Challenges of healthcare Governance in India
Dr. R. Kumar*, & Mr. D.C. Mehandru** Chandigarh

The growing demand for quality healthcare and the absence of matching delivery mechanism pose a great challenge. The responsibility of the healthcare sector is two fold i.e. i) providing world class medical/ surgical services in the hospitals for the Indian people, ii) realization of the Millennium Development Goals of reducing child mortality, improving maternal health and combating HIV/AIDS, T.B. malaria and other diseases. Development of skilled manpower for both the areas mentioned above is inadequate. Numbers is only half the story- the quality and skill is lacking. Clearly, investing in human resources for healthcare is imperative for overall development. India has been ranked at 134 in the Human Development index (HDI) out of 182 countries. (1) Furthermore, as a nation's economic productivity is linked to the health of its citizens, the economic impact of poor health systems may become significant.  Lack of good governance in healthcare has contributed to this poor performance of the country. The change of mindset/concept of the medical personnel to health promotion and prevention ‘whose thoughts and actions remain mired in disease’ is essential. While the medical treatment services are dismal across the country, the role of doctors and others, as agents of health preservation and development is conspicuous by absence. (1, 2).

Development of highly skilled manpower
There is an acute shortage of faculty of medical teachers all over the country. One of the pivotal factors to sustain the projected growth of the healthcare industry in India would be the availability of a trained workforce, besides cheaper technology, better infrastructure etc. Worldwide shortage of doctors, nurses and paramedical staff has led to an exodus of such manpower from India.
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• Ophthalmologist and healthcare columnist
• Industrial development consultant

A major challenge for our nation and the healthcare industry would be not only to retain the healthcare workforce but also to develop an environment, which would attract those abroad to return. Even if the number of doctors were to increase from 0.6 to 0.8 per 1000 population and number of nurses were to increase from 1.5 to 2 per 1000 population to catch up with middle rung countries, India needs 0.2 million doctors and 0.5 million nurses right away.  There is a great need to focus on the software i.e. human resource for healthcare, their numbers matter but more importantly do their skills. Premier medical colleges of Punjab at Patiala, Amritsar, and Faridkot are in shambles due to inadequate numbers and quality of faculty in medical colleges. The staff and faculty of these institutions have lost initiative to work and learn the latest technological skills.  The situation elsewhere is not distinctly better. This trend has to be reversed to revive these premier institutions. (1,11, 12)

There has been a constant brain drain from India to developed countries from early sixties onwards. Emigration of healthcare workers has weakened the already failing health systems in the country. It is still unclear what the new rules of engagement will be to retain and train health care workers, where they are most needed and to mitigate the grave imbalance between the rich and the poor with regard to health care. Many of the tens of thousands of health professionals of Indian origin living outside are willing to contribute their skills to their home country. India needs to create an environment for the NRI brain bank to flow back towards the home country, so that the fruit of advancement in science and technology could be tasted by the natives.(3)

Public health is trailing due to poor economics
The forefathers of Indian Constitution envisaged a nation with equitable access and assistance to the sick and underserved. We have been successful in eradicating small pox and guinea worm and in reducing the incidence of malaria, leprosy and polio to remarkable levels. The $17 billion Indian health care industry, contributing about 4% to the GDP, is expected to grow at a rate of 13% annually in the next five years. However, several challenges remain. India records the largest number of oral cancer patients and diabetics in the world. With 5.1 million HIV/AIDS cases, it is the second largest in the world after South Africa. With 16.5% of the global population, India contributes to a fifth of world share of diseases. The Report of the National Commission on

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