Some good initiatives but no major changes visible on the ground

Health was one of the priority areas of BJP’s 2014 election manifesto. So expectations were high. The three years of the Modi government have seen some initiatives, but no major changes are visible on the ground.

New health policy:

The policy launched in March 2017 was developed with inputs from various stakeholders. Its highlights include

1. Universal Healthcare,
2. Reforms in medical education,
3. Shift in health system to address NCDs and accidents and injuries: New cadre of mid-level health managers at expanded sub health centres called health and wellness centre,
4. Health in all policies to address social determinants of health,
5. Increase in government health expenditure from 1.2 per cent (1.3 per cent in 1990) to 2.5 per cent of GDP; 70 per cent of it on primary care
6. Bringing together traditional systems of medicine to provide holistic care to the population. This needs to have an implementation framework with clear accountability in place.

Efforts to provide affordable healthcare:

Expenditure on healthcare has been shooting up and most of it is out of one’s own pocket. To bring down the rising health expense, the government has taken a bold decision to promote generic medicines. This hopefully will bring down the cost of healthcare as two thirds of medical expense is on medicine alone. The recently launched initiative to provide free diagnostics and dialysis facilities are steps in the right direction. However, there are many challenges in the way of the implementation of these measures.

Reforms in medical education:

Reforms in medical education was long overdue. The government has
initiated steps in this direction with the National Eligibility cum Entrance Test (NEET). It is hoped that it will make the admission process transparent and bring merit into the system. The Medical Commission Bill has been cleared by the Cabinet and will be presented in parliament. The Medical Commission when established will
replace the Medical Council of India which has come in for a lot of flak.

Shortfalls:

The above initiatives while laudable are yet to bear fruits. There is hardly any evidence of improvement in the quality and accessibility of healthcare facilities in country.

No visible progress in universal healthcare:

The number of people going below the poverty line because of medical expenses has been rising over the years. It was 32 million in1999 and 94 million in 2014. Important schemes such as National Health Assurance Mission and National Health Protection Scheme have been on the drawing board for very long time. They need urgent attention. The Central allocation for health has declined and the presumption that with increase in state share to 42 per cent from the revenue pool will result in states increasing their health outlays as per the 14th Financial Commission has not happened.

Lack of integration of private sector in providing public healthcare:

The private sector as provider of healthcare is increasing. There is a need to engage and regulate this sector in providing affordable and quality healthcare. Off late, some private hospitals have been in the news for alleged negligence and overcharging. Poor governance and regulation manifest in such malpractices.

Poor management of public health facilities has lead to disasters like the Gorakhpur tragedy continues to dodge the public health system.

Air pollution has emerged as a major killer, but is not getting the attention it deserves. Swachh air should get the same priority as Swachh Bharat, if not more. How can India be clean when the air we breathe is so foul and life-threatening?
The government has taken some good initiatives, but on the whole the approach seems fragmented. Health is a vital sector; it needs comprehensive planning and concerted efforts.

Health in a limbo

Governments come and go but the state of health in the country seems to remain the same. Consider the children who have been dying due to an unknown disease in Gorakhpur since 2005. The authorities are never prepared to provide adequate treatment and this year, more than 20 children died in one night due to lack of oxygen in the hospital.

Many of these deaths are attributed to Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE). Provisional figures for 2017 put down the number of AES cases as 12806 and those of JE as 2033. In 2013, just before BJP took over, the number of AES cases was 2033 and that of JE was 1086. Experts and authorities are likely to attribute this increase to better reporting and data collection. But BJP’s manifesto had proposed setting up of National Mosquito Control Mission and this is yet to be done. This could have made a difference as JE is transmitted by mosquitoes. The programme would also have protected from other mosquito borne diseases such as malaria, dengue fever and even Zika.

As promised in 2014 manifesto, the BJP government did release the National Health Policy 2017. However, the provisions in this seem more to promote privatisation of healthcare than strengthening of the country’s health system. The policy suggests that services should be strategically purchased from the private sector. However, depending on private sector for something as basic and crucial as health does not seem advisable as private sector tends to overcharge for services. The government is not likely to have enough funds for purchasing all the services that are needed.

The latest report National Health Accounts which assesses the health expenditures and flow of funds in country’s health system provides the financial breakdown for the year 2014-2015 and shows that government health expenditure as per cent of total health expenditure has increased from 28.6 per cent in 2013-14 to merely 29 per cent in 2014-15. This puts undue burden on people who then have to pay from their own pockets. The intent to depend on private sector is also worrisome as the policy also did away with the provisions of Right to Health which was part of the draft policy. The reason for the omission was that the country did not have enough
resources to implement this at present. The government has committed to raise public health expenditure progressively to 2.5 per cent of the Gross Domestic Product (GDP) by 2025. As of now, the government health expenditure is just 1.1 per cent of the GDP.

The government faces new hurdles as the disease profile of the country has changed. Lifestyle diseases have increased in the country and these require lifelong and expensive care. Many of diseases have environmental triggers and this puts the poor at a disadvantage and they would need support from the government. More work on ground is needed and this is something that the government should try to ensure in the remaining tenure.