In a country as diverse and populous as India, the provision of healthcare is a critical issue that intersects with social, economic, and cultural factors. While progress has been made in expanding primary healthcare access, there is a significant gap when it comes to specialized services. The prevailing healthcare approach for many Indians has been one of addressing needs only as they arise. Factors such as cost, travel logistics, and the impact on work hours often deter individuals from seeking specialist opinions when necessary.

This challenge is particularly evident in rural areas where specialists are scarce. Many primary health centers in India lack specialized doctors, pushing individuals from marginalized communities to travel long distances to access these critical services. This disparity highlights the pressing need for specialized healthcare initiatives tailored to the unique needs of these populations.

In most medical situations, consulting a specialist is not a luxury but a necessity. Effective specialist care is crucial when accessed promptly and from the appropriate professional. Primary healthcare serves as both the starting point and the destination of the healthcare journey within society, with specialist care playing a pivotal role in this pathway. Together, these components uphold the health status of the community and can go a long way in ensuring that disparities in health are addressed through a comprehensive approach.

Challenges for vulnerable communities

Geographical Challenges:

Marginalized communities, especially those in remote rural areas and urban slums, often lack transportation infrastructure to reach government hospitals where specialized services are available. As per the Bharat Health Index survey, for specialized treatment such as cancer, neurological or blood disorders, 90 percent needed to travel to a different location for treatment.

Economic Constraints:

The cost associated with traveling to distant hospitals and paying for specialized consultations and treatments is prohibitive for many individuals from low-income backgrounds.

Quality of Care:

Even when individuals manage to access specialized services, the quality of care can vary significantly due to limited availability of medical equipment, general physicians, and lack specialized practitioners like physiotherapists, dentists, and orthopedic surgeons. As per the Bharat Health Index Survey 2023, “only 15 percent of respondents confirmed having a doctor’s clinic or healthcare facility within a five-kilometer radius. In terms of medical practitioners available, while 25 percent had access to general physicians in their area, 92 percent lacked specialized doctors, such as cardiologists, gynecologists, or pediatricians, impacting medical care.”

Need for Specialized Healthcare Initiatives

To address these disparities, specialized healthcare initiatives are urgently needed. These initiatives should focus on:

1. Community-based Services: Establishing community-level healthcare centers staffed with specialized practitioners can bring critical services closer to where they are needed most. These centers can offer physiotherapy, dental care, ophthalmology, and other specialized services tailored to local needs.

2. Capacity Building: Investing in training healthcare professionals from within marginalized communities to become specialized practitioners can help bridge the gap. This approach empowers communities and ensures culturally sensitive care.

3. Mobile Clinics: Implementing mobile healthcare units equipped with specialized equipment and staffed by trained professionals can reach remote areas and provide essential services directly to those who need them.

4. Telehealth: By leveraging telehealth services, the process of accessing specialized medical opinions becomes more convenient, encouraging timelier interventions that can ultimately enhance health outcomes while reducing costs. Utilizing analytics on aggregated data will enable population-wide analyses, correlating clinician advice with health results. Over time, this data aggregation can facilitate the standardization of clinical protocols and the enhancement of care quality.

Nevertheless, when crafting solutions to bridge healthcare disparities between rural and urban India and address the scarcity of specialist care in rural areas, it is imperative to acknowledge that digitizing healthcare necessitates a comprehensive transformation in the knowledge, skills, and awareness of healthcare providers, alongside a shift in patients’ perceptions and expectations.

5. Public-Private Partnerships: Collaborations between government agencies, non-profit organizations, and private healthcare providers can facilitate the delivery of specialized services to underserved populations. Such an approach helps ensure last-mile delivery of services.

Mobile Dental Healthcare: A Case Study

It is noteworthy that while India has the second highest number of dentists in the world (a dentist-to-population ratio better than the WHO recommendation), just about three percent of all the dentists are employed in government service (as per the National Health Profile 2019), which is the primary care provider for a large section of the country’s population, particularly the underserved communities.

Smile Foundation, in partnership with a leading oral health industry expert, is operating Dental Mobile Health Units, to take oral healthcare services to the underserved communities in semi-urban and rural areas of the country. This is one innovative way of taking specialized care right at the doorsteps of the people. Similar collaborative initiatives can help make specialized healthcare more accessible in hard-to-reach areas.

In conclusion, addressing the healthcare needs of vulnerable and economically marginalized communities in India demands a holistic approach that goes beyond conventional healthcare delivery models. By investing in tailored interventions and fostering community participation, we can move towards a more inclusive and healthier society where every individual has the opportunity to thrive.