For decades, successive governments in India have neglected healthcare and this has resulted in a huge backlog and imbalances, especially in view of the galloping population. Unfortunately, Prime Minister Narendra Modi’s government has responded with the same model of “faulty" economic development, where the benefits given to the top eventually reaches the bottom. The inability to identify and address efficiency and governance issues in healthcare will hinder the fulfilment of the grand vision behind the Ayushman Bharat scheme, which promises quality healthcare to the common man.
The “upper poor and lower middle class", which accounts for about 65% of India, needs “facilitation" to unleash its entrepreneurial ability and productivity further. It is willing to share some of the cost of social goods in health, education, electricity and drinking water, if it is offered “standard services at a standard cost" with courteousness from the service provider.
The Indian government needs to make its administration design and delivery of services much better. The public sector has to be expanded to include the social sector. Public-private partnership (PPP) cannot remain a buzzword. Use the corporate sector, but with riders. The idea of a common reporting standard (CRS) is an eyewash to make the corporate sector participate in creating larger volumes of standard social goods, available at standard cost through the PPP mode “facilitation".
The All India Institute of Medical Sciences (AIIMS) in all states, the National Cancer Institute in Haryana, the attempt finally to create more medical colleges around select district hospitals, and the free dialysis centres at district hospitals, are examples of an elitist and a top-heavy approach, though each such initiative is laudable by itself.
To improve healthcare, one needs multiple supportive skills to assist the doctors. We need to set up a Hospital Corporation of India as a holding company of all AIIMS. This should have a set of new modern district and block hospitals under it and should use e-technology for performance assessment and payments to doctors and staff, to do away with the deficiency in availability of “standard" healthcare. The healthcare provided by states is not enough in BIMARU (Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh). The private sector is costly and often unethical in billing, and this leads to impoverishment. Doctors have to be inducted as “partners" in this model, so that their income level goes up. To motivate doctors to join government service, they should be awarded a postgraduate diploma or degree in family medicine based on hands-on clinical experience.
The funding of these new central hospitals is to be done one-third by the central government and the rest by banks, which would examine the viability and readiness when they sanction the loan, thus preventing politically unsustainable decisions, such as those about locations of hospitals. A new set of standard services will flow from this hospital chain setting the benchmark of costing of healthcare both in quality and quantity for the Ayushman Bharat dream to come true.
Prime Minister Narendra Modi’s government aroused considerable hope when the party came to power with his promise of Sabka Saath, Sabka Vikas. However, the initial energy was focused on high-ticket economic growth through corporate effort of tested and tried groups within India and inviting such groups/governments from abroad for rapid economic development, whose fruits would trickle down eventually to each household. In education and health, initially, there was no fresh initiative at all. “Swachh Bharat" was an important and rallying slogan as foundation of genuine public health. However, by itself, it was not enough. Later, some better initiatives were witnessed in the health sector, but quality is hardly visible.
Prasanna Hota is former health secretary in the ministry of health and family welfare.