In the past two decades, there have been numerous positive developments in the health sector, including the Swachh Bharat Abhiyan, Beti Bachao Yojana, a new National Health Policy, the resolve to eliminate tuberculosis, malaria and HIV/AIDS and, of course, some important steps to curb the use of tobacco products. Sadly, India still ranks very poorly in the global health index. In reproductive child health, it accounts for 15% of global maternal deaths and 20% of child deaths. Even Bangladesh and Nepal are doing better. The story is very similar in nutrition. The latest Unicef survey ranks India as the 12th worst country among 52 low and middle income nations, based on the number of children who die in the first month of birth. The situation is equally grim with communicable diseases and is further complicated by significant rise in chronic diseases.
Thankfully, there is renewed political interest in effectively tackling health-related issues. We must deeply internalize that health is a state subject and it cannot continue to be dominated by a top-down approach from the centre. Recently, many states have done significant innovation in their existing programmes, and with good outcome. Unfortunately, there is no active national forum, wherein the cumulative knowledge or the technical expertise gained by the states can be easily shared as a national resource.
While re-looking at the role of the public sector, we should keep in mind the impressive role it played in combating HIV/AIDS, eliminating leprosy and revamping the health services in remote border areas through public non-profit partnerships. Inadequate resources have continued to plague our health system for many years. We have just begun to look at the possibility of generating additional revenue for healthcare by taxing demerit goods like tobacco, junk food and, of course, additional excise duty on alcohol. This needs to be pursued vigorously so that our health budget meets the norms of a developing economy. There is also an alarming shortage of human resources in healthcare. Also, setting up of new AIIMS may not be the answer, but we must upgrade and upscale the credible existing training facilities all over the country.
The recently released mortality report on non-communicable diseases (NCDs) clearly shows the looming threat of such diseases in all Indian states. We need a holistic plan to prevent NCDs through active health promotion activities, particularly with the young population. With the national health policy, efforts have also been made to mainstream Indian systems of medicine, but the integration remains incomplete due to the absence of inter-disciplinary dialogue between AYUSH and allopathic systems.
Although there is a plethora of health research institutions in India, there is little synergy between them. There is also limited role of these institutions in the formulation of major health policies and programmes.
Alok Mukhopadhyay is chairman at Voluntary Health Association of India.