Keeping track of COVID, without again neglecting old foes like TB, leprosy, and measles; chronic lifestyle ailments like diabetes and heart disease and also reining in Antimicrobial Resistance (AMR) will make 2023 a challenging year
Most medical experts have been reassuring us that 2023 will not see a COVID re-run of 2020. That India’s COVID policy, of high vaccinations and gradual opening up followed by localised lock downs, gave most of the population good hybrid immunity from both vaccines and natural infections.
But Health Minister Mansukh Mandaviya has preferred to play it safe, cautioning that the next 40 days are critical as past data revealed a spike in India’s case load 30-35 days after infection waves in East Asian countries.
With Finance Minister Nirmala Sitharaman set to present her fifth straight budget on February 1, 2023 the high probability of another COVID wave will ensure allocation to the healthcare sector will at least keep pace, if not increase, from the previous years.
But it will be crucial to allocate these funds wisely, supporting the weak links in India’s health infrastructure. Thus, policy makers should view 2023 as an opportunity to put into practice the hard lessons of the past three COVID years.
India’s public primary care network could be the best place to start addressing the weakest links. Spreading the spend to primary care, especially in rural areas and tier 3/4 cities, but looking much beyond COVID, has the potential to set right decades of neglect and reduce burden on expensive secondary and tertiary care facilities.
For instance, the Rural Health Statistics (RHS 2020-21) report shows that while there has been improvement, there is a long way to go, especially in certain states. Even out of the sanctioned posts, a significant percentage of posts are vacant at all the levels.
For instance, RHS 2020-21 data shows that as on March 31, 2021 21.1 per cent of the sanctioned posts of female health workers/Auxiliary Nurses and Midwives (ANMs) at Sub Centres (SCs) and Primary Health Centres (PHCs) were vacant as compared to 41.9 per cent vacancies of male health workers in 2021 at SCs.
After the SCs, the PHCs are the next contact point in India’s three tier rural health system, the village community’s first access point to a medical officer. RHS 2020-21 records that at PHCs, 64.2 per cent of the sanctioned posts of male and female health assistants and 21.8 per cent of the sanctioned posts of doctors were vacant in 2021.
The gaps are even more worrisome at the next level of care in the rural sector, the Community Health Centres (CHCs). As on March 31, 2021, out of the sanctioned posts at CHCs, 72.3 per cent of surgeons, 64.2 per cent of obstetricians & gynecologists, 69.2 per cent of physicians and 67.1 per cent of pediatricians were vacant.
These vacancies speak of the urban-rural divide in India’s public health infrastructure, even though digital health solutions like the e-Sanjeevni initiative are bridging some of these lacunae.
Thus 2023 will be about keeping track of COVID, without again neglecting old foes like TB, leprosy, and measles; chronic lifestyle ailments like diabetes and heart disease and also reining in Antimicrobial Resistance (AMR). Tracking climate change and emerging zoonoses will also keep health policy makers and epidemiologists sleepless.
But it’s not enough to have policies, if they’re not implemented speedily or in the proper manner. The medical device sector now is part of the PLI scheme but how many years will it take for medical device companies to actually use these funds, start projects and ensure India is self-sufficient in medical devices?
And will such schemes favour large companies or will SMEs lose out? Mirroring the pharma sector, there’s reason to believe that the cluster approach, with shared resources, will be more beneficial for the larger number of SMEs.
While we make our wish list for 2023, let’s also work on better coordination and trust between government and private healthcare. Schemes like the Central Government Health Scheme (CGHS) have become long drawn out who-will-blink-first contests between the stakeholders. On December 29, based on representations from industry associations like the Association of Healthcare Providers in India (AHPI), the Special Secretary MOHFW extended the validity of CGHS empanelled hospitals to February 28, 2023 or till the new rates are finalised. While conveying this thanks to the ministry, Dr Girdhar Gyani, Director General, AHPI points out that the CGHS rates have remained unchanged since 2014. The hope is that the Ministry will agree to the association’s long pending demand for better rates, given the overall inflation of costs and the financial unsustainability of waiting months for the health ministry to reimburse hospitals for treating CGHS beneficiaries. Will we see some resolution on this front in 2023?
Maybe 2023 can be a year for healthcare leadership to truly lead. As Nilesh Shah, Group President & Managing Director, Kotak Mahindra Asset Management puts it, “We need to invest in the healthcare sector for us and the world. We need to create Infosys, TCS and Wipro-kind of giants in the healthcare sector to serve the local and global populations.” And that’s top of my wish list for the healthcare sector in 2023.
VIVEKA ROYCHOWDHURY Editor
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