The Nitish Kumar government in Bihar has plans to provide basic healthcare facilities to the elderly at the comfort of their homes instead of making them visit a health centre, a move that would not only minimise hospital visits but also infection risks. It indeed is a lofty ideal and is a part of a well-thought out development roadmap called "Saat Nishchay-3", which covers the five-year period from 2025.
One of the objectives of the third edition of the roadmap is ease of living or “Jeevan Aasaan”, and this proposed initiative could save the frail seniors the trouble of commuting, which is difficult and expensive. Under the scheme, the elderly will get routine nursing assistance, which can extend to even emergency situations. A batter of pathology tests, checking of blood pressure, ECG, etc., will be provided under the scheme. It also includes physiotherapy services.
Some of the advanced states like Tamil Nadu and Kerala have been experimenting with doorstep healthcare wherein Mobile Medical Units, which are vans equipped with basic medical facilities and portable diagnostic systems, would provide basic services to people living in low-income areas or those who face barriers in accessing healthcare in health centres. The results have been mixed, and much more needs to be done to make it effective.
Ensuring adequate healthcare infrastructure will be a particularly daunting challenge for states like Bihar, which rank low in the NITI Aayog’s State Health Index. In contrast, given the more than generous financial support from the Centre, thanks to the BJP’s political compulsions and calculations, it will be relatively easier to invest and acquire the vans and medical equipment and hiring drivers.
The biggest constraints, however, will be the lack of trained healthcare professionals such as doctors, nurses, paramedical technicians and other support staff.
Even if the State has the funding, it would not be easy to convince doctors and nurses work in the MMUs in these states.
Cognizant of the issue, the State government will be aggressively recruiting healthcare professionals.
According to media reports, starting this month, the government plans to hire over 11,000 nurses, 663 general doctors, and other professionals. But these personnel will fill the existing vacancies in hospitals and PHCs. The State might need to recruit more professionals for the above plan to cater to the needs of the elderly.
Another major issue with regard to MMUs is the monitoring of their functioning. How would the State ensure that these MMUs actually do the rounds and reach out to the elderly? It will be a governance and implementation challenge, and foolproof systems and processes should be put in place in this regard.
Collecting data on households with elderly persons is critical for better and more effective service coverage. Digital and data infrastructure needs to be customised, augmented and strengthened for this purpose.
As is evident, providing comprehensive health services involves the integration of medicine, technology, data, and community engagement. Expecting the already overworked healthcare staff, especially ASHA workers, to take on additional burden would not work.
Similarly, asking doctors, especially geriatric health specialists, to offer virtual consultation through telemedicine platforms could help address the issue of shortage of doctors to some extent, only if they are not multi-tasking.
The Bihar government’s plans to rope in the private sector and non-profit organisations to fill systemic gaps could give better results.