‘The government should be the main provider of health care services in the country’

Recommendations for the proposed new health policy are: There should be one comprehensive health care policy for the country with the aim of providing affordable, accessible, equitable healthcare. The policy should be pro people in its approach and should cover various aspects of the health system as a whole. For instance, this includes components related to (i) diseases and service delivery (including primary, secondary and tertiary care) (ii) health financing (including insurance), (iii) medical products, drugs and technology, (iv) information, data and research, (v) regulation, governance and stewardship and (vi) health workforce. People should be at the centre of the health system. 

While formulating any programmes or policies, instead of being input driven the focus should be on achievement of measurable health outputs, outcomes and impact with clearly defined indicators and mechanisms to measure the same.

The government should be the main provider of healthcare services in the country.

In terms of its core principles the focus should be on strengthening of the public health care system. This would include, provision of appropriate infrastructure, human resources and financing. The policy should clearly outline that the government is the main steward of the healthcare system with transparent and accountable systems in place for monitoring. There should be a stringent regulatory framework that clearly outlines the role of the private sector in India and monitors its functioning. The not-for-profit private sector should be encouraged and supported with appropriate policy measures.

Ensure that the public health workforce is well motivated and incentivised through provision of financial and non-financial incentives so that talented staff are attracted to work in rural and remote areas through the public health system.

There is a need to focus equally on curative care and emergency services in the country.

The district hospital (DH) is a hub of activity in the country. Each district should have a 500-bedded hospital which caters to most of the curative services of the district. The DH should have at least 100 doctors, an administrative structure, and adequate number of nurses, pharmacists, lab technicians and operation theatre assistants.

A network of emergency of ambulance services should be provided culminating in district hospitals where complete care of an emergency patient could be provided. Every fifth district hospital should be developed as a tertiary care (super specialty) hospital to provide advance cardiovascular, neurosurgical or renal dialyses services etc.

The focus on urban health, disease prevention, immunisation and providing mother and childcare should be maintained. However, the programme of immunisation should not be expanded disproportionately to include diseases like hepatitis, H. Influenza, HPV etc.

With the dual burden of communicable and non-communicable diseases and increasing burden of diseases such as cancers, cardiovascular, MDR-TB, accidental road deaths, mental illness there should be provision for prevention and treatment across the country rather than only in urban areas. The cost of care for such diseases is driving several families into debt and poverty, hence there should be a clear plan for ensuring affordable care to large sections of society. 

There should be focus on strengthening AYUSH and Indian system should be integral part of the health system and not an afterthought. Creation of health mission in the states has created parallel structures of health delivery, which has weakened the directorates. This should be discontinued and all money should flow to the directorates. But presently the capacity of directorates in extremely poor to absorb surplus funds. They need to be strengthened further. Post-graduate medical educations seats need to be increased to match with the graduate level admission.

The regulatory functions of the health system should be strengthened which include various professional councils (MCI, Pharmacy council, nursing councils), drug regulatory bodies and private sector regulator.

Strengthen the domestic pharmaceutical industry and Indian health institutions engaged in research in the public sector. Drug discovery and research should be encouraged for India specific health problems and disease burden.

Private insurance sector should not be allowed to enter into public health system. Model of UK instead of US should be emulated.

The health policy must be accompanied by a road map or a plan of action that translates the policy into practice with clear outcome and impact indicators and timelines for implementation.

– Amulya Nidhi, Co convenor, Swasthya Adhikar Manchh