Towards Better Healthcare

Increase in public spending on health with universal healthcare as a priority should make the nation’s medical arm more comprehensive and inclusive

The elections are over and it is just a matter of procedures before the fresh government takes over. The people have given an unprecedented mandate. Even though the basic issues were missing in the election campaign, at the end of the day people would expect steps to be taken by the new government to improve employment opportunities, job security, proper remuneration, quality healthcare, education, etc. Though none of those featured in the frontline of the agenda during elections, they, nevertheless, remain core issues of life.

It is admitted by repeated documents of the government including the national health policy 2017 document that as a result of out of pocket expenditure on health, 6.3 crore people of our country are pushed below the poverty line. This is a serious issue. There is an immediate need to improve this situation. There is a need for several steps to be taken to ameliorate the situation.

Health is a basic requirement of all individuals irrespective of caste, creed, gender, religious groups or economic status. It is, therefore, imperative that health is recognised as a fundamental right. There is a need to enact National Health Bill as Right to Healthcare Act as it could guarantee every citizen the right to comprehensive and quality healthcare at the state’s expense in a government health facility, and in case of its non-availability, in a private health facility. Health should be included in the concurrent list of the Constitution and adoption of a National Health Policy legally binding on the executive.

For the above, it is urgently required that public spending on health is increased. The share of out of pocket expenditure on health care as a proportion of total household monthly per capita expenditure was 6.9 per cent in the rural areas and 5.5 per cent in urban areas. This poses a heavy burden on households. More than 40 per cent of the population has to borrow or sell assets for treatment, according to the 2004 report of the National Sample Survey Organisation. The estimated costs of Universal Health coverage range between 4 and 6 per cent of GDP. Though considerable, this financial commitment is achievable. As an immediate step, public health spending should be increased from 1 per cent to 2.5 per cent and then to 5 per cent in the coming four years. Direct spending by the government has shown better results compared to the insurance-based healthcare delivery system worldwide.

National Health Profile 2015; Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India estimates that expenditure on medicines constitutes nearly two-thirds (60 per cent) of out of pocket expenditure, forcing them to get buried in a quagmire of poverty. There is a need to implement a Rational Drug Policy that allows drugs to be sold only under their generic names. Exempt production of generics from patent rules. Ensure improved availability, accessibility and affordability of drugs including vaccines and sera in the public health system; through quality-conscious pooled procurement systems and promoting the manufacture of essential medicines. There is a need to adhere to the policy of cost of production for the ceiling of drug price.

In the last few decades, there has been a shift from opening the medical colleges in the state sector to the private sector. This process has been further speeded up in the last four years. In 2017, there were 214 government medical college and 253 private medical colleges. Between 2014-2017, 36 new medical colleges were opened in the government sector and 58 in the private. The colleges in the private sector charge an exorbitant fee to the tune of rupees one crore for the MBBS course. Most of these colleges lack proper infrastructure and violate the norms and forms of medical ethics. There is evident commercialisation of medical education. The policy should be changed to open more medical colleges in the state sector.

Setting up Primary Health Centre at every 30,000 population, with 24-hour service, a Health Sub-Centre at every 5,000 population and a fully-staffed Community Health Centre with all facilities at every 1,00,000 population. Establish round-the-clock ambulance service at every 30,000 population. Post women medical and paramedical personnel in all health centres and hospitals in adequate numbers. All Government health facilities should adhere to Indian Public Health Standard (IPHS) norms.

Social determinants of health such as safe drinking water, sewage facilities, clean environment, proper housing, sufficient remuneration, employment opportunities and job security must be given priority. Rules should be framed accordingly. Assured safe drinking water supply through piped water in all habitations, total sanitation in all households and localities, and enforce complete safeguards against air, water and soil pollution by industries, mines and other developmental projects should be arranged.

Malnutrition must be eliminated by implementing the National Food Security Act 2013 which aims to provide subsidised food grains to approximately two-thirds of India’s people and ensures Maternity entitlements to all pregnant women. Setting up the Nutrition Rehabilitation Centre at each block to address the issue of severely malnourished children is necessary.

Our spending on health is very low, while it is huge on arms race including the nuclear weapon system. Presently, India is the second biggest buyer of arms in the world and also aspires to become an arms exporting country. We have to play a leading role in initiating mutual dialogue with neighbours to strengthen peace and divert money towards health, education, and development.- Millennium Post