquarters hospitals so that every patient gets world-class medical care from the village health center itself. In the long run, this would yield wonderful results. In my opinion, filling the pockets of the private health sector by the government neglecting their health institutions is a big imprudence. (To be continued).
