Question

what are the challenges in delivering healthcare to everyone which must include the socially disadvantaged the economically challenged marginalized community?And also, what keeps them from reaching 'everywhere'.​

Answer 1

Answer:

The Indian healthcare scenario presents a spectrum of contrasting landscapes. At one end of the spectrum are the glitzy steel and glass structures delivering high tech medicare to the well-heeled, mostly urban Indian. At the other end are the ramshackle outposts in the remote reaches of the “other India” trying desperately to live up to their identity as health subcenters, waiting to be transformed to shrines of health and wellness, a story which we will wait to see unfold. With the rapid pace of change currently being witnessed, this spectrum is likely to widen further, presenting even more complexity in the future.

Our country began with a glorious tradition of public health, as seen in the references to the descriptions of the Indus valley civilization (5500–1300 BCE) which mention “Arogya” as reflecting “holistic well-being.”[1] The Chinese traveler Fa-Hien (tr.AD 399–414) takes this further, commenting on the excellent facilities for curative care at the time.[2] Today, we are a country of 1,296,667,068 people (estimated as of this writing) who present an enormous diversity, and therefore, an enormous challenge to the healthcare delivery system.[3] This brings into sharp focus the WHO theme of 2018, which calls for “Universal Health Coverage-Everyone, Everywhere.”

What are the challenges in delivering healthcare to the “everyone” which must include the socially disadvantaged, the economically challenged, and the systemically marginalized? What keeps us from reaching the “everywhere,” which must include the remote areas in our Himalayan region for instance, where until recently, essentials were airlifted by air force helicopters?.[4]

While there are many challenges, I present five “A's” for our consideration:

Awareness or the lack of it: How aware is the Indian population about important issues regarding their own health? Studies on awareness are many and diverse, but lacunae in awareness appear to cut across the lifespan in our country. Adequate knowledge regarding breastfeeding practice was found in only one-third of the antenatal mothers in two studies.[5,6] Moving ahead in the lifecycle, a study in urban Haryana found that only 11.3% of the adolescent girls studied knew correctly about key reproductive health issues.[7] A review article on geriatric morbidity found that 20.3% of participants were aware of common causes of prevalent illness and their prevention.[8]

Why is the level of health awareness low in the Indian population? The answers may lie in low educational status, poor functional literacy, low accent on education within the healthcare system, and low priority for health in the population, among others.

What is encouraging is that efforts to enhance awareness levels have generally shown promising results. For instance, a study in Bihar and Jharkhand demonstrated improved levels of awareness and perceptions about abortion following a behavioral change intervention.[9] A review on the effectiveness of interventions on adolescent reproductive health showed a considerable increase in the awareness levels of girls with regard to knowledge of health problems, environmental health, nutritional awareness, and reproductive and child health following intervention.[10]

The message is clear – we must strive to raise awareness in those whom we work with and must encourage the younger generation to believe in the power of education for behavior change.

Answer 2

There are several challenges in delivering healthcare to everyone which must include the socially disadvantaged the economically challenged marginalised community

Explanation:

• Awareness or the Lack of It: There is lack of awareness amongst the Indian population concerning  important issues regarding their health. Such lacunae in awareness is cut across the lifespan in our nation. The reasons for low health awareness in India are "poor functional literacy", "low educational status", "low accent on education" in the healthcare system, & "low priority for health" in the population, and so on.
• Access or the Lack of It: Physical reach is another important determinants and is referred to as the ability to "enter a healthcare facility" within "5 km" from the place of work/residence. A study in India found that in rural "less than" 40 per cent of the people have access in-patient facilities within a "5 km" distance, & the balance percentage had access only to out-patient facilities
• Even if a healthcare facility is reachable physically, what is its quality of care? Is this service constantly available?A survey by six Indian state reveals that much of the "primary health care centers" (PHCs) lack the basic infrastructural amenities such as beds, sanitation, drinking water services, among others, although the regional (rural) health project has done a lot to boost infrastructure of the Indian government.
• Absence or the Human Power Crisis in Healthcare: Issues such as sufficient numbers of personnel, if they are properly trained, are they "equitably deployed" & is their morale in service delivery reasonably high. Although the private sector contributes for most of the national health expenses, the state-owned health sector is still the only choice for much of the country's rural and peri-urban regions. The absence of a qualified person at the time of delivery when a person has travelled a fair distance  is a major deterrent to population healthcare.
• Affordability or the cost of Healthcare: In the Indian healthcare region, the private sector is the dominant force. Up to 75% of health spending comes in family pockets, and high health care expenses are a major cause of poverty. Furthermore, the problem is the lack of private-sector control and the resulting variability in facilities' quality & prices. Public healthcare that offers low or no costs, is perceived as unreliable, indifferent and is generally not the primary choice, unless private care cannot be provided.
• Accountability or the Lack of it: Being accountable is the procedures & processes wherein  one party justifies & takes responsibility for its activities

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