3 min read.Updated: 03 Jun 2019, 11:39 PM ISTK. Srinath Reddy
Need to deliver Universal Health through increased resources and redesign
The second term of Prime Minister Narendra Modi’s government will feature two landmark anniversaries—the 150th birth anniversary of Mahatma Gandhi in 2019 and the 75th anniversary of India’s independence in 2022. The agenda for health system transformation must gather speed in the years in between to accelerate the country’s social and economic development.
The vision spelt out in the National Health Policy of 2017 must be translated into synergistic actions across various components and levels of the health system. The promise of universal health coverage, offered by Ayushman Bharat, must be delivered through increased resources and redesign as needed. In that process, India can develop, deliver, evaluate and validate several impactful innovations that the world can adopt. The youth bulge in our demographic profile and prowess in information technology will be assets in driving such innovations to transform the health system.
The numbers and skills of healthcare providers, across several categories, can be enhanced to energize the health system, offer employment and leverage technology to improve the outreach, quality, affordability and accountability of our health services. Technology-enabled young frontline health workers will lead in delivering primary healthcare, which is the foundational basis of a strong health system.
Even as the health sector needs more financial resources, the health system can demonstrate efficiency gains to provide better outcomes for the money available. This is possible not only through wider deployment of appropriate technologies but mainly through capable management of health programmes and healthcare facilities. For this, investment in, and proper positioning of, public health cadres and health management cadres will be needed. A National Medical Service can be created under the National Health Mission, to create a national pool of doctors who can be distributed across the states to correct the gross maldistribution that exists. Pooled public procurement and strategic purchasing of cost and quality controlled health services will also add to the economic gains of efficiency.
Comprehensive primary healthcare, initiated through sub-centres upgraded to health and wellness centres, must be strengthened and scaled up through more human and financial resources as well as augmented capacity of primary and community health centres. Provision of drugs and diagnostics, free of cost, at public healthcare institutions, will bring early and substantial relief to the many who are burdened by high out-of-pocket expenditure.
District hospitals and medical college hospitals must be invigorated, especially in states which currently have weak health systems, to provide the supply side strength needed for the Pradhan Mantri Jan Arogya Yojana (PMJAY). That scheme must stimulate the confluence of central and state healthcare financing schemes into a single-payer system and expand to enrol the 60% of the population who are presently not covered by it, through income graded premiums.
Regulatory reforms must be speedily advanced to improve health professional education and quality of healthcare. The bills for establishing a National Medical Commission and an Allied Health Professionals Accreditation Council must get parliamentary sanction at the earliest. The Clinical Establishments Act should be enforced across the country, as a mandatory requirement of PMJAY funding and empanelment.
The ongoing missions for sanitation, clean water, clean energy, nutrition and pollution control must be revved up to protect health, while promoting physical activity and keeping lives free from tobacco and alcohol abuse. Health promotion must be embedded into all policies and must become a feature of community life. Participatory planning and monitoring of health programmes by an engaged and empowered community must result in a social movement for health. An annual National Health Assembly, of multiple stakeholders drawn from across the country, must become the hallmark of such a movement. Only through such democratic decentralization visualized by Gandhiji will the aspirations that soared skyward at the time of our independence find fulfilment in a healthy India.