Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. People want to lead a healthy life but if they fall sick, they like to get hassle-free treatment at an affordable cost. The health care services, therefore, have to be focused on prevention of diseases and their cure. Unfortunately, in India there has been more focus on curative services, which are more costly, compared to preventive services. The Indian System of Medicine (ISM) which is more focused on healthy living and disease prevention has been neglected for long due to political or other reasons and is seen inferior to allopathic system.
There is need to correct this bias and ISM needs to be brought to the mainstream. It is essential to institutionalize and start an integrated graduate medical course having common curriculum from the disciplines of Indian System of Medicine and Modern Science (allopathy). This will help in better appreciation of the strengths of other systems by the new practitioners who will be more armed to handle delivery of preventive and curative services.
Many of the non-communicable and communicable diseases can be prevented by adopting a healthy lifestyle and healthy habits. There is a need to educate people on a continuing basis about the lifestyle health risks and importance of naturopathy, yoga, physical exercises, and healthy food habits in preventing diseases. It is also important to inculcate healthy habits among the young through the school health education.
The issue of safe drinking water, sanitation and good hygiene are closely related to prevention of diseases. The government must continue its efforts to universalize the availability of improved toilet facility, general cleanliness and safe drinking water under Swachh Bharat Abhiyan and related schemes.
One of the issues related to efficient delivery of primary health care services is the absence of professionally qualified and trained cadre of health professional. At present, the clinical doctors, on promotion, are positioned as heads of Block or District health services and they find themselves at a loss to manage various administrative and logistics problems. There is need to have an all India public health cadre (like IAS, IPS etc.) of professionally trained personnel to address the complexities of the Indian health-care delivery system grappling with issues such as leadership, financial management, logistics management, data utilization and social determinants of health. At present, only a few states have public health cadres.
Another important issue is the catastrophic health expenditure which adversely affects the poor people. The catastrophic health expenditure means that people have to cut down on necessities such as food and clothing, or are unable to pay for their children’s education. Every year, approximately more than 150 million individuals, throughout the world face catastrophic expenditure, and more than 100 million individuals are pushed into poverty by the need to pay for health services. These expenditure could be on outpatient services or on hospitalization services.
Pradhan Mantri Jan Arogya Yojana (PMJAY) has been launched to take care of hospitalization expenses by covering approximately 50 crore rural and urban poor population. PMJAY covers medical and hospitalization expenses for almost all secondary and tertiary care procedures. For the success of PMJAY, it is important that patients requiring hospitalization get immediate approvals and timely payments are made to the empanelled public and private hospitals.
For out-patient care, the Government will establish 1,50,000 Health and Wellness centres (HWCs) across the country by 2022. At these HWCs, one mid-level service provider (Community Health Officer-CHO) will be provided along with Multipurpose Female Worker and ASHAs. At present, there are a large number of vacancies of medical officers (50% or more at Primary Health Centres (PHCs) in the States like Madhya Pradesh, Chhattisgarh, Uttrakhand etc). One of the reasons for the vacancies of medical officers at PHCs is that the allopathic doctors find it difficult to stay in rural area.
To overcome the shortage of Community Health Officers at HWCs, it is important that the local graduate doctors of Indian System of Medicines (Ayurvedic etc), with suitable bridge course, be positioned as CHOs at HWCs. This will go a long way to strengthen the primary health care services in rural areas. Immediate need is to prepare the action plan to train 1,50,000 such doctors to give them competencies for providing mid-level health care, especially, with respect to allopathic remedies. The ISM doctors need to be provided legal backing so that existing laws do not come in their way for effective discharge of health services.
For strengthening the infrastructure and manpower requirements of the health system, the public health expenditure need to be raised to 2.5% of the GDP in a time bound manner. It is important to establish trust of the public health institutions of all systems by providing quality health care services. Wherever required, private practitioner may also be roped in to provide health services. The price of drugs and diagnostics needs to be regulated so that patients are not fleeced.
Lastly, the union and State governments need to establish efficient monitoring and disease surveillance systems. These systems should provide real time data and should have a mechanism to take prompt corrective or follow up action based on these monitoring systems. The present experience shows that the data from Health Management Information System are rarely used by States for review, planning and policy purposes. It is a welcome step that NITI Aayog has started releasing annual State Health Index to promote healthy competition among the States. – Financial Express