WORLD HEALTH DAY
On World Health Day, a recipe to identify gaps and transform healthcare in India
More funds for health, but is that all is needed? Here are 10 strategies to achieve health goals for India
By Dr Jitendar Kumar Sharma
1 Public financed health expenditure in India remains around 1.2% of GDP. The overall health expenditure is about 5% of GDP, close to 3.8% coming from private health expenditure. Unlike other countries with higher tax base, the low tax base in India doesn’t allow spending 10%-15% of GDP as public health expenditure. So, judicious use of resources becomes a challenge. The current allocation to state from the Centre is done based on programmes through an annual package or the PIP (Program Implementation Plan) — a lengthy exercise. Instead, states could be given a larger choice to invest in programmes that are more impactful. Current spending from Centre to states (approx Rs 250 per capita per annum) if done on per capita and not on program basis would be impactful.
2 Since induction of National Health Mission, the gap between Directorate of Health Services and National Health Mission has widened. Subsequently, after induction of Ayushman Bharat, Department of Health, in most states, literally runs on a tripod of Ayushman Bharat / state insurance body, Directorate of Health and National Health Mission — duplicating and, sometimes, even contradicting efforts made among departments. If these could be grouped as Indian health services, it will bring in more judicious use of resources and ensure strategic implementation.
3 Public sector units within the ministry of health & family welfare and state health departments have remained with unfulfilled mandates. These institutions have infrastructure that’s no more state-of-the-art to fulfil diverse needs of biologicals, insulin, immunoglobulins, snake anti-venoms, medical devices and radio isotopes. So, it is necessary that these institutions are strategically grouped, partially or fully dis-invested or given an option to jump to a technological infrastructure, which would allow them to meet newer technology and product demands.
4 Ayushman Bharat has started playing a creative role in Indian healthcare. While the middle and lower middle classes are not covered under it yet, a leaf of idea can be taken out of Andhra Pradesh’s Arogya Raksha scheme. At 20% of the cost of market-insurance and premium of just Rs 100, a protective health-cover for a family of about Rs 5 lakh per individual is provided. The advantage of partnerships with LIC or other government insurance agencies in Ayushman Bharat to cover non-poor would be incremental because they would increase the government insurance agencies’ coverage base and bring in a small premium to the government, which can be used for cross subsidizing healthcare for the poor.
5 Talks about regulation of health products and their safety have been going on for decades. However, bringing diagnostics, medical devices and other health products under regulation hasn’t happened because government has followed an adhoc approach of cherry-picking products. A segment-wise inclusion of health products into the regulatory framework will help the economy, industry and patient safety.
6 While the country has been talking about startups and innovative ideas, one still needs three quotations for procurement in the public sector. This has not allowed innovations into the public health space. So, the ministry of health should administer health technology assessment to select start-ups and innovations for evaluation and uptake. The positive finds can be recommended for listing under GeM (Government e-Marketplace), helping states and central government to procure them and help bring innovations into mainstream healthcare..
7 There are contradictory policies on maternal and child health. While on one hand PCPND Act doesn’t allow diagnosis of a foetus’ gender, on the other hand the system as well as society is blamed for declining malefemale ratio. A practical approach would be to mandatorily diagnose the gender and track the female foetus.
8 Normal delivery and Csections have not been included in insurance or assurance-based programmes like Ayushman Bharat. Across states, maternal and infant mortality rates in the public sector is 10 times higher than private sector. So if one were to part with an ideological position, it would be life-saving if neonatal care and maternal care be allowed under insurance or assurance model such as in Ayushman Bharat and state sponsored health schemes involving private sector.
9 Not all doctors who clear MBBS get into a master’s course because of shortage of super-speciality seats. So, Medical Council of India and National Board of Examination must aim to increase the number of seats under DNB, MD, MS and MCH to at least 70% of MBBS seats. Follow-up audits by MCI and DNB will ensure that suitable super-speciality specific developments are achieved and technology to augment student-faculty ratio becomes a possibility.
10 While complaining about low density of healthcare human resource in rural areas for 70 years, the gap couldn’t be filled as human resources prefer urban amenities. The e-sub centre model funded by World Bank has transformed rural health infrastructure by creating close to 7,000 rural health ATM’s just in AP. While the nurse facilitates diagnosis and attends to a patient, telemedicine connectivity in Public-Private Partnership aims to connect all sub-centres to medical hubs where doctors diagnose and prescribe medicines. The electronic prescription of drugs is routed through command to the drug vending machine inside the subcentre and the medicine is dispensed. The e-sub centre or health ATM model has the potential to reach every village and shift healthcare human resource in a reverse manner from rural areas to urban areas, providing more opportunities in secondary and tertiary care.
(The writer is MD&CEO, Andhra Pradesh MedTech Zone and executive director of Kalam Institute of Health Technology. Views expressed in this article are personal)
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