"Health is like money, we will never have a true idea of its value until we lost" is a very significant statement of Josh Billings.

 Overview

India is a democratically-governed country. It is true that India is endowed country, and establishing a stronger health system is a major undertaking. Around 70% of India's population lives in rural areas. and the government is responsible for providing primary health care to the population. So, government is always working to improve access to primary health care. Health is a fundamental human right, and the Constitution recognises it as such in Article 21.

The Indian health-care system has seen significant changes in the twenty-first century, although there remain significant variations between cities and countryside. In India, where public-sector health-care institutions produce poor results, there has been a significant migration toward private-sector hospitals. Furthermore, the cost of doing business in the private sector is much higher than in the public sector. However, the administration is now putting its potential into action, and better services are being perceived.

 Definition and concepts of health system-

The health system encompasses a wide range of health activities, health programmes, medical care institutions such as hospitals, clinics, and primary health care centres, as well as government policies aimed at delivering the best possible health care to its population. WHO defines a health system as "the sum total of all the organisations, institutions, and resources whose primary objective is to immunise people."

 Component of health system-

Health System Includes - Concepts which refers to health and diseases Ideas refers to equity Objects refers to hospitals, health centres Persons refers to health care workers viz. physician, nurses

 Current Scenario of Health-Care System in Indian-

Currently in terms of revenue and employment, healthcare has become one of India's most important industries. Hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment are all part of the healthcare industry. The Indian healthcare system is expanding rapidly as a result of expanding coverage, services, and public and private sector financing. India's healthcare delivery system is divided into two categories i.e. public and private sector. The government, or public healthcare system, has a limited number of secondary and tertiary care institutions in major cities and focuses on delivering basic healthcare in rural regions through primary healthcare centres (PHCs). The private sector supplies the bulk of secondary, tertiary, and quaternary care facilities, with metros, tier I, and tier II cities having the highest concentration.

 COVID-19 Impact on the Healthcare-

It is now clear that the COVID 19 epidemic will place a substantial strain on our already scarce healthcare resources. According to an initial study on coronavirus infectivity an infected patient will infect the other two people, during the initial phase of epidemic. The exact number of people who may be affected in the near future is difficult to predict. COVID-19 takes roughly 67 days to infect the first one lakh people, according to the World Health Organization, and just 12 days to infect the following one lakh. The next one lakh became infected in just four days. Globally, the number of confirmed cases is now about 41.7 lakh.

The coronavirus pandemic has posed numerous issues for industrialised countries, and these challenges would exacerbate for emerging countries such as India as the number of infected cases rises. As a result, it is our job to use healthcare resources wisely in order to protect our frontline warriors. We don't have specific treatment for this. So, even after vaccination, supportive care for sick people and numerous prevention strategies will be the only way to keep this pandemic under control.

Major issues faced by healthcare system in India-

 Shortage of doctor- According to a WHO report, India's doctor-density ratio is 8 per 10,000 people, compared to one doctor per 1000 people. The same message is conveyed by India Spread's data.

 Finance- Because they cannot afford care, the majority of Indians do not seek treatment even after becoming aware of their ailment. Around 70% of medical expenses come from the patient's own pocket.

 Poor Public Health Infrastructure - People are forced to seek medical care at private hospitals due to a lack of public health infrastructure, which pushes them into poverty. Only 7% of sub-health centres and 12% of primary health centres fulfil Indian Public Health Standards (IPHS) requirements, indicating a lack of PHCs (22%) and sub-health centres (20%).

 Insurance- The majority of people do not have health insurance because they cannot afford it. In comparison to 83.5 percent in the UK, the government contributes around 32 percent to insurance.

 Poor healthcare ranking: India is ranked 145th out of 195 countries in terms of healthcare quality and accessibility, trailing only Bangladesh and Sri Lanka.

 Commercial motive: lack of transparency and unethical practices in the private sector. These private hospitals are opened by some business personnel merely for monetary gains.

 Flop schemes: The government has devised a number of programmes. However, they have failed to upgrade the system and make it more user-friendly. In the absence of uniform and large increases in health spending by States, the NHM's share of the health budget declined from 73 percent in 2006 to 50 percent in 2019.

Statistics on the state of health-

1. India spends 1.4% of GDP on health, less than Nepal, Sri Lanka. Source: India Spend, January 2018.

2. 70 percent of the overall household expenditure on health in the country is on medicines. Source: WHO

3. An estimated 469 million people in India do not have regular access to essential medicines. Source: WHO

4. While 63% of primary health centres did not have an operation theatre and 29% lacked a labour room, community health centres were short of 81.5% specialists–surgeon, gynaecologists and paediatricians. Source: India Spend, January 2018

5. In 2014, 58% Indians in rural areas and 68% in urban areas said they use private facilities for inpatient care, according to the 71st round of the National Sample Survey Source: India Spend, January 2018

6. Various studies have shown the rising out-of-pocket expenditures on healthcare is pushing around 32-39 million Indians below the poverty line annually.

7. Heart disease (1/4 people) and stroke is the biggest killer of men and women in India.

8. 7% of Indians fall below the poverty line just because of indebtedness due to this expenditure, as well as that this figure hasn’t changed much in a decade. About 23% of the sick can’t afford healthcare because of these payments.

9. 55 million Indians were pushed into poverty in a single year due to unaffordable healthcare. (PHFI, 2018)

10. 33 out of 55 million fell under the poverty line due to expenditure on medicines alone. (PHFI, 2018)

 Initiative to improve health care system in India-

India has initiated a number of reforms that could have far-reaching implications for the health sector and the broader economy. These include:

- Launching Ayushman Bharat, which encompasses the National Health Protection Scheme (Pradhan Mantri Jan Arogya Yojana), for coverage of tertiary care for vulnerable populations and Health and Wellness Centres initiative for the delivery of comprehensive and integrated primary care.

- Setting up the National Health Authority to implement the PM-JAY.

- Initiating the provision of universal sanitation coverage and making the country open defecation–free through the Swachch Bharat Mission.

- Launching Intensified Mission Indradhanush 2.0 to achieve 90 percent vaccination coverage for children under 2.

- Providing clean cooking fuel under the Pradhan Mantri Ujjwala Yojana scheme.

- Providing nutritional and social support for all National Health Protection Scheme.

 Conclusion-

India has made it a priority to provide complete care for both mother and child. It has developed policies that enable for the inclusive design and execution of neonatal care programmes. However, when examining the rate at which the targets have been met thus far, as well as the pace at which they will be met in the future, it has to concentrate more on policy formulation in terms of increasing the capacity of current human resources, increasing the amount of money committed to new-born care, and finding areas through operational research that might improve the quantity and quality of new-born care in India. We need to operationalize and move forward now that the roadmap has been determined.