Reviewing the role of states

Scientific advancement in healthcare has allowed human beings to double their life spans and effectively address life-threatening diseases such as malaria, cholera and plague that have in the past wiped out several civilisations. India in this direction has done well in addressing some lethal diseases and improved health indices but this achievement would not be possible without the strong support of the states. The states have shaped India’s health system in many ways, determining and influencing key system components such as insurance coverage and ensuring quality of care.

The panel discussion on ‘Reviewing the role of states’ brought to light some key learnings from the states of Chattisgarh, Manipur, Tripura and Rajasthan. The discussion also got the audience to share some learnings from states such as Arunachal Pradesh, Karnataka and more. Dr Rakesh Kumar Srivastava, Ex- Director General of Health Service, GoI, Advisor, WISH FOUNDATION was the moderator for the discussion who guided the panel to shares state specific innovations that each of them have come up with and good practices that they follow. The other panelists were Dr Dev Varma, Director of Health services & Ex-Officio, Add Sect, Govt of Tripura, Dr K Rajo Singh, Director of Health Services, Govt of Manipur and Dr Sarveshwar Narendra Bhure, Mission Director (NHM), Government of Chhattisgarh.

During the discussion, panelists spoke on the programmes and practices they follow that cover aspects such as efficient financing models, good governance, proper utilisation of funds, improving infrastructure and capacity building and addressing talent crunch.

Dr Varma began by giving a brief about the number of health centres and government hospitals in the state of Tripura. He also threw light on the lack of trained manpower in his state. “You will be suprised that we do not have a neuro surgeon at our trauma centre and therefore, we call this it the trauma care centre,” he miffed. He continued talking about manpower crunch in the state and informed about the two new medical colleages that have been established in order to resolve this issue. He also hightlighted their health financing scheme and said that it is a model which can be replicated by other states as well.

He also spoke on the lack of quality healthcare services in the state so far and how the state government is currently, trying to improve quality. Dr Singh gave a background of the state of healthcare in his state of Manipur. He spoke of all the difficulties they face in providing healthcare services to their people. There were no trauma centres in the state untill recent times. They are now establishing two to three  trauma centres. “Despite several difficulties that we face, we are trying our best to provide appropriate care to our patients. We are also providing medical and health insurance. We have recently introduced the Chief Minister’s health Protection scheme and are hopeful to better our health services using this scheme.”

Key Takeaways:

• India needs a strong health financing scheme
• Indian states need innovative public health delivery mechanisms that can be replicable and scalable
• Role of the private healthcare sector and the pharmaceutical industry in improving accessibility and affordability of healthcare in India is crucial
• NHPS can bridge the gaps in public health

Adding to this, Dr Srivastava pointed out that Indian states need innovative public health delivery mechanisms that can be replicable and scalable. Dr Bhure looked at present healthcare situation in India in a positive light. He said that our challenges needs to be turned into opportunities for making India a better healthcare provider. He went on to say, “In the last 71 years after India’s independence, our nation has done well in improving the state of healthcare. We need to acknowledge the kind of effort the government has put in, to provide health services to the citizens. Having said that, we still have a long way to go.” He also spoke on the SDGs for healthcare set by WHO and highlighted that India still needs to work towards achieving them. “We needs a strong public health financing system for the country”, he maintained. Further, he highlighted that states which spend significantly on health also have better health indices and medical outcomes.  “There is a clear rural-urban divide when it comes to healthcare services, which needs to addressed. There is huge disparity in terms of health services in the rural areas. The government needs to focus on accessibility in rural areas first and in urban areas, the government needs to focus on affordability. With the introduction of the NHPS, we hope to bridge the gaps in public health as well”, he mentioned.

Bhure also spoke about the crucial role of the private healthcare sector and the pharmaceutical industry in improving accessibility and affordability of healthcare in India.

Moving forward, Dr Srivastava, presented his view as a public health worker and cited examples on innovative solutions from the state of Rajasthan. The solutions were around creating a strong supply chain management system and on increasing accessibility through  developing sub-centres for health services.  He also  informed that states such as Haryana, Madhya Pradesh and Chattisgarh have already started working on the system to create sub-centres.

The panel discussion was followed by a Q&A session where delegates raised questions related to proper utilisation of funds, governance of health programmes and manpower shortage.

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