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Saturday, August 18, 2012

Less than one bed for 1,000 people in rural hospitals


New Delhi: Not just doctors, in rural India it's a scramble for hospital beds too. There's less than one bed — 0.9 by health ministry estimates — for every 1,000 people in a rural hospital. Worse, experts say that almost 50% of these are nonfunctional, either because of lack of manpower or shortage of equipment. 
    Releasing the latest statistics on Friday, Union health minister Ghulam Nabi Azad said a single bed in a government hospital caters to over 1,500 people in rural India. 
    The National Health Profile 2010 reported that India has a public sector availability of one bed for 2,012 people in 12,760 government hospitals: around 0.5 beds for every 1,000 people. 
    This, when India actually has a higher absolute number of hospital beds than many others. Dr K Srinath Reddy, who headed the Planning Commission's high-level expert group on universal health coverage says that in most countries, three beds are available per 1,000 population in the public sector. 
    "But in India, 0.9 beds are available per 1,000 population, far below the glo
bal average of 2.9 beds. We have to find how we can increase bed strength. But more important is to see how to make the beds already available, functional," he said. 
    Availability of public hospital beds in rural India varies widely: from just one bed per 4,471 population in central India to one bed per 1,650 population in the southern states, according to a study by a private consultancy. 
    Dr Reddy estimates India requires at least 2.1 beds per 1,000 population, as against the current 0.9. Since India is moving towards daycare facilities and
ambulatory care, which means shorter and fewer hospital admissions, the country will ideally not require three beds per 1,000 population, he said. 
    Dr Shakti Gupta of AIIMS added, "The thrust now is more on daycare centres. The concept is that patients should be investigated at daycare and once found fit for surgery should be admitted. The average stay of a patient should be around three to four days. Earlier, we would admit a patient, waste seven-10 days on diagnosing the problem and then take him for surgery." 
    Also, increased use of distance treat
ment options such as telemedicine will ensure people don't need to come to a hospital. "To reach the target of two beds, we will have to increase the capacity in our community health centres and district hospitals," said Reddy. 
    A recent Technopak study indicates hi-tech diagnostics and interventions will lead to a shift in healthcare delivery from predominantly in-patient to outpatient settings. The study predicts that 75% of all surgical procedures in India in 2020 will be conducted in outpatient ambulatory surgery centres. This will also cost 47% less than in-patient services. 

    Kavita Narayan, a hospitals and health systems expert at the PublicHealth Foundation of India said the real issue is lack of investment in publichealth infrastructure. "We spend less than 1% of our total GDP on health at present against over 20% GDP by the US. At least in this Plan period (2012 2017), we must spend a minimum 3% of GDP on health," she said. 
    Narayan said primary healthcare services at village level should be a pri ority, so that people don't need to visit hospitals. "It is of utmost importance that the government puts money in pri mary healthcare so that things like fe ver, diarrhoea, broken bones and dog bites can be fixed at a primaryhealth centre. Hospitals should provide higher end services." 
    In 1948, the Bhore committee on pub lic health had recommended one bed per 1,000 population. The population has skyrocketed, but "we still haven't been able to reach that target," Gupta said. 
    On roping in the private sector to ramp up health infrastructure, both Narayana and Reddy suggest multi stakeholder governing bodies that in clude patients for running hospitals. 

BED BOTHERS 
India has one of the lowest patient-to-bed ratios globally There are 0.9 beds per 1,000 population, way below the global average of 2.9 beds A 2010 study said India has a public sector availability of one bed per 2,012 population in 12,760 state hospitals. That makes it 
half a bed per 1,000 population Sri Lanka has 3.1 beds per 1,000 population, China has 3, Thailand 2.2, Brazil 2.4, US 
3.1 and UK 3.9 
Two beds per 1,000 by 2022 is the Planning Commission's target 
Availability of public hospital beds in rural India varies widely: from one bed for 4,471 people in central India to one bed for 1,650 in southern states 
Urban India has approximately one private sector hospital bed for every 422 people

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