- Health is a state subject; some states invest double the national average in healthcare while the others do poorly
- District hospitals across over 700 districts need more beds and not necessarily cast in stone demarcated facilities
- Public health labs are more suited for districts
- Over 7,000 blocks may need more patient care lab strengthening
- PPP is an option that could be tried
The Indian healthcare sector practitioners have a reason to rejoice with Finance Minister Nirmala Sitharaman picking the sector in her stimulus measures' presentation on Sunday. Sitharaman announced that all districts will have infectious disease blocks and public health labs have been planned to be set up at the block level. While the focus and concern is admirable, the crying need is not really a centrally designed infectious disease handling model, the healthcare experts say. There is a need for finances and resources, they add.
However, these should come with a freedom to decide on which one is best to bridge the gap in healthcare delivery. The reason being that not all states are alike, apart from the fact that health is a state subject. Some states like Kerala, Himachal Pradesh, Mizoram, and others have higher spending on healthcare. Some even spend at double the national average. But, these have different gaps to fill when compared with states like Bihar, Uttar Pradesh, and others.
More beds, not silos
Keshav Desiraju, former union health secretary and a veteran health care expert, feels that an ideal situation would be one where funds are transferred to the states with a freedom for them to decide where they would want to invest in healthcare delivery. A majority of states really need more beds at the district level, he says, adding that many may not necessarily need blocks for infectious diseases. They need beds that can be put to use quickly for infectious diseases in times of pandemic. In other words, any district hospital with over 100 or 150 beds will need more beds with an option to deploy them as per the need or otherwise.
Patient-care labs for blocks
Dr Rajib Dasgupta, professor and specialist in the area of epidemiology at the Centre of Social Medicine and Community at the Jawaharlal Nehru University, says that the move by the finance minister on infectious disease block at the district level is a welcome measure.
But, it can't be done overnight as it will require not just facility creation but also right staffing with appropriately trained professionals backed by the necessary equipment. Dr Dasgupta is also a firm believer in the diversity of the healthcare delivery capability across states and districts. So, the measures to bridge the gaps should be best left to the states to decide on where to invest. However, the measures are not quite in favour of public health labs at the block level. These are more suited at a district level and therefore across over 700 districts in the country. This is because, by definition, public health labs undertake epidemiological services, including studying the disease dynamics, as against patient-centric tests that pathological laboratories normally do. So, public health labs, that have supporting infrastructure at the district level with the government hospitals and medical colleges, become more appropriate at the district level.
However, they also need to be backed by a public health cadre to undertake the epidemiology services. At the block level, Dr Dasgupta is more in favour of strengthening the pathological laboratories that are focused on patient care. He also wants them to be backed with an adequately trained staff to man them and provide the required services.
Linkage with ISDP
Some of the experts are also not clear on where does the existing Integrated Disease Surveillance Programme (ISDP) under the ministry of health fit in with the announcement by the finance minister. It's for the reason that ISDP, assisted by the World Bank, is aimed in any case at strengthening disease surveillance for infectious diseases. Its stated mission being: "To strengthen the disease surveillance in the country by establishing a decentralized State based surveillance system for epidemic prone diseases to detect the early warning signals, so that timely and effective public health actions can be initiated in response to health challenges in the country at the Districts, State and National level."
Pathology labs are crucial
About 70 per cent of all clinical decisions are based on pathology tests and therefore strengthening lab infrastructure is crucial, says, Dr Arvind Lal, chairman and managing director of Dr Lal Pathlabs. And says, it goes beyond infectious diseases, which are only one side of the problem. "In India, 65 per cent of all deaths in India are today because of non-communicable diseases like diabetes, high blood pressure, cardiac failures, cancer, liver, kidney and lung diseases apart from stroke and all these need a pathology lab backup."
PPP can hasten up implementation
Infectious diseases are seeming like things people will have to learn to live with, Ranjan Pai, chairman, Manipal Education and Medical Group, says. "Nothing like having a good public health system that can help in early detection so while I have not seen the details, in general, what is being attempted is a good idea provided they are well-staffed and well-run," he also says.
This is important because when you want to do a large expansion in a short period of time, getting good, trained staff may be a challenge. The focus therefore now has to be on how the plans can be executed well. In this, the government could look at a PPP (public-private partnership) model.