As per Health Ministry data, there are 20,306 government hospitals in the country. Rajasthan leads with 3,145 hospitals and Jammu and Kashmir stands at the number two with 2,812 hospitals.
Going by the statistics, J&K has the higher number of health institutions in rural and urban areas than neighbouring Himachal Pradesh (160), Punjab (240), and Haryana (159). Uttar Pradesh, the most populous state, has only 831 hospitals.
The primary health care services are greatly underutilized because of low quality treatment, lack of responsibility, weakening regulation, no transparency, lack of proper management, insufficient resources and prevalent corrupt practices.
On other hand, it is discovered that private hospitals are aimed at providing better healthcare facilities to the patients and also contributing a positive role in order to lower the public hospital burden.
Patients are compelled to visit private hospitals because of worse conditions and low quality treatment at public hospitals. But the very high and unaffordable prices of treatments at private hospitals push the patients back to bad conditioned public hospitals.
The first priority for achieving Universal Healthcare should be “a determined effort to strengthen our public health systems.” Primary health care must be improved, starting with sub-centres, the first health post for the community. By staffing them with well-trained non-physician health care providers, both facility-based and outreach services can be provided without being doctor dependent. District hospitals too should be strengthened to provide high quality secondary care, some elements of essential tertiary care and training to different categories of health care providers. This would also help in relieving unending crowds in tertiary care hospitals.
The second priority should be to improve the size and quality of our health workforce. Without this, the promise of Universal Healthcare (UHC) will remain an empty entitlement. Since primary health care is our first priority, resources must be devoted to the production of competent and committed community health workers for the frontline, mid-level health workers or AYUSH doctors for the sub-centres, and general and specialist nurses as well as non-specialist doctors for primary health centres.
More specialists are needed for higher levels of health care including the district hospitals. New nursing and medical colleges should be preferentially set up in districts which presently have very few, linking them to tertiary-care hospitals.
Public health competencies must be increased through inter-disciplinary education which is aligned to health system needs. Improved management of all of these human resources must involve better incentives for recruitment and retention, cadre review and creation of well defined career tracks.
The third priority should be to provide essential medicines and diagnostics free of cost at all public facilities. At the same time, referral linkages and patient transport services should be improved to integrate primary, secondary and tertiary health care in the public system.
Difficult to reach areas and vulnerable population groups should receive special attention, even as the principle of universality must be applied while designing health services.
The fourth priority must be to put in place the necessary public systems for Universal Healthcare. Regulatory systems need strengthening — from hospital accreditation to health professional education and from drug licensing to mandatory adoption of standard management guidelines for diagnosis and treatment of different disease conditions at each level of health care.
A state inter-operable Health Information Network is needed to improve governance, accountability, portability, storage of health records and management. Community participation must be supported to actively engage people in the design, delivery, monitoring and evaluation of health programmes.
And finally, larger investments should be made in health promoting programmes in other sectors such as water, sanitation, nutrition, environment, urban design and livelihood generation.
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