The individuals in India commonly rely on private sectors more than public sectors because the public sectors are providing poor services. The private sectors are providing eminent facilities with advanced features. The healthcare machinery in India is discussed and various manufacturers are introduced. Also, the medical devices and equipment are elaborated with the major healthcare industries.
Table of Content
Structure of Healthcare System in India: Government Machinery
The role of private healthcare providers is increasing nowadays in providing services to people who need assistance. The private healthcare structure is divided into two parts: profit and non-profit organizations.
On the other side, public healthcare primarily constitutes community healthcare centers, primary health centers and sub-centers. And these centers are extended into sub-sections based on the provision of facilities, services and resources. Though, the secondary healthcare system is recognized as sub-district hospitals. These hospitals are established based on the health needs of the districts.
Furthermore, the tertiary level of healthcare includes the district hospitals and teaching hospital which are associated with medical colleges.
India has twenty nine states and seven union territories and further divided into districts and blocks. Since the population of India stands after China around 1.25 billion, it has been challenging to maintain the health care system and structures fulfilling the needs of our population post-independence. Therefore, the public and private healthcare systems needed comprehensive planning and management, and required strong policies to implement in India.
Sub Centers
A Sub Centre is planned in rural areas to provide healthcare services. They are fully secured and covered by the national government. At least two workers (one male and one female) are required in mandates to assist a population of about 5000 people. The population criterion is limited to 3000 inhabitants for dangerous, hilly or remote locations. These sub centers are working to encourage and persuade rural people towards healthy nutrition and habits of wellbeing in a long run.
Primary Health Centers
The primary health care centers are established in advanced rural areas, for the population of about 30,000 or more and it is limited to a population of about 20,000 for dangerous or hilly or remote locations. Their centers are expected to have clinics with doctors (1 Medical officer and 1 AYUSH), 4-5 beds and a pharmaceutical facility. The patients can be referred from sub-centers to the primary health center to get more advanced treatment. As compared to sub centers, the primary health centers are supported by the state government instead of the national government.
Community Health Centers
The community health centers are also funded by the state government and have better and superior facilities than primary health centers. Here, the population covered is about 1,20,000 while it is limited to 80,000 for hilly and remote areas. There are around 30-50 beds to treat patients needing admission. These centers have a physician, anesthetist, surgeon, ophthalmologist, gynecologist and a pediatrician. The patients from these centers can be referred to the general or district hospitals, when required. This center acts as a referral unit for four primary health centers and also considered as first referral units for intensive care, blood storages, deliveries and new born childcare.
District Hospitals
The district hospitals are considered as a final referral center for the primary and secondary health care for public. Every district is expected to have at least one hospital in India, whereas in practice only 605 hospitals are available in 640 districts. The number of beds required is between 70 to 500 which is depending upon the population of the district and its needs.
Medical Colleges
There are medical colleges and research centers or hospitals that are controlled by the national government, like one of the largest and renowned centers is All India Institutes of Medical Sciences (AIIMS). These hospitals or centers are well equipped with special and advanced facilities. There are also regional special centers that may be controlled jointly by state and national government like regional cancer center.
Profit and Non-profit Organizations
These organizations are categorized into the private sector. The private hospitals are profit making units and may have the advanced and modern facilities based on the hospital dimensions. The patients are required to pay for the health care services themselves from out of their pocket. The private organizations are also responsible to manage the hospitals on their own.
On the other hand, non-profit organizations have different sources of funding such as donations or under government schemes. The patients do not have to take responsibility of the expenses or may have to do a minor contribution towards health care expenses, while the organizations get managed by the funding sources.
Machinery (Medical Devices and Equipment) of Healthcare
Nowadays, the number of hospitals is increasing which also increases the requirement of healthcare facilities and therefore the demand for refined medical devices and equipment. By the use of electronic and communication technologies, the medical devices are equipped with many advanced features such as sensing, processing, control, display, and accuracy.
As per global medical device nomenclature, the medical devices and products are of different types and the products are in the range of 14,500. These products are selected by the hospital facilitators based on the requirements of hospitals depending upon the health problems of population in that area.
Moreover, the medical technology is improving and advancing, making significant efforts to encourage innovation in the healthcare sector which is also providing the opportunity to be benefitted in the Indian market. In the past, the healthcare system is significantly improved in India due to the advancement and innovation in the medical technology, biotechnology and biomedical engineering field.
The government health sector is also working to improve the healthcare products with modern technologies. However, the improvement is only marginal but increasing gradually due to the competition in the market. The government is expecting from the medical product manufacturers to produce good quality products for public healthcare sector.
Moreover, the international contributions are also tied up with the domestic manufacturers of the medical products to improve the quality such as 3-Ms, Philips medical system, Becton Dickinson, naming a few.
Furthermore, some of the leading medical devices manufacturing industries are GE Healthcare, India Medtronic, Johnson & Johnson, Wipro Technologies, HCL Technologies, Texas Instruments, Nidhi Meditech System, Biopore Surgical, BPL Healthcare India, etc.
There are a number of key challenges faced by the manufacturing sectors such as:
- Low Penetration
- Affordability
- Accessibility
- Awareness
- Nascent Regulatory Environment
- Complex Rules and Guidelines
- High Capital requirement
- Low Indigenous Manufacturing
There are some recommendations given by the experts in view to make improvement in the healthcare industry as follows:
- The legislative amendments need to improve, for enabling the widespread Medical Device Regulations.
- Training and skill development is the necessity for resources and funds allocation, whereas the upgrading is also required.
- Creating an ecosystem for the improvement in medical technology via development, quality, testing, waste management, etc.
- To improve the provision of healthcare services, the GDP needs an increment from 1% to 3%.
- The collaboration between medical universities and medical centers are encouraged.
- Quality enhancement training is necessary for the medical and paramedical staff members which can be resourceful for innovative and creative efforts.
- Improve the medical technology education in respect of curriculum.
- A unique reform is required in the insurance sector to motivate individuals for accepting the insurance policy, largely.
National Health Policies and Programs
Ministry of Health and Family Welfare plays an important role in healthcare in India while announcing and implementing the policies and programs related to health care. It works towards providing universal access of quality healthcare.
National Health Mission (NHM)
NHM has various goals to achieve in the healthcare structure through proper mechanisms. The main mechanisms of NHM comprise strengthening of the healthcare system in rural and urban areas in respect of the neonatal, child, adolescent health and also the communicable and non-communicable diseases. It has various levels of monitoring and evaluating the healthcare system at central, states, districts and blocks. Many different programs have been introduced under the umbrella of NHM as a part of the program.
National Rural Health Mission (NRHM)
NRHM pursues to provide affordable, quality and accessible healthcare to rural inhabitants. The special focus is given to the Empowered Action Group States as well as Jammu and Kashmir, Himachal Pradesh, and North Eastern States under NRHM.
A decentralized health delivery system is its mission to cover all levels of healthcare. Some of the major initiatives taken by NRHM are ASHAs, Rogi Kalyan Samiti, Untied Grants for Sub-Centers, Sanitation and Nutrition Committee for Village Health, Janani Suraksha Yojana, Janani Shishu Suraksha Karyakarm, Mother and Child Tracking System, Medical Mobile Units, National Ambulance Services, Rashtriya Bal Swasthya Karyakram, Rashtriya Kishor Swasthya Karyakram, Child and Mother Health Wings, Free Diagnostic Services and Free Drugs, and adolescent Health Services, ‘Delivery Points’ identification, Universal Coverage of Health care, Quality Assurance and many others.
Some of the major disease control national programs under NRHM are as follows:
- Vector Borne Diseases Control Programme
- Leprosy Eradication Programme
- Revised TB Control Programme
- Blindness Control Programme
- Iodine Deficiency Disorders Control Programme
ASHA
ASHA is known as Accredited Social Health Activist. It was launched by NRHM in 2005 to fulfill and notice the rural needs, particularly for vulnerable sections of humanity. ASHA is the first port of contact for women and children in the rural population for any health related demands. She has been providing for good health services in rural India.
ASHAs are working for the following activities:
- ASHA provides information to the community on determining proper diet and nutrition, sanitation, healthy living and working conditions and hygienic practices at doorsteps.
- ASHA provides information to the pregnant women while visiting their homes in the village. They are expected to deliver information to pregnant women regarding safe delivery as well as breastfeeding practice, complementary feeding, how to take care of young child, immunization, contraception and infection’s preventions.
- ASHA also provides health care services for some diseases such as diarrhea, fever, and first aid for small injuries.
Rashtriya Bal Swasthya Karyakram (RBSK)
RBSK a pioneering and motivating initiative was launched under the National Health Mission by the Ministry of Health & Family Welfare, Government of India in the year 2013. The initiative encourages the screening of child health and provides services for early intervention with a universal and comprehensive approach of primary identification.
The scheme aims at early detection and management of diseases, deficiency conditions and development delays in children and defects at birth. RBSK is an additional component for the school health care system, since for the age group from birth to 18 years, anganwadi centres and government schools are also involved under the scheme. Therefore, children will get free assured services through RBSK.
Janani Suraksha Yojana
Janani Suraksha Yojana was introduced by Ministry of Health and Family Welfare under the national rural health mission in 2005, for safe motherhood for poor pregnant women. The scheme was launched with the objective of reducing the maternal and neonatal mortality.
It has a clear linkage between pregnant women and the government which is also identified by ASHAs. The yojana is mainly focused in the states having low institutional delivery rates hence called low performing states such as Uttar Pradesh, Bihar, Uttarakhand, Orissa, Assam, Madhya Pradesh, Jharkhand, Rajasthan, Chhattisgarh, and Jammu and Kashmir.
Health, Sanitation and Nutrition Committee at Village Level
Under the National Rural Health Mission, the Village Health, Sanitation and Nutrition committee was formed for collective actions on health related issues in the villages. This committee also functions as a subcommittee of the gram panchayat, with the minimum of 15 members.
The responsibilities and roles are as follows:
- To register all pregnant women of village for antennal care.
- To survey on nutritional status and nutritional deficiencies, among women and children of the village.
- To vaccinate children against vaccine preventable diseases
- To involve the ASHA, AWW, ANM and ICDS Supervisor.
- To monthly supervise and monitor the health and nutrition in the village. Supervising the functioning of Anganwadi Centre (AWC) of the village.
Rogi Kalyan Samiti
The provision of basic preventive, curative and promotive services is a key motive of the government and policy creators. Therefore, Rogi Kalyan Samiti contributes to our government and policies on the same objective. It is a simple management structure of a group of hospitals’ trustees, local panchayati raj institutions and NGOs.
Some of the objectives involved are as follows:
- Ensuring the compliance to maintain the standards in hospital facilities and healthcare centers, in accordance to the government
- Ensuring accountability of the health care providers towards the community
- Ensuring transparency in respect to the financial resources received from the management
- Improving and modernizing the health care services in the hospitals
- Supervising the working of National Health Programmes and schemes in the hospitals
- Conducting the health camps
- Generating resources through aids, user charges and other resources
- Establishing affiliations with private institutions to improve
- Ensuring construction and expansion in the hospitals premises
- Ensuring proper biomedical waste management
National Urban Health Mission (NUHM)
NUHM, like NRHM is also a part of NHM. It was approved by the government of India in 2013. It is primarily focused upon the urban inhabitants who are poor and vulnerable. It aims to provide public health services such as sanitation, drinking water and vector control. Urban Social Health Activist (USHA) and Mahila Arogya Samiti are two important pillars of NUHM.
Below are some of the major health programs NUHM works upon:
- Control and Prevention of Diabetes, Cancer, Cardiovascular Disease and Stroke
- Tobacco Control Program
- Mental Health
- Prevention and Control of Deafness
- Prevention and Control of Fluorosis
- Health Care of the Senior Citizen and Elderly Person
- Sexually Transmitted Diseases Control
Ayushman Bharat Yojana
Ayushman Bharat Yojana has been launched in 2018 and is also known as Ayushman Bharat – National Health Protection Mission (AB-NHPM) or Pradhan Mantri Jan Arogya Yojana (PMJAY) or Modicare. To address health care holistically, this scheme extends beyond curative care, covering preventive and promotive health care, taking actions at primary, secondary and tertiary care systems.
This mission is expected to make extensive impact on comprehensive health care and insurance landscape. This scheme contemplates the adoption of the standard treatment guidelines and specific packages costs for surgical procedures. It also envisages extensive use of Information Technology and data analytics to observe or monitor the implementation of the scheme and to manage any fraudulent claims. This will further improvise the health sector and provide a future roadmap of reducing deficiencies in health care systems.
In the later stage, this scheme is expected to strengthen primary care services, including OPD treatment, and increasing the coverage to entire population, achieving the target of universal health insurance.
Technological Advancements in India
The healthcare industry in India has become equipped with technological advancements in various sectors, which have turned out to be very helpful for medical practitioners. Moreover, from last few years, practice of robotic surgeries has also increased in the hospitals. Numerous diagnostic centers are also established in urban and rural areas. They are facilitated with modern healthcare devices / equipment.
On the other hand, the patients are also able to make a choice among suitable doctors for their treatments. The individuals are also aware of the nearest emergency healthcare centers, where the ambulance facilities are provided in a critical situation.
Scientists and researchers are continuously working on improving the healthcare technology like there are various health care devices such as watches which are embedded with ECG sensors to count the heart beats or measure the critical situations. A patient can wear a watch and the ECG is monitored continuously.
In case of any abnormality, the information of abnormal condition is transferred to a doctor mobile or a healthcare centre via the Internet. Thereafter, a doctor can advise special assistance accordingly. Similar to the above example, is a tracking system embedded in the hospitals, where it can help to track patient movements. The movements are captured and recorded to observe the activities of a patient.
One eminent example of technology advancements is the use of lighting at homes and hospitals. The research has given various evidence that the different colours of light affect the health improvement in individuals. For example, the light of blue colour is useful in the hospital for patients to have peace of mind.
These days healthcare is enabled with mobile wearable technology and remote monitoring systems. These technologies are helpful to doctors for determining the diagnosis and treatment. This makes the treatment fast, accurate, and feasible.
