World Bank Loan to Indian Health Sector

• The World Bank and the Government of India have agreed on two complimentary loans totaling $1 billion to assist and improve India's healthcare system.

Highlight

• The World Bank is providing two complementary loans totalling $500 million to assist India to upgrade its health infrastructure and get ready for upcoming pandemics.
• The loan will be utilised to fund India's premier Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), which will enhance the public healthcare infrastructure throughout the nation and was launched in October 2021.
• India's surveillance system will be prepared to find and report epidemics of concern thanks to the $500 million Public Health Systems for Pandemic Preparedness Program (PHSPP).
• The Program-for-Results financing tool, which emphasises outputs above inputs, is used in both loans. The loans' total maturity duration, which includes a five-year grace period, is 18.5 years.
• A second Enhanced Health Service Delivery Program (EHSDP) loan in the amount of $500 million will assist the government's efforts to improve service delivery through a primary healthcare model redesign. Both of these loans make use of the Program-for-Results financing instrument, which emphasizes the achievement of results rather than inputs.
• Delivering health services in seven states—Andhra Pradesh, Kerala, Meghalaya, Orissa, Punjab, Tamil Nadu, and Uttar Pradesh—will also be given priority under one of the loans.

Challenges in the health sector

Lack of medical personnel

• In remote locations, there is a severe lack of infrastructure, last-mile connectivity, and medical personnel. g.: Doctors serve urban India (population of 30%), where there is 1 doctor for every 1800 people.
• Significant shortages of services (human resources, medical facilities, and diagnostic facilities in the public and commercial sectors), are made worse by wildly unequal distribution across and within States.

Infrastructure for public health in disrepair:

• Most patients must visit private hospitals and clinics because of the nation's deteriorating public healthcare system.
• PHCs (22%) and sub-health centres (20%) are in insufficient supply, and only 7% of sub-health centres and 12% of primary health centres adhere to Indian Public Health Standards (IPHS) standards.

Strong Private Player Role:

• The private sector in India provides over 70% of healthcare services. India's overall healthcare system may fail if private healthcare collapses as a result of financial hardships or other circumstances.
• The private sector is responsible for more than 70% of all healthcare spending.
• Although there is a trend towards hyper-specialisation in Tier-1 cities, private hospitals are underrepresented in Tier-2 and Tier-3 cities.

High out-of-pocket costs:

• The most recent National Health Accounts (NHA) estimates, which were published in March 2021, indicate that patients are responsible for a sizable portion of medical costs—up to 61% of the total—by themselves.
• Even the impoverished are compelled to choose private healthcare, which requires them to pay out of pocket. As a result, 63 million individuals are thought to experience poverty each year as a result of health expenses.

Weak Insurance Penetration:

• The cost of healthcare per person is among the lowest in India. In comparison to 83.5 percent in the UK, the government contributes about 32 percent to insurance.
• Because 76 percent of Indians lack health insurance, there are hefty out-of-pocket costs there.

Fake Doctors:

• Eighty percent of outpatient care is delivered by rural medical practitioners (RMPs), who lack formal training in the field.
• Humans fall prey to quacks, frequently resulting in severe impairments and fatalities.

Initiatives :

• The Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) intends to improve basic, secondary, and tertiary care services throughout India and develop the nation's health infrastructure.
• Ayushman Bharat: Uses a dual-pronged strategy by
• To bring healthcare closer to households, health and wellness centres have been created.
• the creation of the Pradhan Mantri Jan Arogya Yojana (PMJAY) to shield families living in poverty and in vulnerable situations from financial risk brought on by health events.
• the Ayushman Bharat The Digital Mission intends to link hospitals all throughout the country's digital health solutions. Every citizen will now have access to a digital health ID, and their medical records will be safeguarded online.
• The National Ayush Mission is a federally funded programme for the advancement of folk remedies.

Way forward

• India requires a comprehensive strategy to address issues in the healthcare sector.
• This entails the participation of all parties, including the governmental, private, and individual sectors.
• Although though it is less than the average public spending in the world, which is 5.4%, there is an urgent need to raise it to 2.5% of GDP.
• The effectiveness of health and wellness centres will be crucial in lowering the higher burden of out-of-pocket health expenses, which will be crucial in achieving a stress-free and comprehensive wellness system for everyone.

Instead of continuing the existing trend of sporadic and insufficient increases in health spending, there is a need to make significant and ongoing investments in public health over the coming ten years.