Historically, Punjab has contributed significantly to the growth of the country. It has given several soldiers, sportspersons and intellectuals who brought laurels to the country. Following Independence, Punjab was at the centre of the Green Revolution and became the food bowl of the country. Over the years, Punjab has been going through various difficulties — terrorism in the 1980s, lack of growth subsequently, increasing unemployment and substance abuse. The neighbour across the border has been creating problems and of course narco terrorism seems to be a continuous threat.
The present political change raises the huge hope of bringing an end to these problems and providing better education, healthcare and employment security to the public.
‘Health is wealth’ is a popular saying. Scientifically, a healthy body has a healthy mind. Optimum and affordable healthcare to each individual should be the prime responsibility of the state government. In Punjab, efforts to improve healthcare delivery have been going on for some years, but there has been a lack of hard decisions because of political compulsions to achieve these objectives.
An honest analysis of the state of our public healthcare system should begin by asking ourselves why the PHCs/CHCs/district hospitals (DHs) and state medical colleges don’t have the confidence of the public. The reasons are not far to seek and include: a) lack of adequate staff and manpower; (b) lack of infrastructure facilities, including routine, high-end investigation facilities, essential drugs and consumables; (c) lack of, of course, desired work and service culture.
Thus, the main focus should be to address these issues and ensure effective manpower management and monitoring of performance. Medical colleges also need special attention as these colleges establish and guide the standard of care in the state. There should be networking of PHCs/CHCs/DHs/medical colleges for referral facility as a routine norm.
At present, in the state, the private sector is playing a major role in healthcare in Punjab, whether it be primary, secondary or tertiary care. Even under the Ayushman Bharat Yojana, operational for over two years, nearly 68% of the money spent has gone to private sector hospitals. During the Covid-19 crisis, private hospitals played an important role. While these hospitals must continue to perform, we must ensure that the public healthcare system is also improved, so that good quality healthcare is available to all sections of society and to prevent out-of-pocket expenditure on healthcare. The government should also support charitable organisations which provide good and affordable healthcare services.
Of course, there is need to regulate private entities to ensure evidence-based care and prevent any exploitation. Checks and balances must be built in to ensure that clinical care, diagnostic and therapeutic procedures are carried out as per the evidence-based guidelines. The government should consider to adopt The Clinical Establishments Bill after due discussions with the private sector, of course, to avoid an inspector raj approach.
It is important to remember that the role of the government in the field of public healthcare is not limited to the healthcare infrastructure alone, but requires a coordinated and multi-pronged strategy covering other sectors as well. For instance, the social determinants of health like living conditions, safe drinking water, unadulterated food, clean and unpolluted air, sanitation, sports facilities and social security increasingly contribute to the occurrence or prevention of diseases. Adopting a multi-sectoral approach is, therefore, also the need of the hour.
We must also recognise some positive steps taken in the state in the past which has and will further help to strengthen our healthcare facilities. The WHO appreciated the novel initiative by the Punjab Chief Minister Free Hepatitis Programme started in December 2016 and then adopted by the Centre in 2019 as a national programme. The performance of the state during the Covid-19 pandemic has been praised at the national level. Punjab is the first state in the country to initiate vaccine for preventing cervical cancer. New facilities which were conceived by the state leadership, raise hope of better healthcare and research in the state and also for the adjoining states. These include the Homi Bhabha Cancer Hospital and Research Centre at Mohali, built with support of the Government of India on the pattern of Tata Cancer Centre, Mumbai, and the recently approved Regional Institute of Virology to be built on the lines of the National Institute of Virology, Pune, by the Indian Council of Medical Research. The AIIMS in Bathinda and the PGI satellite centres in Sangrur and Ferozepur will add significantly to our healthcare infrastructure.
Thus, the health system in Punjab has its strengths and weaknesses. Importantly, it faces fresh challenges which also create new opportunities for growth and betterment. Some measures of reform are quite essential if we are to satisfy the healthcare needs of our growing population and meet the basic objectives of being able to provide an affordable primary, secondary and tertiary healthcare facilities to all sections of society. Of course, it is important to initiate steps to attract bright professionals to public sector facilities by offering attractive, deserving remuneration and other facilities. You need good doctors to take care of the health needs of society. Society can ill-afford to put their health needs in the hands of low and mediocre professionals.
Let me conclude on an optimistic note since I believe that we have good reason to be hopeful for our future. I am confident that the new leadership is committed to making every effort to fulfil the healthcare needs of our great state in the years to come. Let us, therefore, resolve to adopt all necessary measures so that our healthcare system becomes a model for the other states in the country to emulate. Though the state needs to allocate more resources to achieve this, but in doing so, it must ensure to maximise the impact of the funds that are spent.