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AES strikes again

Unless the upcoming Union Budget incentivises states like Bihar to drastically improve its health indicators, it is fairly certain that outbreaks such as AES will become a regular occurrence

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For the past decade, districts in Bihar have seen outbreaks of Acute Encephalitis Syndrome (AES) during the peak summer months. Inspite of this history and almost a year since the roll out of Ayushman Bharat, this year was no different.

The toll had passed 130 by end-June and is likely to increase, even as health officials play the blame game.

State health authorities blamed parents for allowing their hungry children to overeat Bihar’s famed Muzaffarpur lychees. The children were severely malnourished and should have been part of the state’s nutrition schemes. But, even those children part of the midday meal scheme were getting only part of the meals.

The centre stepped in with Union Health Minister Harsh Vardhan dispatching five teams of senior paediatricians and paramedics to Muzaffarpur.

But how does one attract permanent medical and para medical staff to these areas? In some cases, air conditioned ICUs, vital for treating AES, could not be used as some primary and community health centres lacked competent staff.

Poor sanitation and severe poverty round off the dismal picture. It seems certain that Bihar will be re-visited by AES next summer too.

That is, unless the budget can incentivise states like Bihar to drastically improve its health indicators. The recently released Health Index 2018 is a sorry report card of how states have fared on selected health indicators. The Niti Aayog hopes that the ‘Healthy States, Progressive India’ report ‘will propel states towards undertaking multi-pronged interventions that will bring out the much-desired optimal population health outcomes’.

Among the 21 larger states, Kerala tops the rankings, while Bihar is 19th, with Uttar Pradesh last. But even Kerala cannot get complacent: it is one of six larger states to show a decline in performance from base year (2014-15) to reference year (2015-16). It is understandable that states with high ranks will show less incremental improvement. In fact, maintaining their ranks itself is a tall order.

The June 2019 Health index is the second edition and it is already evident that the index is flawed and does not reflect the individual needs or scenarios of states. Is it fair to compare Kerala with a population of 35 million, with UP which has a population of 200 million? This is not to excuse the poor performance of UP on the NITI Aayog Health Index, but just to put the size of UP’s problems into perspective. We need a different approach for larger states. What’s works in Kerala may not work in UP.

The Niti Aayog itself admits that the ‘learnings that have emerged during the process of development of the Health Index, will guide in refining the Index for the coming year and also address some of the limitations.’

But states had better heed the health index and its rankings. The Ministry of Health & Family Welfare is linking the Index to incentives under the National Health Mission. States showing a potential to improve will presumably get more funding. And specific interventions showing promise will get additional focus.
But the major flaw of the Health Index is the lack of health data systems and without good data, all conclusions could be shaky. Thus, it is even more important the Finance Minister Nirmala Sitharaman hikes health’s share of the budget allocations. India’s health spending is an abysmal 1.15 per cent of GDP which needs to be increased to at least 2.5 per cent of GDP. If not, we will fall short of the UN’s sustainable development goals. Universal Health Coverage will also remain a distant reality.

The Niti Aayog recognises that besides the health ministry, health outcomes are impacted by the private sector and other sectors. For instance, the availability of affordable and quality medical technology. India has been a net importer of medical devices; upto 80 per cent according to some reports. Post GST, medical device imports have reportedly become 11 per cent cheaper. Domestic MSME med-device manufacturers have warned that imports are up 24 per cent, from Rs 31386 crore in 2017-2018 to Rs 38,837 crore in 2018-2019.

Medical technology and devices is one of key target areas of US firms. According to a report of the US Department of Commerce, the expansion of India’s super-specialty hospital chains, both in the private as well as government sectors, is an opportunity for overseas organisations to set up hospitals in India through the foreign direct investment. This is besides exporting high-end medical equipment like operation theatre products and training through simulation labs. Midst the US-China trade war, can Prime Minister Modi leverage this interest to infuse better health systems in the areas which need them most? After all, he has won his second term and can take tough decisions. While US President Trump has a year and a half to his poll test. It could be the best opportunity to arrive at a more equal win-win situation for both countries.

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