By Gyan Pathak
The Lady with the Lamp, the founder of the nursing profession Florence Nightingale, had said that a hospital should do no harm to the sick. However, it is a commonplace thing in India for a patient to suffer in the hands of doctors, nurses, and hospital administration. This tragedy of a patient fails to attract the human attention of those who, fortunately, never happened to undergo such predicaments. Such tragedies are in such a large number that it loses the human face to become a matter of dry statistics. COVID-19 outbreak has underlined the need to change it urgently.
The very first thing that attracts our mind is the corruption, dereliction of duty, and lack of resources, personnel, and infrastructure in implementing quality health care system in the country. Everybody in the hospital seems to have become professional lacking sympathetic approach towards a patient. Majority of patient faces rudeness, favouritism, and at the worst their economic exploitation by the so called professionals. During the pandemic, we have seen how some big companies even tried to exploit people by selling their products, despite the well established ethics that health care services are supposed to treat patients through therapeutic services which are not only evidence-based and effective but also safe.
Health services in rural areas are far worse than in the urban areas of the country largely due to lack of hospital and nursing facilities, which are nearly absent. Almost all the resources of hospital care are located in the urban areas. Recently, ADB has made a study on the ‘Quality Implementation on Urban Health Care Services in India’, which finds certain improvements under the National Urban Health Mission, though it has indirectly admitted that the country needs much to do to assure quality health services to all.
The National Health Policy of India of 2017 enunciates improvements in health status through concentrated policy action in all sectors by expanding preventive, promotive, curative, palliative, and rehabilitative services provided through the public health sector, with focus on quality. The quality programme across the country is monitored by the central quality supervisory committee in the Union Ministry of Health and Family Welfare, and by the quality assurance committees at the state and district level. However, they have largely failed to implements qualities, though they have some minor success in their credit. It goes without saying that much more is needed to ascertain the quality of health care because even the built-in system of assessment within NUHM fails to ascertain the quality.
Flowing from the National Health Policy, quality of health care has emerged as a key thrust for both policy makers and public health practitioners, and as an instrument of optimal utilization of resources and improving health outcomes and client satisfaction. The National Urban Health Mission of India has developed a road map for improving the quality of its health services. It is officially claimed that the National Urban Health Mission has been striving to provide quality health care to all citizens of India in an equitable manner. However, the major problem with its implementation is that we have adopted various models and approaches in a fragmented manner in a bid to assure quality.
Though under the mission, the total quality management or quality management systems have replaced the ad hoc quality control or quality assurance process, we do not see the quality service in majority of our hospitals. It is in this backdrop the report says that quality is an ongoing process without any defined endpoint, and continuous quality improvement is the mantra for success. Therefore, national efforts to sustain quality in health services must be sustained and incrementally augmented to strengthen universal health care, especially for the vulnerable poor in urban settings, it concluded.
The brief has suggested that the implementation of quality in health services requires step-by-step, systematic, and comprehensive approach with full commitment of management and implementation of a practical road map. This very suggestion is an indirect indictment of the Indian performance.
In another suggestion, which also reveals the weaknesses of the quality implementation programme, it says that development and execution of a quality framework is feasible through management commitment, adoption of standards, training of human resources for health in executing the standards, documentation of process, and undertaking assessment.
The paper says that quality is implementable only through concerted, sustained and coordinated efforts by the national authorities, health system, and communities. Quality costs, but poor quality costs more.
It may be mentioned here that there is a tendency to invest less in health services which has resulted in its being far from perfect. The incidence of healthcare associated infection is very high. In developing countries as a whole this figure rises to 10 per cent. These infections can be easily avoided through better hygiene and rational infection control practices.
A large number of patients do not receive appropriate, evidence-based care. The goal set by the World Health Assembly in 2003 of immunizing 75 per cent of people with the influenza vaccine by 2010 is yet to be achieved. Irrational use of antibiotics in health facilities has accelerated selection and spread of antimicrobial resistance, which has become a major public health issue. Globally, the cost associated with medication errors is estimated at $42 billion annually, not counting lost wages, foregone productivity, or health care costs.
The World Health Organization estimates that 303,000 mothers and 2.7 million newborn infants die annually around the time of childbirth, and that many more are affected by preventable illness. Further, some 2.6 million babies are stillborn each year. Nearly 40 per cent of health care facilities in low- and middle- income countries lack improved water, and about 20 per cent lack sanitation. Poor quality care disproportionately affects the more vulnerable groups in society. The economic and social costs of patient harm caused by long-term disability, impairment, and lost productivity amount to trillions of dollars each year. In addition, duplicate services, ineffective care, and avoidable hospital admissions— features of many health systems—generate considerable waste.
Up to a fifth of health resources are deployed in ways that result in very few health improvements. These scarce resources could be deployed much more effectively in expanding and improving quality of health services. People need a strong policy articulation followed by implementation of access to safe and quality curative and preventive services to facilitate and augment their productivity.