INDIA IN MEDICAL POVERTY TRAP.AND NEW CHALLENGES

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Submitted: August 11, 2018

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Submitted: August 11, 2018

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Despite some progress and promises of modern medicine, most of the developing countries including India is still struggling to get the fundamentals of medical care: simple diagnostic tests, affordable medicines, and efficient supply distribution to much needed poor patients.

As distribution and medical service are very costly for the poor, hence it is affordable to rich people.

What about the poor Indian people’s health?

Globally there are 746 million people in extreme poverty. 218 million people are in India under extreme poverty conditions as per 2013 statistics (In 2018 it has gone up by 350 million), these 350 million people cannot afford to meet minimum hospital expenses. This global demographic illustration shows that India is the highest in the number of poor people.

When it comes to people’s health care, problems are huge, expensive, and widespread, especially in India, In near future, It can be more difficult because of poor infrastructure, poor R & D medical research, uncontrollable population and lack of awareness about certain nascent diseases, which are fast-spreading.

What I ponder in a way forward is to develop humanly possible ways to meet future challenges. And the result has to include medical care at a low cost but highly innovative. Before going into big picture, let me create a framework or backdrop about future challenges we have to face not only in India but also globally.

  1. From the global perspective, the Global economy is the fragile but Indian economy is somewhat on green pasture.  The Indian internal realities are factious, fissiparous and highly breakable due to uncontrollable corruption, political instability, the provincial government’s dominance, individual and idiopathic ambitions of politicians for central leadership etc.  So, there will be great turbulence on envisage radar and constant dynamics make India as highly volatile nation for any time crisis in near future.
  2. Growing population and depleting resources lead to uncertain energy, water and food in the future.
  3. Changing global climatic conditions leads to new diseases and natural calamities.
  4. Growing sensibilities among caste, religion and genders.
  5. Mass extinction in the animal kingdom, untoward changes in terrestrial and ocean ecosystem,
  6. Global unrest hints to mass exude to nearby countries leads to poverty escalation and unprecedented global dependency will lead to inter-connectedand inter-dependent new manifestations. 
  7. India will be the youngest country by 2020 but the number of elderly is likely to rise significantly 20% of the population to be elderly by 2050. So does the healthcare expenditure. By 2021, the elderly population in India will number 143 million. Presently, the elderly is divided into three categories: the young old (60-70) the middle-aged old (70-80) and the oldest old (80 plus). This 143 nation will have to bear their healthcare expenses.

As the things stand, there has been a mounting awareness that educating population about health is of significant importance in India, where the health care system is underdeveloped, fragile, or vulnerable. In the past 10 years, the healthcare sector has been poor to look-after disadvantaged groups, who face financial barriers to have access to health care services and are exposed to financial risk due to illness. Indian government’s negligence had resulted in and led to the medical poverty trap.

How can we define this poverty trap in the Indian context?

  • The poverty trap is defined as the self-reinforcing mechanism which causes poverty to persist.
  • Many factors can lead to the poverty trap, such as limited access to credit and corrupt governance, poor education systems, lack of public healthcare, or poor infrastructure.
  • The term medical poverty trap has been coined to describe the negatively dynamic relationship between ill-health and poverty.  

Now, we sum up relevant empirical evidence and learn from past experience in order to improve the future of healthcare sector.

For India, the World Health Report pointed out three fundamental objectives of health systems.

  1. Improve the health of the poor and ill-afford populations they serve.
  2. Early response to people’s health issues and expectations,
  3. Provide financial protection against costs due to illness.

If we look at South American developing countries, we must regard them as the most successful health care systems among developing countries in the world.

Our neighbouring country, Vietnam is far better to India, as for social and demographic background, Vietnam has been implementing the compulsory social health insurance programme to the identified poor, which provides an opportunity to compare the effectiveness of public finance allocation.

The Indian government endeavour in this regard is lacklustre.  The evolution of a methodology and implementation is very poor, non-systemic and unscientific. The design of healthcare for socially backward and economically poor people must be based on elaborated background differences, considering levels of poverty, their awareness about diseases, environmental cleanness, the eligibility of health benefits in lieu of insurance package, and the effects of insurance on health-seeking behaviour.

In India, most of the reforms appeal to social and health insurance are very poor, as the main approach to improve the health care system is to protect the poor. Here below, I am attaching a WHO format, which gives you a clear picture, where India stands among some poor and developing countries.

One of the key components of social health insurance is the size of the benefits package, that is, which health care services are included, whether the included health care services are completely access-free, and if not, to what extent patients share the minimum costs.

The effects of social health insurance heavily depend on how the benefit package interacts with the severity/cost of disease as well as with patients’ income. We can illustrate this interaction by employing a partial rather than a general equilibrium model.

More specifically, we consider a utility-maximisation individual living in two periods:

  • The current period when they fall ill (therapeutic)
  • And the following period(convalescence)

Then, the benefits in return depend on how generous the insurance programme is. It goes without saying that to what extent the government is willing to invest in or subsidise.

Thereby the introduction of social health insurance might create a possible betterment to poor Indian population to come out from the medical poverty trap.

What are the possible consequences resulting from the medical poverty trap?

  • Untreated morbidity.
  • Fasting spreading of contagious diseases
  • Reduced access to care.
  • Long-term impoverishment.
  • Irrational use of drugs.

 

If the benefits package is not sufficiently generous for the household income and healthcare expenditure and if there is an obligatory contribution, the poor could be pushed into an even deeper poverty trap. On the contrary, if the benefits package is sufficiently generous, the poor could seek care without suffering an unaffordable or over-burdened cost.

To tackle Indian problem, Workers in the respective field like Insurance sector, Pharmaceutical industry, who are not necessarily physicians, need to invent simple, rugged, reliable, low-cost diagnostic systems, inexpensive drugs, and simple record-keeping systems. They also often need additional training.

I believe in mankind, but I don’t believe in people. People believe in mankind are generous and substantial. They lead a blessed life, can do some miraculous things and stand as a good role model. I have gathered a remote case study from a tier III city in south India as I pursue it here for the reader’s perusal.

An HIV patient, when given proper treatment for nine months, he recovered and was healthy. The recovered patient developed a sense of humane outlook towards fellow-patients and trained himself to help other HIV patients. He had become a full-time health worker, showing what can be accomplished even in poorly supplied areas. This is humanly possible humane.

There are some changes envisaged in the next 35 years.  Maybe, we can predict still lot more happenstances. So to lead and manage these changes, we shall need the new class of Leaders, Managers and new innovations.

But all people are not the same as cited above. We, the human beings, are as such, basically diversified by religion, caste, creed, colour, age and gender etc, and support same group intentions on ideological prejudices.

So, I am, in this article pointing at every reader, how you or we can cope with changing future.

When government fails, there are NGOs and some private bodies, who can work on aligning the activities of funding, manufacturing devices and drugs, distributions systems.

I do not believe in donating money to any needy lot. Helping through money still worsens the situation, as the recipients become more dependent instead of accustom to hard work. But enabling poor to earn more makes them to coup-up in hardship and become resilient. In parallel, we have to create affordable healthcare ecosystem.

To keep pace with, we must use technology to improve the efficacy of existing drugs and develop point-of-care diagnostics that can be used reliably under difficult circumstances.

Indians are known for imagination, creativity and innovations. So, institutions like IITs, IISc can go hand in hand to invent low-cost handheld blood-testing devices that can be of great use in poor regions. They are small enough to be hand-carried and is sturdy and reasonably accurate.

Engineers can be encouraged to make devices that work reliably in wet, humid, and dusty conditions, after perhaps being carried for miles on the back of motorbikes.

Of course, there are no clear ways to get everyone together, but human endeavour should never at rest. 


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