A Stitch In Time Saves Nine, But Where Are Needle And Thread?

The proverb “A stitch in time saves nine” is as suitable for a torn piece of cloth as it is for a deep wound. The point is addressing smaller challenges timely helps in avoiding bigger challenges and saves greater investment of money, resources, energy and time.

The proverb is apt as much for the healthcare industry as for any other. Countering diseases at the ground level and treating patients at the primary level leave lesser scope for situation and condition to spiral out of control.

It need not be emphasized more than a robust primary healthcare will reduce dependency on tertiary care.  A lot has been said and talked about it. However, other than few efforts here and there, not many in India really know the way out.

The Torn Piece of Cloth: Behavioural Dichotomy in People
The Indian healthcare system is faced with two types of challenges. On one hand, there is a massive population with trust deficit on institutional care, modern medicine and sciences, and on the other, there is huge preference and in fact ambition for people to be treated by the biggest names and at the biggest facilities.

Working on the ground in the rural areas of 6 states through over 120 centres have made us realize how difficult it is to change the behavioural patterns which are an outcome of years of beliefs entrenched in an individual to trust the village quack rather than the village doctor.

At the same time, there is a larger belief about the best nearby healthcare facility. The fascination of the big building, hundreds of employees, the machines, polished floor, etc and the belief of receiving cure for the disease are what draws the average uneducated, rural patient to seek the best quality treatment. It is the icing on the cake if the healthcare delivery provider can provide treatment in really economic costs.

There is a third and growing challenge, the dwindling trust on healthcare providers if something goes wrong. The medical knowledge is at times beyond the comprehension of the city educated folks, leave alone the rural people. Amidst this gap of understanding, if something goes wrong, the trust is lost and people jump to conclusions.

With these conflicting behavioural patterns existing, primary healthcare has the most to lose.

Where Are the Needle and the Thread?
After the torn cloth, comes the question of the availability of the needle and the thread. The needle and the thread here refer to the health and wellness centres (HWCs) — the latest term for primary healthcare centres (PHCs).

While India is converting its PHCs into HWCs, which is defined as “the facilities which start providing the larger package of comprehensive primary health care”, it needs to be redefined in terms of services it will provide.

HWCs need to be more than a name change. They need to be equipped with diagnostic and pathological services, equipment’s and technology, medicines and medical staff. It has been the need of the hour to integrate diagnostic and testing services at the primary level so that diagnostic requirements are adhered to simultaneously and not postponed or referred to another level of care.

It is estimated that 72% of out-of-pocket expenditure happens for non-hospitalized patients. Also, the majority of diseases can be identified or prevented at the primary level, provided there is the right human resource, knowledge and technological services. The government has committed 1200 crore for 1,50,000 HWCs, where the setting up cost of 1 HWC is estimated to be around 17 lakh and the running cost of 7.5 lakh per year is over and above the cost of the PHC that exists today. This is without accounting for the cost of medicines, diagnostic services, and other expenses.

Also in question is the manpower. In 2017, India had around 10,22,859 doctors registered with medical council of India, with a doctor to patient ratio of 0.62 to 1000 people, while as per an India Spends report, India is short of 1.94 million nurses. The transformation of the HWCs and creation of new HWCs need to be better equipped with human resource for effective delivery of healthcare services.