Experts call out for efficient public healthcare spending

Focus should be on curbing NCDs

Experts and health policy analysts have strongly advocated the urgent need for revising spending norms in the healthcare sector with a focus on curbing the rising non-communicable disease (NCD) burden as necessitated by the changing disease profile in the country. This can be achieved through better coordination and adoption of best practices to arrest the economic and social burden of chronic disease in India. In the past few years, NCDs have certainly taken a centre-stage and become the leading cause of death and sickness when compared with the communicable diseases.

The key recommendations are developing a collaborated multi-sectoral effort through public private partnerships, mobilise resources, build capacity and train health workforce; calling out for universal framework with inclusion of a programme for NCDs for a holistic method to make India a disease free nation; provision of financial risk protection through public private insurance which would reduce out-of-pocket expenditure; enhanced individual intervention through pro-health education, regular health check-ups, reduction of salt/sugar intake and physical activity and setting up separate annual healthcare budget for NCDs and working towards an integrated, multi-sectoral approach to tackle the spread of NCDs.

Currently, diseases like diabetes, hypertension, cardiovascular diseases, and cancer are taking as many as 63 per cent of the lives in India. NCDs, and their risk factors, that are the leading cause of mortality and illness have created a vicious cycle. Costs associated with NCDs worsen poverty, while poverty contributes to rising incidence of NCDs. Modern lifestyles pursued in urban cities lead to higher cases of NCDs. This in-turn poses a threat to sustainable development. NCDs burdened India also experiences deprivation of the deserved level of economic productivity due to the grasp of these lifestyle diseases, mostly, on the working population of the country. Ironically, the productive workers can only produce to their maximum capacity if they are healthy and free from the dangerous grab of NCDs.

According to a Lancet report published recently, high blood pressure, diabetes and household air pollution feature among the top five risks associated with poor health and deaths in India and are accountable for 7.8 per cent, 5.2 per cent and 4.7 per cent of the total health loss in India. The ongoing initiatives in various Indian states with regards to child and maternal health are laudable. But, India has to still work towards a holistic health plan with alignment of similar initiatives to curb the NCDs burden.

Dr Sanjiv Kumar, Executive Director, National Health Systems Resource Centre (NHSRC) said, “NCDs can be effectively addressed through actions across various ministries and sectors. The ministries of agriculture, food processes, transport, urban development, labour, commerce, urban and rural local bodies, all need to work together to promote healthy lifestyle as well as reduce intake of salt and sugar; etc. This can be done only if health issues are incorporated and addressed in all policies.”

According to Dr Anand Krishnan, Professor, Community Medicine at AIIMS, “Provision of financial risk protection to the population, through public and private insurance can surely reduce dependence on out-of-pocket payments. With the current objective of establishing an overall ‘accessible, affordable and effective’ healthcare system in the country, we need a universal framework which can spearhead a focused programme to ensure effective awareness and early diagnosis to prevent and control NCDs.”

According to Dr Kenneth Thorpe, Chairman, Partnership to Fight Chronic Disease, “The urgent requirement is to understand the need for an integrated approach to tackle the spread of non-communicable diseases, through involvement of individuals, state governments and the centre on one platform. An annual healthcare budget for NCDs must be set aside for delivering public health services to patients. Healthcare financing models need to be developed with public and private collaboration to reduce the burden of expenses of both the government and the public.”

To meet the challenge of rising numbers of NCD cases, the need of the hour is to develop an efficient mechanism of allocating public health spend. India spends less on healthcare than other middle income countries with a meagre 1.3 per cent of GDP contribution to public health. For the same, Dr Charu Garg, Advisor, Health care Financing, NHSRC feels, “Spending should be increased on primary care with focus on preventive care. Education and awareness for individual-level interventions, promotion of healthy behaviour, regular health check-ups, reduction of salt/sugar intake, promoting physical activity, early detection and treatment are some factors that need to be focused upon. All this will limit disease progression and costs incurred on expensive treatment.”