The ambitious National Health Policy, 2017 (NHP), which aims to achieve universal health coverage and deliver quality healthcare services to all at affordable costs, has a rough road ahead with its implementation on ground.
While the policy aims to be a guiding document for the government, it has several challenges such as lack of infrastructure and amalgamation of various streams of the healthcare sector, which will have to be addressed if it has to be a success story.
“First, challenges of inadequate facilities, infrastructure, coverage, access and quality continue to plague the health system. Over 95% of facilities function with less than five workers, and only 195 hospitals in the entire nation operate with quality certifications. Essential diagnostics, such as mammograms have scant coverage of only 1%," said K. Madan Gopal, health vertical, National Institute for Transforming India (NITI) Aayog, the government’s policy think tank, in his paper published in the latest issue of the Indian Journal of Community Medicine.
Gopal’s paper titled Strategies for ensuring quality health care in India: Experiences from the field highlighted that India even lags behind its neighbours, including the Maldives, Sri Lanka, Nepal and Bhutan, in terms of certain indicators such as incidence of tuberculosis and premature deaths due to non-communicable diseases (NCDs). The NHP aims to increase life expectancy at birth from 67.5 to 70 by 2025.
“India’s average life expectancy (68.3 years) is some 10 years shorter than that of the Maldives, drawing attention to some shortcomings in India’s strategy for quality health. This is despite a decade of the ambitious National Health Mission implementation. Perhaps, patching the gaps in the ground-implementation of the pioneer programmes of the government needs a determined revisit," said Gopal in his paper.
“While one would expect private sector care to have higher quality, there is increasing evidence suggesting poor quality. Problems with the public and private health setup are largely the same—gulf of difference between the reported and actual diagnostic and treatment facilities, the tendency of over-prescribing and subjecting patients to unnecessary interventions, lack of efficient monitoring mechanisms, and poor implementation of regulatory controls," he added.
The ambitious NHP looks at problems and solutions holistically with the private sector as a strategic partner. It also seeks to promote quality of care with a focus on emerging diseases and investment in promotive and preventive healthcare.
“One major cause for concern is limited use of the health management information system as a proactive management tool in government health programmes. There is also inadequate linkage between research institutions and the implementation wing. The HIV/AIDS programme seems to be losing steam due to shortage of resources and dwindling political commitment," said Shailaja Chandra, former secretary (health), ministry of health and family welfare.
NHP talks about close collaboration of alternative and allopathic systems of medicines. In recent years, efforts have been made to mainstream Indian systems of medicine, but integration remains incomplete due to the absence of healthy interdisciplinary 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 formulation of major health policies and programmes. We can look at the possibility of merging some of these institutions and providing them with adequate budget, infrastructure and human resources, particularly to address the key national health issues," said Amit S. Ray, professor of economics, Jawaharlal Nehru University.
An area of major concern is environmental degradation, with the pollution levels in most major cities reaching alarming proportions, even as India wakes up to a major health threat. “Almost half of our urban population does not have basic civic amenities. In the name of industrialization and development of our backward areas, we are polluting the limited sources of safe drinking water of local communities. The indiscriminate use of pesticides is a cause for serious long-term worry. Public places and even the holiest rivers of this country are fast turning into garbage dumps," said Chandra.
“Effective implementation of the Swachh Bharat Abhiyan can go a long way in addressing many of these concerns. We have almost 400 million people living in urban settings in India. Unfortunately, the Urban Health Mission is yet to effectively begin its work at a large scale. It might be worthwhile to look at some recent experiments being done by the states," she added.