With launch of Ayushman Bharat or Pradhan Mantri Jan Aarogya Yojana, government has taken a big step to provide universal health care (UHC) to Indian population. However, UHC will be an empty vessel without patient safety. Access to poor quality of healthcare may kill more patients than it saves. Patient safety and quality of healthcare are two sides of the coin of healthcare services. We need to make serious and continuous efforts to improve patient safety practice as coverage improves with PMJAY.
We have so much of media attention to possible hazard of nuclear power plant accident or air crash but deaths due to medical errors and adverse reactions go unnoticed. The probability nuclear power plant is one in hundred million and air crash ten times higher at one in ten million and chances of a preventable hospital death is hundreds of thousand times more at one in 300 (Lucian Leape 2001). Patient safety certainly needs equal if not more attention from the government and other stake holders than air craft and nuclear accident safety. We do not have precise data for India. It is estimated that for every 100 hospital admissions we have 12.7 adverse events in India. We have about 5.2 million injuries due to medical errors resulting in about 3 million deaths a year. According to WHO, globally we have 6 million excess deaths per year due to lack of quality healthcare year.
The problem is not confined to developing countries alone. In OECD (Organization of Economic Cooperation and Economic Development) countries the causes of quality failure include errors, failure to use effective care, overuse of ineffective care etc result in 15% of all hospital deaths, costing about 1.4 to 1.6 trillion dollars a year to their economy. In the US about 30% of antibiotics are used unnecessarily.
In India and China, only 25-50% of the times clinicians adhere to evidence based Rx for common conditions asthma, chest pain, diarrhea and tuberculosis. In low and middle income countries about 134 million adverse events take place resulting in 2.5 million deaths a year. With increase in non communicable diseases which need lifelong or long-term care the adverse events become more common (Crossing the Global Quality Chasm : Improving Healthcare Worldwide. National Academies Press, Washington DC)
The causes of adverse events include medical errors, delay or failure in providing effective care, unnecessary medications and interventions, disregard to person’s values and resources etc.
Patient Safety in healthcare facility – Goes beyond medical care. Lack of clean water, sanitation or broken supply chain of essential medicines and other supplies contribute to adverse health outcomes.
Way Forward to reduce these preventable deaths, disability and human sufferings include:
- Redesign health care system with paradigm shift to people centred model with bottom up approach including self-care and family level care before falling sick, early detection, timely seeking of care and compliance and follow-up.
- Implement National Patient Safety Implementation Framework (2018-2025): An excellent framework prepared by the government must be implemented in letter and spirit. The earlier initiatives such as Clinical Establishment Act and Indian Public Health Standards have remained on paper.
- Rational approach to trade margin for private hospitals and medical products: The private sector provides medical care both outpatient and inpatient care and is preferred by people over public sector. This has happened by default as public sector did nor keep pace with the demand. The government is actively engaging the private healthcare providers in Ayushman Bharat and other government schemes such as National Free Diagnostic Scheme and Dialysis Schemes etc. However, the prices for the interventions and products are fixed without adequate engagement of private healthcare providers and manufacturers. The prices offered often vary from one central scheme to the other, reflecting lack of uniformity in fixing prices. The private providers’ genuine interests need to be considered to ensure that they are able to maintain quality and are not pushed to cutting corners to survive.
- The social determinants of health need to be addressed to keep people healthy
Sanjiv Kumar is the Chair of Advisory Committee of Indian Alliance of Patients Groups and Chair Indian Academy of Public Health. He is a Formerly Executive Director at NHSRC, IIHMR, New Delhi and also a Senior Advisor in UNICEF.
The views expressed in the article above are those of the authors’ and do not necessarily represent or reflect the views of this publishing house.