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India’s healthcare is under recovery: But what are the dangers of relapse?

Dr. P R Sodani
Wednesday, February 28, 2018, 08:00 Hrs  [IST]

Even as India is projected to be the youngest country across the world by 2030, the strengthening of the public health institutions is a must. The National Health Policy of India 2017 focuses on strengthening the health system. As a critical element, the policy proposes to raise public health expenditure to 2.5 per cent of the GDP in a time-bound manner with allocation of a major proportion (two-thirds or more) of resources to primary care. The policy is a comprehensive approach addressing infrastructure and human resources gap along with leveraging digital technology in strengthening health systems. The National Health Policy 2017 realizes the need of better regulatory mechanisms, primary healthcare to be comprehensive and universal, preventive and promotive focus, and very important is patient centric approach. The policy recommends mainstreaming Ayush with general health systems. The National Health Policy aims to achieving universal health coverage and delivering quality healthcare services at affordable cost.

Data and digitization is the new oil that drives the world. Connecting healthcare to digital technology, the health ministry established National Digital Health Authority (NDHA) of India to regulate, develop and deploy digital health across the continuum of care. The extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system is on the way.

A key government intervention known as the Janani Shishu Suraksha Karyakaram (JSSK) scheme encompasses free maternity services for women and children, a nationwide scale-up of emergency referral systems and maternal death audits, and improvements in the governance and management of health services at all levels. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) aims to provide comprehensive and quality antenatal care to pregnant women at the 9th of every month under the motto of "IPledgeFor9".  The Maternity Benefit Act of 2017 passed by the Centre reflects government’s commitment in the fully paid absence from work to take care of the neonate. Not just women, the health ministry has extensively generated discussions and actions around the role of men in family planning. Battling the two leading cause of death amongst children, Mission Indradhanush has successfully immunized 3.55 crore children against the deadly diseases.

The government has also tried to brings down the end price of stents used in heart surgeries.  In February last year, the National Pharmaceutical Pricing Authority (NPPA) had reduced prices of coronary (heart) stents by up to 85 per cent. It capped them at Rs 7,260 for bare metal ones and Rs 29,600 for the drug eluting type. In today’s scenario when about 3.4 crore people in the country are suffering from one heart disease or the other and about 2 lakh people opting for angioplasty every year, this is a welcome step by NPPA.

Similar effort was made by the NPPA to cap the prices of implants used in knee replacement surgery. Late last year, it brought down the prices of implants by up to 69 per cent by capping the cobalt chromium implants to Rs 54,720. NPPA also capped prices of a second surgery to Rs1.13 lakh. Rates of metals that are needed in treatment, like titanium and oxidised zirconium, were capped at Rs 76,600 by the NPPA. The move has been aimed at bringing down the cost of knee replacement surgery for the elderly in the country.

The government is also setting up two new All India Institutes of Medical Sciences (AIIMS). This was long desired as the one in Delhi is not able to effectively cater to all the patients flocking to it.

The government has also started free door-to-door check up of people aged between 30 and 69 for early detection and treatment of heart disorder, cancer and diabetes. Given the fact that Indians generally seek medical assistance when their ailments have risen to unmanageable levels, this initiative will definitely help in screening and early detection of medical problems and would go a long way in keeping the population fit and also reduce pressure on hospitals which are struggling with capacity constraints owing to huge number of patients.

Issues relating to domestic production of sophisticated medical devices and pharmaceutical equipment manufacturing in India are being addressed. These will augment the accessibility and affordability of high-end equipment within the country. An MoU between India and Papua New Guinea is in the offing on cooperation in the field of Healthcare and Medical Science.

But, a lot has to be done before the nation can be called an ideal one in terms of health and healthcare facilities. Air pollution is one of the primary causes for premature deaths in India. One out of every third child in Delhi has impaired lungs. The Swacch Bharat drive would be ineffective without clean air. We are facing the doubled edged sword of obesity and malnutrition. Better surveillance of hospitals and their facilities should be in place. There is a need to engage and regulate private sector in providing affordable and quality healthcare. Poverty stricken people have increased from 32 million (1999) to 94 million (2014). Important schemes such as National Health Assurance Mission and National Health Protection Scheme have been on the drawing board for very long time and needs urgent attention.

Another area that needs urgent attention is the abysmally low rate of medical insurance in the county. Medical insurance rate is just about 20 per cent and there is no reason why 80 per cent of the population should be left uninsured.
Many people do not avail medical treatment for their problems because of affordability issues. Government has to come out with innovative medical insurance schemes to cover even the poor. In the absence of insurance, poor people end up going to quacks and ill trained medical practitioners which only compounds their problem.

Another area the government must look into is the exemption limit for expenses on preventive health check up from taxes. The existing provision on preventive health check by people which is exempted from taxes is just too small. An increase in this limit will encourage people to go for such check-ups and take preventive measures so that they can avoid ailments.

(Author is pro president at The IIHMR University, Jaipur)


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