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New Delhi, July 01, 2019:
The latest NITI Aayog’s State Health Index and the past last few weeks have signalled a crisis in India’s healthcare sector that witnessed some exceptional developments in Modi 1.0 that made healthcare in the 2019 elections a subtle mascot, instrumental in securing a historic second election victory for Prime Minister Modi. And now in his second innings, team Modi 2.0 should be able to turn on their governance lens on Healthcare and capitalise on increasing the penetration of health by making the ecosystem tech enabled, patient-friendly, and systematically robust, both at the central and state level. The renewed focus on medical devices as a sunshine sector through the National Medical Devices Promotion Council has realised the huge potential of this sector which now needs to be taken forward to make India among the top devices manufacturing hub globally and end import dependence with a prudent approach to pricing and encouraging domestic players to make quality healthcare affordable and accessible to the masses.
A long-term window is now available to complete the tasks Modi 1.0 set out to do five years back. All eyes will now be on Ayushman Bharat, the triumph-card which played an important part in influencing voters that targets 500 million people, which comprises 40 percent of the poorest. Despite some teething problems and a dire need for further reforms, fraud-management and more spending, this huge initiative launched last year as one of the world’s largest publicly funded healthcare programmes — has made a difference and over 25 lakh people have benefitted so far. Challenges such as making the scheme financially viable, fraud-free, making timely payments for the empanelled hospitals out of which nearly 50 percent are private, and covering their marginal cost, are aspects which need to be addressed now more minutely. Provisioning of telemedicine and diagnostic laboratory facilities at the 150,000 health and wellness centers (HWCs) that were planned to be set up by 2022, need to be put in place along with AYUSH setups as an added service at these facilities. NITI Aayog estimates that nearly 2500 more hospitals will be constructed in various parts of the country in the next five years. Linking the primary centers with the hospitalization plan, a sophisticated IT system, that has a strong anti-fraud approach and can keep cost under control, provide better purchasing policies for medical supplies and drugs, and an increased focus on providing preventative health services by increasing availability of nurses, pharmacists, and other paramedical personnel in these centres, along with an equal ratio of MBBS and postgraduate medical seats to fulfil healthcare basics is now a needed priority to meet the SDGs and the Universal Health Coverage.
The newly formed National Medical Devices Promotion Council and revisiting “Make in India” amidst the US-India trade-war saga will be extremely crucial for Modi 2.0, especially when India has immense potential to become self-reliant and emerge as a rewarding hub for low cost manufacturing, reduce import dependency in this sector while creating employment and growth. In this direction, strengthening regulatory systems for pharmaceutical products and an essential-devices list and a separate pricing policy for medical devices need to be created.
And finally since health played a pivotal role for Modi 2.0 to come back to power at the centre, the governments first Union budget of 2019 that is to be presented in a few days must show 25-30% rise compared to the previous budget, along with stimulating States to increase their health budgets parallelly, and steadily increase every year its public health spending to 2.5% of GDP by 2025. The major areas to emphasize should now be on health financing, health workforce, and strengthening the National Health Policy 2017, a well drafted document that can needs to be revisited since it had a variety of disease control measures and targeted to tackle health challenges ranging from HIV to TB, infection to mental health, trauma, screening for NCDs such as hypertension, diabetes, CVDs, common cancers, control of indoor and outdoor air pollution with high priority to water, sanitation and maternal and child health nutrition, and proposed a multi-sectoral action aided by analytic capacity for health impact assessments for an effective and equitable health system.
India’s health indicators have lagged behind peers and neighbours despite accelerated economic growth. The gaps are still wide despite some impressive health gains in Prime Minister Modi’s first term. With the 150th birth anniversary of Mahatma Gandhi and the 75th anniversary of India’s independence featuring in the second term of Prime Minister Narendra Modi’s government, the agenda for health system transformation needs to accelerate and Modi 2.0 needs to show that Political will is even more important than professional skill for addressing India’s health and much can be achieved over the next 5 years for the Prime Minister to proudly proclaim from the Red Fort that India’s progress in health matches its economic development.
(The author is Vice President – External Affairs at Sahajanand Medical Technologies, a leading developer and manufacturer of minimally invasive coronary stent systems. Views expressed are personal.)
By Rajiv Chhibber
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