India also needs to continue to look inward and fix the gaps in our public health systems
Delivering the fifth Ramnath Goenka Memorial Lecture, philanthropist Bill Gates chose to speak on the theme, ‘Creating an equal world: The power of innovation’. As Microsoft co-founder Gates scripted the now familiar Silicon Valley basement to billionaire story, becoming the idol for every IT nerd. Now as co-chair of Bill & Melinda Gates Foundation, he is using his wealth to bridge the gaps in key areas, ranging from health, education to climate change.
Like many countries, India has benefitted from funding from The Gates Foundation. Unlike many nations, India has also been crucial to the success of the Foundation. India’s expertise to make more affordable medicines and vaccines has allowed the Foundation to stretch its dollar. Gates mentioned India’s contributions to affordable HIV medications and low-cost rotavirus vaccines, which have benefitted patients not just in India but across the world. Gates also commended India’s tackling of the pandemic, making special mention of the digital public infrastructure platform, which allowed the quick roll out of vaccines developed in India.
Reminding us that three years after the pandemic, most countries’ health systems are still not completely back on track, Gates feels that our country has the potential to develop into a hub of “innovation and ingenuity,” to herald a “new era of global partnership” which can overcome the world’s greatest challenges.
So can India’s healthcare sector deliver its part on this potential, building on the COVID lessons and going beyond COVID? While the ACT-Accelerator played a pivotal role, it needs to be replicated with major changes to make it more inclusive. In a year when India has G20 presidency, the country is expected to ‘strive to build a consensus among member countries on the need for such a permanent institutional platform.’ As per a blog on the World Economic Forum website, ‘We will deliberate on how its new avatar can have an expanded scope on healthcare, along with much stronger governance and accountability.’
Rajesh Bhushan, Union Health Secretary reiterated this agenda during the 1st G20 Health Working Group (HWG) meeting under India’s Presidency in January, when he highlighted India’s aim to achieve convergence in discussions across various multilateral fora engaged in health cooperation, as chair of the G20 Presidency. We await the action plan to make this happen, over the next three HWG meetings due in Goa, Hyderabad and Gandhinagar, and the Health Ministerial Meeting, hoping that a year will be sufficient to put in place a framework that prevents the next pandemic as well as ensures our health systems are more resilient.
India needs to continue to look inward. The COVID pandemic exposed the huge gaps in India’s public health systems. State governments are responsible for the health in their jurisdictions, and there is huge variability on health parameters.
A recent study (Venkateswaran, S., Mishra, M., Iyer, N., (2022). The Political Journey of Healthcare in Select Indian States (CSEP Working Paper 42). New Delhi: Centre for Social and Economic Progress) examines the political trajectory of health in five Indian states. While acknowledging that many aspects influence health progress, including fiscal health, governance, institutional capacity, the authors make the point that the political priority accorded to health by a state’s leadership remains a key driver.
Included in the recent monthly newsletter of the Lancet Citizens’ Commission on Reimagining India’s Health System, the study concludes with four insights. One, political ideology plays a role in driving attention to health, but political legitimacy can be linked with healthcare to drive attention in the absence of an ideological driver. Interestingly, the authors point out that external stakeholders can create an environment where legitimacy is linked with healthcare.
Two, sensitising politicians to electorally rewarding policies elsewhere, and relevant to the state’s development journey, can motivate them to act. Three, state capacity is a key variable in the confidence to undertake reforms and the choice of reforms. Four, both the Central government and external stakeholders such as civil society can contribute to agenda setting at the state level.
The study assumes more importance this year, with nine states due for elections. Will the leaders of these states pay more attention to making health systems more resilient? Will civil society and other stakeholders ensure that health becomes a rallying point? And more importantly, will the politicians follow through with appropriate action post elections? And if they don’t, will they be held accountable?