The doctor alone can’t save you

There is a dire need to move towards an integrated healthcare delivery system


There is ample evidence suggesting that highly skilled, trained and empowered nurses and allied health professionals can be the leaders of change, playing a critical role in improving the reach of health services in underserved areas. Photo: S. Kumar/Mint
There is ample evidence suggesting that highly skilled, trained and empowered nurses and allied health professionals can be the leaders of change, playing a critical role in improving the reach of health services in underserved areas. Photo: S. Kumar/Mint

Isn’t it ironical that we are able to look up the ratings of a restaurant for a meal and make an informed choice, yet have no idea of the quality of skills, training, certification or even the legitimacy of healthcare providers in India? Those in whose hands we place our own selves and our loved ones for medical care? We are talking more than doctors here. We are talking more about the rest of the healthcare-provider system, in rural and urban India—nurses, pharmacists, X-ray technicians, lab technicians, dieticians, community health workers, auxillary nurse midwives, over a hundred different types of professionals who contribute to and constitute the health workforce in India.

Other than a handful of public medical institutions, it is virtually impossible for you or me to get medical care efficiently for everyday aches, pains, coughs and colds. The only indicator of quality service in the private sector in an average Indian’s mind seems to be the price that one pays for services. So, if I am paying Rs.1,000 for a 15-minute consultation to a doctor, well, he must be the Shah Rukh Khan (SRK) of medicine, no? Similarly, if I am able to afford a super-deluxe room in a medical facility that has room service, fresh flowers on the table, a TV and a smiling nurse, my knee surgery must show all promise of being successful. You get the drift.

Extending the Bollywood analogy here for a minute, just like it takes more than SRK and some pretty Swiss mountains to make a blockbuster, it takes a whole team of healthcare workers, each of whom know when and how to play their parts, to ensure quality health outcomes. It takes more than the doctor to keep us healthy.

As the Indian healthcare sector gains prominence in the coming decades as one contributing in a major way to overall national economic growth and development, market forces will make it virtually impossible for both the public and the private sector to ignore the current chasms in quality of service delivery and care, primarily impacted by the quality of skills of all healthcare professionals responsible for care delivery.

While the system has seen positive growth over the years, there is a dire need to move towards an integrated healthcare delivery system that leverages technology, skilled manpower and has a patient-centric approach for service delivery. Significant factors such as growing population, increasing affordability, mounting patient awareness and unconventional technology-driven systems are few that will drive the future of healthcare in India. Unlike many Western counterparts, India does not suffer from a scarcity in its potential to grow a large healthcare workforce, given the youth-centric population growth trends.

Globally, there is mounting evidence that healthcare as a composite whole can only be improved if human resources for nursing and allied health sciences are developed, nurtured and enhanced in a systematic and planned manner. There is also ample evidence suggesting that highly skilled, trained and empowered nurses and allied health professionals can be the leaders of change, playing a critical role in improving the reach of health services in underserved areas.

However, our system buckles under pressure because of serious issues with the quality, training, consistency and availability of a large number of skilled healthcare personnel needed to cater to the healthcare needs of 1.2 billion people, among others. India currently has the world’s greatest burden of maternal, newborn and child deaths. As much as 40% of all births occur with no trained professional supervision. In 2008 alone, India lost 68,000 mothers and 1.8 million children under the age of 5 to maternal and child morbidity.

There is a significant lack of standardization across medical education in general and in teaching advances in skills and technologies that emerged in the past decade, in particular. One of the most critical tasks ahead of us, therefore, is the standardization of the quality of medical, nursing and allied health education frameworks to match global best practice norms, including regulating the institutions and licensing the professionals as needed.

An urgent and coordinated effort towards addressing skill and competency gaps at all levels of healthcare delivery would thus improve public health outcomes; at the lower levels, this would also create meaningful and sustainable employment opportunities in the health sector for the youth of a growing India.

Kavita Narayan is head of hospital services unit at Public Health Foundation of India.

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