Insight: How India can plan its healthcare priorities

Improving the quality of healthcare access even in remote areas, use of high-tech medical equipment, need for well-trained healthcare professionals & access to emergency care are where investments need to go
The Indian healthcare sector is on the path to improvement in both quality and quantity. It is gradually enhancing the well-being of communities and the development of the nation. This is most evident in the dramatic increase in life expectancy: In 1901, the average Indian lived just 24 years. Even after independence, in 1951 life expectancy had climbed to a paltry 32 years. Today, the average Indian reaches 69 years of life, or more than what used to be two lifetimes.
This is because of a phenomenal decline in infant and maternal deaths, because major communicable diseases have been brought under control, and smallpox and polio have been eliminated. However, the overall performance of the healthcare sector remains below international benchmarks. When it comes to strengthening the entire system, what should be the priorities for investment?
Looking at ways to strengthen the healthcare system, the first approach recommended by researchers PR Sodani, Neeraj Sharma, Md Mahbub Hossain, SD Gupta, and DK Mangal of IIHMR University, Jaipur, is to improve the service quality of maternal health interventions.
This requires a string of investments across the entire course of human birth, from ensuring family planning for the last few who still lack access, to ensuring that all mothers are provided with transportation and access to facility births or have skilled attendants at home births. It also involves improving availability of more high-tech equipment and personnel to tackle serious complications like obstructed labour, ante-partum and postpartum haemorrhage and eclampsia.
In Andhra Pradesh, the researchers find that ensuring all women have access to all or almost all of these interventions will over the next two decades cost about Rs. 3,000 crores. In total, this investment would save more than 6,000 mothers and 20,000 new-borns. Put into financial terms, the total benefits to society would be worth Rs. 22,000 crores. In other words, each rupee spent on these maternal health interventions would generate benefits worth seven rupees.
Need for Sufficient Emergency Care & Ambulances
A shortage of ambulances means that people die due to delays in reaching timely healthcare facilities. Prior research suggests that there should be about 33 ambulances for every million people in urban areas, and three-times more in rural areas.
The new analysis shows some tough choices need to be made. Providing sufficient ambulances for the urban areas of Andhra Pradesh would over a decade cost about a thousand crore rupees. But it would save 4,236 lives each year among patients of Ischemic heart disease, road traffic accidents, and obstructed labour. Each rupee spent on strengthening ambulance services would generate social benefits worth a very worthy Rs. 17.
Rural Healthcare in Shambles
But the researchers’ analysis shows that there is a huge difference in the efficiency of serving urban and rural areas. An adequate number of ambulances in rural Andhra Pradesh could save almost three times the number of lives each year.
But unfortunately, the cost would skyrocket to 8-times the cost of urban ambulances. Each rupee invested would generate more modest social benefits worth Rs. 6. These are still considerable returns compared to many policy choices, but the stark differ-ence highlights challenging decisions that policymakers will need to make.
Family Planning Awareness in Dire Need
Finally, the researchers highlight the huge benefits from investment in family planning, to help women ensure space between pregnancies. Doing so has a huge range of benefits: it prevents unwanted pregnancy-related health risks in women, indirectly reduces infant mortality, reduces the spread of sexually transmitted diseases, empowers people and enhances education, reduces adolescent pregnancy, and helps in reducing population growth. Roughly five percent of the female population in the state still need contraceptives.
Targeting these women is a challenge, but this can be achieved by expanding access to family planning services. The total cost is Rs. 386 crores for Andhra Pradesh. Most benefits come from demographic dividends but also from child and maternal lives saved due to family planning methods would also be important. The total economic and social benefits would be worth about Rs. 6,310 crore for Andhra Pradesh. This means every rupee would generate societal benefits worth about 16-times the investment.
These quite remarkable returns highlight the impact that can be made by carefully focusing on further strengthening health systems, to close remaining gaps.


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