Friday, February 10, 2012: 03:53:43 PM



Mayank Madhani identifies the threats and opportunities in the health infrastructure sector

Indian healthcare expenditure is still among the lowest globally and there are significant challenges to be addressed, both in terms of accessibility of healthcare service and the quality of patient care. India rates poorly on even the basic healthcare indicators when benchmarked against not only the developed economies, but also other BRIC nations.

The significance of hospital infrastructure can be underscored simply by highlighting the fact that Indian healthcare industry is currently estimated at $40 bn, of which, 50 percent comprises hospital infrastructure, followed by pharmaceuticals at 25 percent, insurance and medical equipment at 15 percent, with diagnostics making up for the balance 10 percent. The health care industry is expected to grow to about $79 bn by 2012 and almost $280 bn by 2020, and the growth of hospital infrastructure is expected to be proportionate to it.

A Dose for Infrastructure
A significant portion of the Indian population is unable to access healthcare services, which is primarily a consequence of lack in healthcare infrastructure, and lack of trained and qualified manpower. Accessibility to healthcare infrastructure on an overall basis is relatively imbalanced and is extremely limited in many rural areas of the country. In addition, existing healthcare infrastructure is unplanned and is irregularly distributed. Further, there is a severe shortage of trained doctors and nurses to service the needs of the large Indian population.

The private sector has evolved a multipronged approach to increase accessibility and penetration. It has tackled the issues of lifestyle-related diseases with the development of high-end tertiary care facilities. Also, new delivery models such as day-care centres, single specialty hospitals, end-of-life care centres, etc., are on the horizon to service larger sections of the population and address specific needs.

The Rural Cause

Though almost 70 percent of the population still resides in rural areas even today, a major portion of the funds (public and private) is allocated to the urban centres. There is no way we can enhance the quality of rural health without making primary and secondary healthcare amenities available to rural areas.

People have, therefore, been forced to choose between meagre and inefficient public services or provide for expensive private treatment at the nearest town/city. At times, they are complelled to forego healthcare entirely, except in life threatening situations, due to the fear of sliding into debt.

This represents significant opportunity for the private sector. The government can also play an important role in facilitating this evolution. There is a dearth of primary and secondary healthcare facilities across rural India. The existing set of public hospitals at district and sub-district levels have poor management and inadequate funding. Adding to their share of woes is the fact that they are grossly understaffed and have poorly maintained or outdated medical equipment. The need is to assess, plan, build, restore, upgrade and maintain, primary and secondary healthcare hospitals in rural areas to ensure that every village or cluster of villages above a certain population can avail healthcare benefits in its immediate vicinity of less than 2–5 km. A significant investment in the existing medical infrastructure is the order of the day.

Number Crunching

Vital Signs India US UK Brazil China
Life expectancy at birth (in years) 64 78 80 73 74
Infant Mortality Rate (Probability of dying by the age of one as per 1000 live births) 52 7 5 18 18
Maternal Mortality Rate (per 100000 births) 254 13 7 77 34
Hospital Bed Density (per 10000 population) 12 31 39 24 30
Doctor Density (per 10000 population) 6 27 21 17 14

Source:WHO, World Health Statistics, 2010

To the Roots
Neev has been observing and studying the phases and trends displayed by the Indian medical and healthcare industry for over two decades, although it made serious contribution to the field of healthcare infrastructure, as a modest civil contractor, only a decade ago. It observed a trend reversal for tertiary and super specialty treatments (erstwhile being performed only in advanced foreign countries) which are now being performed successfully in Indian hospitals, by Indian doctors, at an affordable cost. While Neev has a strong reason to believe in the Indian 'Medical Tourism' potential story, it is equally disconcerting to witness the apathy shown towards the allocation of resources and the overall ‘Program Management’ for the development of healthcare infrastructure in rural India. The author is Head of Project, RMC Division, Neev

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