Health is the most precious blessing for human beings without which one can become uninspired, de-motivated and unable to thrive for success. Health is the capability of an individual to adjust in life changing conditions to function not only in current situation but also to get ready for future. Hence in developed nations, peoples' healthcare always remains the first priority of their respective governments.
According to Lewis, human beings can become victims of various diseases. The patient is in need of treatment by a physician, a registered nurse, or other health care provider. In chronic situation, a patient is required to be admitted to a hospital for proper treatment and care.
As per Health Ministry data, there are around 23,000 government hospitals in India. Rajasthan leads with 3,145 hospitals and Jammu and Kashmir stands at the number two with more than 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. Despite of having abundance of hospitals in Jammu and Kashmir, the healthcare is panicking in dire straits.
Public hospitals in shambles
Hospitals are of two types: public hospitals which are owned by government and receive governmental grants and private hospitals operated privately and mostly profit oriented. The overall standard of health services being provided are not according to the public expectations in developing countries like India primarily because of very poor health investment (1.5 percent of GDP) as compared to developed nations - having an average health investment of more than 10 percent of GDP.
Due to rapid population growth and lack of facilities in health sector, especially in rural areas, there is a reasonable demand for better health care because of consistent beneficiaries dissatisfaction from the existing facilities and services. Problems and difficulties faced by patients at public hospitals are ranging from unavailability of facilities to staff negligence. The reasons behind poor health services at public hospitals are limited governmental funding, lack of governmental interest in launching new healthcare projects and over-burdened public hospitals.
Moreover in public hospitals, the doctors, supporting staff and nurses are less serious in attending the patients or to provide individual care to the patients, take care of cleanliness, sterilization of equipments, and lack of feedback mechanism showed a low commitment level towards their responsibilities.
Similarly, it is accounted that the frustrated attitude of public hospital staff towards patients due to overcrowding, lack of staff cooperation, unavailability of medicines and blood for serious patients, unequal treatment on the basis of rich and poor, lack of staff, inadequate sterilization, lack of proper cooling and heating system for serious patients, poor condition of wards cleanliness, problem of accommodation etc. are the contributing factors towards increasing patients disparities at public hospitals. It is also argued and noticed that doctors and other staff come late, doctors/staff leave hospitals early and don’t take extra work load for patients. This could be one of the major causes of public dissatisfaction from the Government hospital’s treatment due to absentees of hospital staff, ranges from sweepers to physicians.So, it is pointed towards rejection of this fundamental right that is health, to millions of poor people as poor majority cannot afford treatment at high level private hospitals.
There is serious conflict of interest that the qualified doctors posted in public hospitals are trying to incline patients to their personal clinics instead of giving full attention to patients at their duty in public hospital. Also it is noticed that doctors in public hospitals spend very little time on patient’s check-up which is even less than a minute per patient. There is also a raising concern that patients in public hospitals especially tertiary hospitals are being attended at many times by junior intern doctors without under direct supervision from their seniors. It is also argued that the patients have to wait for weeks or months to get higher diagnostic investigations done like CT Scans, MRI Scans, Echocardiography etc. Moreover, the doctor-patient ratio in Jammu and Kashmir is among the lowest in India and it is likely to remain so if the Government continues with the traditional sluggish process of recruitment.
The government is busy in setting up new medical colleges, despite the fact that Government Medical College Srinagar and Government Medical College Jammu are in dire straits due to the lack of beds, poor infrastructure, lack of doctors, unending crowd of patients, lack of medicines, lack of proper hospital management - creating a huge problem for patients at Outdoor Patient Department (OPD), in-patient department and emergency wards. It is very sad state of affairs that sometimes patients are advised to wait their turns to get bed or are sometimes seated two to three patients on single bed.
In order to overhaul these problems, the government needs to increase the health sector budget (that is not up to the mark as per standard guidelines) and to initiate rural health programs to ensure access of poor people to good quality of health services in society. Poor patients should be provided medicines free of cost, doctors and other hospital staff is suggested to give proper attention to patients equally without any discrimination. Government needs to provide all the necessary equipments and facilities to public hospitals at district levels and incentives for staff to make the treatment environment more conducive for doctors to facilitate them while treating the patients. In order to ensure good governance at public hospitals, a proper feedback and complaint mechanism and monitoring system needs to be installed and known to the public in every district of the society.
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. Off course,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.