The Modi Government started off well by appointing Dr Harshvardhan as the Cabinet Minister of Health, who prioritised four issues: reforming medical education; launching a national health assurance programme; focussing on infectious disease control programmes; and focussing on prevention – reducing tobacco addiction, integrating yoga and ayurveda with modern medicine. His sudden shift to another ministry, however, signalled the falling importance of health. Budgets fell or stayed constant, even while accommodating new cost intensive initiatives such as outsourcing dialysis units in district hospitals; NACO merged as a routine activity of the ministry; and immunisation expanded exponentially under a programme called Indradhanush.
This last year has, however, been eventful with four critical policy initiatives that, if well designed and implemented, can be game-changers. The first was the release of the ambitious Third National Health Policy (NHP) that stands out for two important
commitments:
1. Focussing on primary care by envisioning the strengthening of the sub centres located at 5000 population as wellness centres; and
2. Acknowledging the need to strategically purchase services from the private sector for expanding access. However, achieving the goals and the vision laid out in the NHP require an immediate trebling of public investment from the current level of 1.10 per cent of GDP. Inadequate resources can make the NHP a non-starter and India can stand to lose one more opportunity to make the much needed paradigm leap.
Impelled by the need to reduce cost of care, the second critical development is the capping of prices of essential drugs, consumables and devices like stents and mandating physicians to prescribe only generic drugs. This is a commendable and bold initiative. Its effective implementation will, however, require to be accompanied by strong regulations and an institutional capacity to enforce them.
The third and fourth are related to two noteworthy landmark legislations, pertaining to the Medical Council of India and Mental Health. Apropos to the scathing Report of the Parliamentary Standing Committee in 2014, the government has submitted the draft bill for Parliamentary approval, setting aside the elected MCI of 1932 with
a government nominated National Medical Commission. Laws are but what one makes of them. If the right people are appointed, this body can contribute in bringing in a much greater sense of accountability in the sector and a rapid scale up of the country’s potential.
Fingers are crossed, since the inappropriate appointments made to the prestigious National Board of Examinations has caused deep concern. MCI reform can help the sector come out of the morass of corruption and nepotism that it has got trapped into. Therefore, the challenge before the government is to stand firm on merit alone being the sole criteria for consideration and not barter away the future of the health sector to political expediency. The second landmark legislation is related to making
access to mental health services a right and in safeguarding the privacy and the dignity of those in need of help.
Alongside the above agenda, the government needs to be aggressively proactive on two critical issues – reducing the surging TB resistance and assuaging the growing anger among the people at the high cost of private care and the low quality of services in public hospitals. Hospital reforms and stringent regulations to rein in the private sector are urgently required.
Reconciling the conflicting stakeholder interests is problematic and requires full support of the political leadership. It is hoped that the government will work towards a well calibrated reform process that will encompass increased resources aimed towards universalising access to basic healthcare and health determinants like nutrition, tap water and sanitation, while at the same time, bring in institutional reform to improve efficiencies through better management and governance. Attention to these two aspects can improve health and well being by over 90 per cent – not by commercialising healthcare. 2018 can be a year to look forward to.