Equitable Healthcare Access

 

What is Equitable Healthcare Access?
By – Dr. Devendra Tayade

India as a country has made humongous progress since its independence. But a report published by The Economist suggested that the bottom half of the Indians are equal to the destitute parts of Africa which is something to worry about (India has a hole where its middle class should be, 2018). When 56% of the countries population lives below the empowerment line (McKinsey&Company, 2014), to ensure stability, the population must be assured of three fundamental needs, viz., livelihood, healthcare, and education (Keeble, 1988). To achieve this objective, the private sector that has dominated Indian healthcare, needs to step up and support the public sector by providing equitable healthcare to society.

Equitable healthcare can be defined as a way of delivering healthcare wherein the organization reaches out to the community and delivers high-quality care that transcends the various forms of inequity, to everyone with dignity and irrespective of their ability to pay.

While it depends on an organization’s mission if they wanted to provide equitable healthcare or not, a group of experts believed that healthcare professionals learn at the expense of poor people and hence, it becomes their moral responsibility to ensure that they give back to society.

It is easier said than done though as the organizations that tried to provide equitable healthcare came across multiple barriers.

  • Unavailability of skilled manpower (Doctors and support staff) has been one of the major barriers for the organizations in providing equitable healthcare access. Though India has closed in on the Doctor-Patient ratio prescribed by the WHO (1:1000), their inequitable distribution has meant that patients in the rural areas have to visit nearby towns or cities for a basic consultation (Raman Kumar, 2018).
  • Difficult geographical terrains coupled with poor roads act as another barrier for the rural population to access care.
  • In the absence of access to conventional care for a prolonged period, this segment of the population resorted to seeking healthcare from the local quacks, which was unscientific and gave rise to superstitions. This created a social barrier for healthcare professionals who intended to provide high-quality and evidence-based care to rural communities.
  • The patients who somehow managed to reach cities seeking care had to face multiple financial barriers as in addition to the exorbitant cost of healthcare, they had to take care of travel and accommodation while losing their daily wages further compromising the financial health of the family.

In these hopeless conditions, some organizations that had the right mindset have found ways to overcome these barriers and have been providing equitable healthcare to the masses. A few of them are mentioned below-

1. Task shifting: On properly studying the process of care delivery, few organizations realized that with proper training, most parts of the tasks that a doctor needed to do could be carried out by auxiliary/support staff. Shifting these tasks to the support staff enabled doctors to focus their attention on the areas that they were trained in i.e. diagnosis and surgeries. This meant that that with the same number of doctors and a few support staff, these organizations were able to see more patients hence, solving the problem of lack of doctors.

2. In house training: Task shifting from doctors required a cadre of workers who could do the parts of the tasks that were earlier done by the doctors. Identifying the training needs, creating an in-house training program and recruiting local people into these training programs helped healthcare organizations to solve the issue of lack of skilled manpower.

3. Use of technology: Organizations that provide equitable healthcare used technology in two ways to achieve their objectives. They are as below:

  • Capturing real-time data: In the form IT systems and Electronic Medical Records (EMR), the use of technology enabled healthcare organizations to capture real-time data that provided evidence for proactive decision making in the clinical as well as non-clinical area. This ensured that the patients received high-quality care.
  • Improving access to care: To provide healthcare at the right time, it was important to provide it close to the patient’s doorstep. Lack of specialists and their unwillingness to travel to the rural hinterland because of some valid reasons required a concrete solution. This problem was solved to an extent by the use of telemedicine. With the help of telemedicine, the doctors in the city could interact with the patients sitting miles way in some village and provide primary care. Off late, the telemedicine has also been used in emergency medicine to remotely monitor the patients and guide the local doctors to take necessary steps. This has resulted in a reduced burden on tertiary care, low cost of accessing healthcare and reduced carbon footprint.

With the changing environment, the barriers will keep changing their form but one enabler will always act as a fountainhead of solutions i.e. the willingness to provide equitable healthcare. With the willingness, an organization would create its unique path in the absence of one in their quest to provide equitable healthcare.

References

Keeble, B., 1988. The Brundtland report: ‘Our common future’. Medicine and War, 4(1), pp.17-25.

McKinsey & Company, 2014. From Poverty To Empowerment: India’S Imperative For Jobs, Growth, And Effective Basic Services. [online] McKinsey Global Institute, p.36. Available at:
From poverty to empowerment: India’s imperative for jobs, growth, and effective basic services
[Accessed 9 April 2020].

McKinsey & Company, 2014. From Poverty To Empowerment: India’S Imperative For Jobs, Growth, And Effective Basic Services. [online] McKinsey Global Institute, p.36. Available at: From poverty to
empowerment: India’s imperative for jobs, growth, and effective basic services [Accessed 9 April 2020].

Raman Kumar, R., 2018. India Achieves WHO Recommended Doctor Population Ratio: A Call For Paradigm Shift In Public Health Discourse!. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259525/ [Accessed 9 April 2020].

The Economist, 2018. India has a hole where its middle class should be. [online] Available at: https://www.economist.com/leaders/2018/01/13/india-has-a-hole-where-its-middle-class-should-be [Accessed 9 April 2020].