Group 2_A | SDG 3 : Good Health and Wellbeing

Introduction

The SDG-3 “Good health and well-being” aims to increase the access to health facilities to the underprivileged areas of the world and tackle healthcare problems such as maternal mortality, infant mortality, communicable diseases, substance abuse, traffic accidents, reproductive health, research and development of vaccines and medicines for communicable diseases as well as reproductive and mental health. While the quality of life has increased for many people across the globe, at-least half of the world still lacks access to essential health services. Until quality healthcare is accessible to people across the globe at all spectrums of society, the world cannot move towards a sustainable future.

State of healthcare in India

Despite the significant progress made in the past 75 years, the Indian healthcare system still falls short in fulfilling the needs of its burgeoning populace. The Global Burden of Disease Index 2016 ranked the Healthcare quality of India at an abysmal 145^th. India has already missed the MDG targets of Maternal Mortality Rate and Under Five Mortality Rate and still underperforms in these metrics compared to its peer nations.

Source: Economic Survey

The recent COVID19 pandemic has exposed the inadequacies in Indian healthcare. Global Health Security Index ranked India’s pandemic preparation at an unimpressive 66^th position.

The inadequacy in Indian healthcare varies also across regions. According to NITI Ayog’s report, Kerala has the best healthcare facilities (80/100), while Jharkhard was at the bottom of the list (45.33).

Reasons for Inadequate Healthcare facilities:

1. Inadequate Healthcare budget: India spends around 1.2% of its GDP on public healthcare. Due it being a state subject spending is left to the discretion of state governments. Wide variances in healthcare spending by states have implications on their healthcare parameters.

Source: Economic Survey

2. Poor Infrastructure: India lacks well-quipped hospitals, medical facilities, and medical colleges it requires for sustainable healthcare. The recent Human Development Report claims that India has just 5 hospital beds per 10,000 people, ranking it 155^th out of 167 nations.

3. Lack of Trained Medical Personnel: India has only 20.6 health workers for every 10,000 of its people, much below the mandated lower margin set by WHO to achieve the SDGs. Most of these health workers are concentrated in the urban areas, leaving the rural healthcare system severely undermanned.

4. Insufficient Primary Healthcare: There are very few primary healthcare centres in India. What’s more, they hardly ever function properly, being prone to absenteeism by doctors, nurses, and midwives. This is a major problem, as a well functioning primary healthcare system can solve many of our problems.

5. Lack of Awareness & High Out of Pocket Expenditure:. Lack of education education combined with poor healthcare facilities also leads to people depend on bogus practitioners and non-institutional deliveries. Inadequate insurance penetration despite many government schemes leads to high out-of-pocket expenditure. India’s OOP expentidure is among the highest in the world, and has direct correlation with poverty.

Source: Economic Survey

6. Larger number of private players: Inadeqaute public health facilities has led to mushrooming of private hospitals which generally charge very high fees.

7. Growing Non-Communicable Diseases: like Diabetes and Cancer are putting additional burden on the healthcare system. In fact, the largest number of admissions under Ayushman Bharat scheme were for cancer treatment.

Major developments and policies for healthcare

Some of the most prominent reforms under the Ministry of Health and Family Welfare (MOHFW) are –

1) The National Health policy 2017: It aims at improving life expectancy at birth to 70 years from 67.5 years by 2025, increasing health expenditure by the government to 2.5% by 2025.

2) Ayushman Bharat: Provides hospitalisation cover of Rs 5 lakhs to all eligible families.

3) National Health Mission: Th flagship scheme of Ministry of Health focusing on both rural and urban areas the reduction of child and maternal mortality, prevention of communicable and non-communicable diseases and increasing access to healthcare facilities

4) Janani Suraksha Yojana: to promote institutional delivery for pregnant women.

5) Pradhan Mantri Surakshit Matritva Abhiyaan: Provides intensive care and consultation to all pregnant women

6) Universal Immunization Programme: Provides free vaccination against 12 diseases to all children across the country.

Success stories from India

Improved Immunisation

India’s UIP(Universal Immunization Programme), an extensive vaccine delivery system, with over 27000 vaccine storage units across the country has been very successful. 80% of vaccination takes place in the outreach sessions in more than 600,000 villages. UIP has steadily improved public health in India. India was declared as polio-free in 2014, a major milestone in the country’s public health scenario.

Access to Medicines

Over 65% of population did not have access to essential medicines until government renewed its focus on procurement and distribution of medicines.

To combat several factors like poor stocking of essential medicines, inadequate budgetary support, inessential and costlier prescriptions for medicines, the Jan Aushadhi scheme was initiated which has made the country take rapid strides on this front as captured in the infographic below.

Community Health

Accredited Social Health Activists (ASHAs), introduced by the National Rural Health Mission, are the key cadre in India’s community health program that seeks to improve maternal and child health. The ASHAs have played a major role in functioning as link workers, increasing usage about condoms, oral contraceptive pills, delivery kits and simple life saving drugs.

Business Implications & Responses

One of the major and most relevant examples of why good health is a vital predictor of business progress is the way in which businesses and economies have been disrupted by the COVID19 pandemic in the last 2 years. According to a McKinsey report, the costs of the pandemic alone have contributed to close to 8% of the global GDP while the total costs spent on healthcare cover in 2020 come to ~15% of the total global GDP. To put things in perspective, the global GDP is expected to be ~$93 trillion this year and the corresponding healthcare costs are ~14 trillion. Only two countries in the world have a GDP that exceeds the global costs of healthcare in the previous year. While no single company is to blame for the high numbers, investing in employee healthcare coverage has proven to be a pricey affair for businesses all over the world, and finding appropriate solutions will be a significant financial boost for organisations everywhere.

The obvious question is why employee wellbeing isn’t deemed a big enough issue when we already know the financial implications of not doing so. The biggest reason for that is the complications that come with trying to measure employee wellness and physical health. A HBR study notes that the current metrics being used to assess the benefit of employee wellness are probably not the most reliable. The traditional approach currently used by companies for measuring the same is identifying how much they spend on employee health costs and see how it has progressed over the years compared to other companies. However, the benefits of investing in employee wellbeing don’t always show up in the company’s balance sheet. There are a variety of other parameters like increased productivity, lower absenteeism, and improvements in acquisition and retention of talent that also have a huge financial impact on a company’s workings.

The major roadblock in realizing the importance of measuring employee wellness, health, and its impact on how businesses function is that there are no uniform set of metrics companies use to measure them. In a bid to address this, the US has set up accreditation bodies in the recent years that employ a uniform set of metrics to rank businesses on their employee wellness and healthcare programs and the corresponding healthcare cover and support offered by them. Some of the big accrediting organizations in the US are NIOSH and HealthLead which have managed to onboard and collaborate with some of the biggest Fortune 500 companies to help them realize how they’re faring on these parameters. This has also resulted in businesses better identifying where they’re lacking and working on improving accordingly. While these accreditation organizations are already institutionalized in the US and other major countries, India is still far behind the other big countries with respect to having a standardized board that accredits companies based on their preparedness in providing their employees with a robust health support. For a country that spends as little as just 1.3% of its GDP on healthcare support and infrastructure, not having a regulatory body gauging how businesses are doing in these metrics can be a very costly affair. Businesses don’t often know if their expenditure is in line with the expected estimates and the expected capital investment may not be very useful too.

Analysis

In the aftermath of the phenomenon of countries world over establishing regulatory bodies to accredit the work done by companies to help improve the health and wellbeing of their community, a lot of companies have started realizing the importance of undertaking CSR initiatives as a medium of improvement of health and wellbeing and not just a PR stunt to increase their audience base. While running a critical analysis of the CSR initiatives undertaken by these companies, we discovered how much India is lacking on these fronts. As mentioned in previously, companies have started to realize the importance of wellbeing and healthcare of a community and are acting accordingly. Given below are a few CSR initiatives undertaken by some of the bigger companies too which have realized the importance of such initiatives –

· Bajaj Auto – The Bajaj group has placed a lot of importance on the healthcare wellbeing of its community. As such, in addition to pledging huge amounts of capital support every year, the company has also built a hospital that provides healthcare support to people below the poverty line in Aurangabad. Additionally, it has also set up a bunch of other specialty hospitals treating other major diseases like eye disorders and cancer. The company has also helped set up primary healthcare centres (PHCs) in three national parks in India thus covering a wide spectrum of both regions, people, and places in India.

· Johnson & Johnson – J&J has been an active advocate for CSR activities for a few years now. While it has helped improved the state of healthcare by means of capital infusion and building infrastructure, J&J has not restricted itself to just that. The company has also smartly identified the problems which when addressed will lead to more long-term and self-sustainable solutions to the healthcare problem facing India. As a result, it has dedicated its efforts primarily in improving the strength of the healthcare workforce by conducting dedicated training programs and bootcamps across cities in India. In addition to this, it has also run a multitude of awareness and disease control programs across the globe while providing the people below the poverty line in its community with free access to quality healthcare.

· MasterCard – As part of efforts made through the Mastercard Impact Fund, Mastercard along with American India Foundation (AIF) launched a hundred bed mobile hospital in Jalna district of Maharashtra. In addition, it has helped Modulus Housing, a startup incubated at IIT Madras, in deploying deploying MediCAB extension hospitals.

Conclusion

Ever since the introduction of the 17 SDGs, countries and companies world over have been actively setting internal goals and working towards meeting them. Some of the biggest changes we have witnessed after the introduction of the SDGs is the smart identification of where they need to make investments along with how much needs to be spent on these improvements. The introduction of accreditation bodies has also made sure that companies follow up these goals with actual action and made sure they take CSR initiatives not just as a PR exercise and to actually improve the living and healthcare conditions of their employees and people in their community. While there is still a long way to go before our community as a whole realises its healthcare targets and ensures secure and good health for all its inhabitants, the steps taken by the introduction of the SDG and the corresponding follow-up action on part of the government and some big private players has been very encouraging.

References:

· Economic Survey of India

· https://timesofindia.indiatimes.com/india/5-hospital-beds/10k-population-india-ranks-155th-in-167/articleshow/79769527.cms

· https://www.thehindubusinessline.com/news/national/5-reasons-why-indias-healthcare-system-is-struggling/article34665535.ece

· https://www.mckinsey.com/mgi/overview/in-the-news/good-health-is-good-business

· https://www.hsph.harvard.edu/ecpe/the-business-benefits-of-a-healthy-workforce/

· https://indiacsr.in/csr-mastercard-and-american-india-foundation-launch-first-portable-hospital-in-jalna/

· https://www.jnj.in/our-societal-impact/corporate-social-responsibility-policy

· https://cdn.bajajauto.com/-/media/bajaj-auto/Investors/Annual-Reports/Supplementary-Report-on-CSR-activities-2019-20.ashx

· https://www.mohfw.gov.in/

· https://www.bajajauto.com/corporate-social-responsibility

· https://www.expresshealthcare.in/features/milestones-in-indian-healthcare/191620/