The tragic child deaths in Baba Raghav Das Medical College, Gorakhpur, UP; A poor man carrying his wife’s dead body on his head because there was no hearse available in this Odisha hospital; The shocking incineration of babies in a Kolkata hospital - these and similar incidents hit the healthcare headlines in the year 2017.
Deep-rooted malaise
Symptoms of a deep-rooted malaise in the healthcare system, these unfortunate incidents highlight the urgent need of fixing the system with the introduction of a trained cadre of health managers to implement it, rather than the knee jerk reaction of looking for scapegoats and subjecting the over worked, underpaid health care providers to punitive action.
The private sector in healthcare has fared no better. Media stories of patients being fleeced for treatment abound. The handing over of a live new-born to its parents as dead, shook the nation’s conscience. Such stories are just the tip of the iceberg. There is much worse happening in hospitals both government and private hospitals, which goes unreported.
Today the scenario in the private health care has shifted from doctor-owned hospitals to corporate hospitals where investors are only looking for return on investments. They are not under the Hippocratic Oath; nor are they guided by ethical norms imposed on doctors by medical authorities and professional bodies. There is an urgent need for an empowered authority to regulate the working of hospitals including fees they charge and curb snead to be put on illegal and unethical practices. The media needs to play a far more constructive role than just “Breaking News” and putting health providers in the dock and subjecting them to media trial.
New health policy
There is no deny that there have been some welcome initiatives taken by the government this year. The new health policy launched in March came after 15 years of the last policy. Developed with inputs from various stakeholders, its highlights include: Commitment to move towards universal healthcare; Reforms in medical education; Shift in health system to address noncommunicable diseases (NCDs) and injuries: New cadre of mid-level health managers at expanded sub health centres to be renamed; Health and wellness centres; Health component in all policies to address social determinants of health; Increase in government health expenditure from 1.2 per cent of GDP to 2.5 per cent and 70 per cent of it on primary healthcare; Bringing together traditional systems of medicine to provide holistic care to the population.
Implementation & accountability
The implementation and accountability framework of the new health policy, 2017 with clear cut accountability must be drafted and adopted; an implementation cell should be created in the Prime Minister's Office with active public engagement to monitor progress of implementation and hold politicians and bureaucrats accountable.
India continues to be a country with one of the lowest government expenditure as a proportion of gross domestic product (GDP), and the lowest per capita health expenditure - China spends 5.6 times more, the US 125 times more. Indians meet more than 62 per cent of their health expenses from personal savings, called "out-of-pocket expenses", compared with 13.4 per cent in the US, 10 per cent in the UK and 54 per cent in China.
Low health allocation in govt budget
The health allocation in the Union Budget 2017 did not match with the government's healthcare ambitions, particularly when adjusted against inflation and the new health programme announced. The Rashtriya Swasthya Suraksha Yojana launched this year was an improvement on the Rashtriya Bima Suraksha Yojana with the annual limit per family increased from Rs 30,000 to Rs 1,00,000, with an additional "top-up" of Rs 30,000 for senior citizens. Estimates suggest that enrolling all BPL families in the country in health-insurance programmes would cost Rs 2,460 crore to Rs 3,350 crore, or half the cost of building a six-lane national highway between Delhi and Jaipur.
The year saw important steps to promote generic drugs and control the prices of essential medicines and medical devices. However, the availability of generic drugs needs to improve and more needs to be done to pass on the benefits of price control to the public. There is a need to address healthcare expenditure in a comprehensive manner. Healthcare expenditure is known to push a very large number people below poverty line every year.
Communicable diseases
In January 2018, India will celebrate seven years of being polio-free. But, we need to remain vigilant, as two neighbouring countries continue to be polio endemic. In June, the World Health Organization certified Bhutan and Maldives as measles-eradicated. In India, measles deaths have declined drastically from an estimated 100,000 in 2000 to 49,000 in 2015. India needs to learn from the experience of its neighbours to accelerate efforts to eliminate the disease. To meet the 2020 measles elimination and rubella control goals, India needs to make greater efforts to increase measles vaccination coverage. The government set ambitious targets for disease control and eradication - elimination of Kala-azar and Filaria by 2017, Leprosy by 2018, Measles by 2020 and elimination of tuberculosis (TB) by 2025. These goals are ambitious but show political commitment to move fast in elimination efforts.
Comprehensive approach
Overall there have been some good initiatives in healthcare sector this year, but there is a need to address health issues in a comprehensive manner to make healthcare affordable in India. The government must give priority to health with increased health allocation in the next Budget. As 80 per cent to 90 per cent of health is attributable to no-health sectors, the government must engage other sectors and include a strong health component while framing policies for other departments as well.
( Author is with International Institute of Health Management & Research, New Delhi)