Sopan Correspondent
India
lags behind on health goals such as maternal and infant mortality and
sanitation, the basic premise for prevention of communicable
diseases
Many in the country believed that India's economic progress so far
has failed to bring about the desired improvement in health services in the
country. The gap between the rich and the poor in terms of access to health
services is most glaring, even bigger than that in the field of education. This
reality to some extent has been accepted even by member of the newly
constituted NITI Aayog Bibek Debroy, who had recently remarked that the country
had lagged behind on health goals like maternal and infant mortality, as well
as sanitation, which is the basic premise for prevention of communicable
diseases. The communicable diseases account for more than 50 per cent of the
total illness in the country.
Surveys reveal that India
lags behind even Sri Lanka, Bangladesh and Nepal on many fronts including
infant mortality rate, child immunisation rate and even life expectancy. Even
as private urban tertiary care centres vie for global medical tourism, the
stark failure of basic public health services profiles the paradox of India's health
system.
Even as India is
considered to be a global pharmacy hub for inexpensive generic drugs, the draft
National Health Policy put out recently informs that over 63 million Indians
face the threat of poverty each year due to unaffordable health care
expenditure. Huge inter-state disparities in health indicators testify to the
widely varying quality of health services across India.
The 2015 deadline for
meeting the Millennium Development Goals (MDG) targets turned the spotlight on
the poorly performing health system. So there is an urgent need to resolutely
revamp the health system to make it capable of delivering the targets set by
the new health goal. So it is rightly said, "If we do not create the
future, the present extends itself."
Targets are desired
to be achieved by 2030, which include reduction in maternal mortality to less
than 70 per 100,000 live births (India is at 178 now); end preventable deaths
of newborns and under-five children; end the epidemics of HIV, TB, malaria and
neglected tropical diseases; reduce by one-third premature mortality from
non-communicable diseases (deaths before 70 years from cardiovascular and
chronic respiratory diseases, cancers and diabetes); halve deaths and injuries
from road traffic accidents; provide universal health coverage, including
financial risk protection, and access to essential medicines and vaccines to
all; universal access to sexual and reproductive health services; substantially
reduce harm from hazardous chemicals and pollution of air, water and soil.
Thus the target as
desired by the goal set by the UN, sets the agenda to make health as the core
of the development efforts. Even as India's aspirational draft national
health policy document of 2015 awaits an uncertain fate, with health remaining
at the fringe of budgetary priorities, the SDG for health provides a road map
of what a caring society must aim to achieve for its people.
Can India do it?
Yes India
can do with the right mix of investment, innovation and integrity. Public
financing of health
must rise, in central and state budgets, to invigorate
primary health services, strengthen district hospitals and expand the health
work force. Essential health services, drugs and diagnostics must be provided
without financial burden, through a system of universal coverage. Different
streams of health financing must be channelled into a single payer system that
procures quality care as a cashless service from a mix of providers. Several successful models exist across the
world to show that a fine balance of economy, efficiency and equity can be
achieved by health systems which are configured for universal health coverage.
The broad framework has to be common across states, with enough room for
context-specific modifications. No Indian should be denied needed health care
wherever he or she may reside, work or travel in the country.
Innovation, in the face of physician non-availability in
many rural areas and disorganised urban primary health services, calls for
technology-enabled nurse practitioners and community health workers to provide
frontline services and chronic continuous care in community settings. Auxiliary
nurse midwives, armed with android tablets configured with an array of
diagnostic tests and decision support systems, are now working in six districts
of Jammu and Kashmir
to transform maternal and child health services. Mobile phones have become
powerful tools in the home management of diabetes and hypertension.
Telemedicine and mobile medical units are bridging distance to improve access.
As the role of allied health professionals is expanded, millions of young
persons, especially women, can be gainfully employed, invigorating both health
and the economy. Indian systems of healing too can help to reduce unmet health
care needs.
This action agenda requires political commitment to a vision
that values health as a societal imperative for accelerated, sustainable and
equitable development. It also calls for integrity in delivering that vision
through good governance which optimally utilises health system resources. This
involves rational and transparent priority setting, corruption free procurement
processes, standard management guidelines, robust regulatory systems and timely
monitoring and evaluation. The malaise of purchased seats in medical colleges
and the dubious role of councils that regulate health professional education
has been debated for long, even before Vyapam shocked the nation. It calls for
grit and guts on the part of policymakers to clean these Augean stables.
Moreover, India
has rightly been defined as a nation which lives in its villages and thus it
mirrors its economy and well being. Nation's development is essentially the
development of its people and so it is imperative for the government to make
human development an inseparable component of the overall well-being of
mankind.
India
bears the load of roughly 17.5 percent of the global population and one-fifth
of the world's share of all diseases and nutritional disorders. Apart from this, one cannot deny the fact
that India
has achieved truckloads in advancing healthcare and overall health standards
over the past six decades.
Public financing of healthcare sector and budgeting schemes
for a healthy rural India
is paramount. After all, access to healthcare is essentially dependent on how
healthcare has been financed. The Union budget for 2015-16 allocated no more
than Rs33,152 crores to finance the health sector. It is not that enough as it
is only about one percent of GDP.
The policy makers now need to realise that the greater the
proportion of public investments, the greater the access provided to crucial
healthcare services. It comes off as no surprise that a nation that spends only
a minuscule proportion of its total social sector expenditure on healthcare is
failing equity in access to very basic healthcare services vis-à-vis other developing
countries developing nations.
However, the recent initiatives for developing our
healthcare have been satisfactory. The "Swachch Bharat Abhiyan"
launched with much fanfare on October 2, 2014, which aims at attaining an
open-defecation-free India
by October 2, 2019 is quite a welcome idea. It aims at providing hassle free
access to toilet facilities to all households in villages as also initiating
solid waste management activities at Panchayat level to augment hygiene.
Thus, there needs to be a calibrated focus to address
disparities in budgetary allocations, disparities within and among states and
regions, there is an inevitable need to bring health services under the
umbrella of universal health coverage.
