Recent news reports reveal the Union Health Ministry and the Medical Council of India have notified the introduction of a new three-year postgraduate course – MD (family medicine). This is welcome news, particularly against the backdrop of medical students flocking to become specialists. For a nation where healthcare access is still a burning issue, the silent, precipitous decline of the family physician against the swift, ubiquitous ascent of specialists has been one of India’s unsung healthcare tragedies.
The Government’s initiative to revive the institution of the family physician is worth applauding and supporting. This could be one of many concrete steps needed to boost healthcare access. Barely a generation ago, family physicians were almost akin to an extension of every family. Having been associated with a family for years, each family physician – also called a general practitioner or GP – was well aware about the disease history of each family member. Even the physical, psychological and psychosomatic problems of each individual were known to the GP.
Contrast this with modern-day specialists. They know little about the medical histories of patients – let alone knowing about the patient’s family medical history. This is one of the many reasons for the healthcare burden rising sharply in recent times. Whereas a GP could treat an ailment for a couple of hundred rupees – inclusive of consultation and medicines – a specialist could charge a couple of thousand rupees merely for consultations. The prescribed drugs may cost another thousand rupees.
Considering the scenario, it is mostly the well-to-do who regularly visit specialists whenever ill. The not-so-well-off usually visit quacks or resort to procuring medicines from local chemists; these worthies prescribe drugs despite knowing the prevalent practice is against the norms. Needless to say, such unsafe practices sometimes lead to tragedies due to over-prescription or wrong prescription of drugs.
When needy patients do visit doctors due to the severity of ailments, high treatment costs are something they can ill afford. Consequently, many are forced to sell off assets, with some even being pushed below the poverty line due to exorbitant medical costs, since medicines account for between 50% and 80% of healthcare costs. Poverty due to healthcare costs is especially true in rural areas. In fact, statistics cited by the Government indicate that 20% urban residents and 28% rural people have no money for healthcare; 40% hospitalized persons borrow money or sell assets; and 35% hospitalized persons drop below the poverty line due to hospital expenses. A study published by The Lancet medical journal reports that every year an additional 39 million Indians are pushed into poverty because of healthcare expenses.
The above facts make it clear that healthcare costs need to be pared and healthcare access should be improved. The Government’s efforts to bring the family physician back to the forefront of primary healthcare are therefore steps in the right direction for achieving these twin goals.
But given the complexities and gargantuan scale of India’s healthcare challenges, solo initiatives by the Government may not successfully achieve the targets. The National Rural Health Mission (NRHM) is one case in point. Set up in 2005, NRHM has successfully reduced India’s infant and maternal mortality rates. Yet these are still high when benchmarked against the global average or even against mortality rates of developing nations. Conversely, Government efforts in tandem with private sector initiatives could go a long way in ameliorating these problems.
Permit private entities a level playing field and they would be more than happy to address India’s healthcare hurdles. Pathfinder Health India is one such initiative that has already launched ground-level operations in this direction. A primary healthcare venture, Pathfinder Health India has been set up with social intent by an alliance of Indian and British social entrepreneurs, many being clinical practitioners passionate about revamping primary healthcare in India and making the family physician or GP practice a national model.
Under the name ‘Health India’, Pathfinder has been establishing holistic family practice by focusing on reviving the age-old family medicine and strengthening the GP practice in India. With some centres already operational in Delhi, it expects to open around 145 centres across India by 2015. The centres are being established via the hub-and-spoke model as it benefits patients by ensuring they don’t travel too far for treatment. The model comprises satellite healthcare units supported by primary healthcare centres (PHCs) located within easy commuting distance. This facilitates outreach to nearby poorly-served rural and semi-rural communities. Designed to support between five and ten Docs in Boxes (DIBs), each PHC will meet the needs of between 10,000 and 20,000 people. Ten DIBs in turn will serve a larger patient population of about 80,000 to 120,000. The DIBs would venture out into the poorer communities, whereas the hubs would serve the existing local community.
From metro cities, Pathfinder centres will cascade into tier 2, 3 and 4 cities. Urban communities will ‘pay as you go’ at these healthcare centres. Health India is presently working with interested insurance companies to provide a suitable insurance cover. Below-poverty-line patients could be partially supported by Government-backed insurance schemes. The success of this family medicine endeavour would ensure people are not over-medicated and quality healthcare develops as a system. Pathfinder’s model will encourage GP practices and help in piloting new ways of providing healthcare services by focusing on hard-to-reach communities and overcoming barriers to essential services.
These healthcare centres will also focus on key areas such as immunization, cervical screening, minor surgery, family planning, Ayurveda, homeopathy, palliative care, health messaging, early health interventions, diagnostics, community awareness and engagement, amongst others.
Moving forward, in tandem with Government measures, such private initiatives could play a key role in improving healthcare access, affordability and availability in India.
The author is Chairperson and Managing Director, Pathfinder Health India.
The views are personal.