by Dr. Shuchin Bajaj

As doctor and social entrepreneur by profession, I work closely in the rural areas of the country. Every day, I witness the enormous toll of poor health on people’s lives as diseases that could be prevented with adequate health measures and education cause disabilities and death and deepen poverty. Even now, as COVID remains a clear and present danger, an outbreak of Japanese encephalitis —a mosquito-borne illness—is threatening millions of people across rural and semi-rural areas, while a fever of unknown cause is filling up hospital beds in North India.

One story that remains with me illustrates the problem that I am talking about. I was once working in a rural clinic when an elderly man accompanied by a crowd of children came in. His daughter-in-law had malaria, a disease transmitted by mosquitoes. I gave him malaria medicine and told him that they all needed to take a tablet once a week to prevent the disease. Three weeks later, the man returned. This time, it was his grandson who was suffering from severe malaria. When asked if they had taken the medicine that I prescribed back then, he explained that they had all taken the medicine as suggested by me but mentioned that it was difficult to break the tablet into 13 pieces. His response left me in awe. The man continued that, to overcome the problem of dividing the tablet equally among all, he ground it into flour and baked it into bread so that each one of them could receive their share. Having dealt with scarcity all his life, this grandfather had assumed that one pill would have to be divided among all family members.

I believe basic prevention has the potential to transform and hence save lives. If he and his family had regular access to primary care and community health education, they likely would have understood the basics of prevention, and his grandson would have been spared. The burden of disease in the community—and the poverty it causes—would have been much less. As it is, almost 60 million people in India slip below the poverty line every year due to avoidable health crises and healthcare costs.

To address the enormous gap in our rural healthcare delivery, we must understand that primary healthcare, which focuses on preventing people from getting sick in the first place, is the only way out. And only the government has the capacity to ensure primary care delivery to India’s 650,000 villages.

In 2018, the central government allocated funds to build a network of 150,000 primary and preventive health care centres as part of its overarching health care scheme, Ayushman Bharat. Although proposed four years ago, almost 20% of these centres do not even have electricity or water connections to date. On paper, more than 50% of primary health centres have doctors, yet there is no data on how many actually show up and provide services. The healthcare system is simply not equipped or staffed to provide healthcare that can prevent disease in the first place.

The hospital group that I founded, Ujala Cygnus, has opened a number of cardiac care clinics in small towns. At the inauguration of any clinic, I always ask people: “Would you want to have a heart attack and be treated really well at our centre, or would you rather not have a heart attack at all?” Unsurprisingly, the answer is always the same. Nobody wants to have a heart attack. However, government resources are more focused on treatment than on the preventive aspect.
A well-known programme run by the government offers free kidney dialysis services. However, it needs to be noted that more than three-quarters of kidney failures are caused by uncontrolled diabetes and hypertension, which can easily be detected and treated at the level of a primary health centre. Yet, less than one-third of cases of diabetes are detected and diagnosed early during the onset of the disease, and an estimated 77 million people in India have diabetes.

Even as the Central Health Ministry refuses to release funds already allocated, it continues to keep health care on austerity. In the most recent national budget, funding for the health sector was essentially flat, with the health sector receiving a meagre 0.75% of capital expenditures—less than the amount allocated to space .

The healthcare system is in dire need of inclusive development becoming an integral part of service delivery. The government of India has committed to achieving universal healthcare by 2025. It will take far more than words and goodwill to get there. The government must come through on its plan for preventive health centers servicing all of India—and most especially its rural areas—or see an ever-mounting burden of disease, both chronic and infectious, and mostly preventable, continue to tear away the health of the nation.

Shuchin Bajaj is a medical doctor and social entrepreneur. He operates a network of more than 18 hospitals, outreach clinics, and digital health services in North India.

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