Health must find its way into all State policies
India’s dilemma is to expand the coverage of health services and also meet the demands of patient groups
India is at the crossroads of its journey to provide healthcare to its 1.3 billion people. While major achievements in the past decade include big reductions in maternal and under-5 mortality, elimination of polio, maternal and neonatal tetanus and guinea worm disease and significant expansion of community-based health services, several challenges remain. The most pressing one is dealing with the growing number of people with non-communicable diseases, like hypertension, diabetes, cardiovascular diseases, cancer and chronic lung disease. These conditions now account for more than 60% of the disease burden and premature deaths. Diabetes and hypertension are no longer diseases of the elderly. They strike the young, affecting productivity and economic growth of the country.
The world has pledged to achieve universal health coverage (UHC) by 2030. This includes not only treatment of diseases, but preventive and promotive health services, as well as palliative care and rehabilitation. The WHO report on Making Fair Choices on the Way to Universal Health Coverage says that to achieve UHC, countries must advance in at least three dimensions: Expand priority services; include more people; and reduce out-of-pocket payments. In each of these dimensions, countries are faced with a critical choice: Which services to expand first, whom to include first, and how to shift from out-of-pocket payment toward prepayment? A commitment to fairness — and the overlapping concern for equity — and a commitment to respecting individuals’ rights to healthcare must guide countries in making these decisions.
A good example of targeted essential services is the Janani Suraksha Yojana that provides free maternity care and cash incentives to poor women to deliver in government health centres. The next steps are to improve quality of care; detect complicated pregnancies earlier; provide for emergency caesarean section and blood bank
There are many obstacles that lie in front of you on the road to success. When doubt creeps into the back of your mind and you start to question yourself, eventually you get derailed in accomplishing your goal. This is the main cause why people often say that everyone around them is getting better whereas they are stuck in the same place or getting worse. What we stand to gain and what we stand to lose in life totally depends on what we chose to focus upon.
Successful people have a clear picture between doubt and faith; they set their facilities in district hospitals; and expand the coverage to include deliveries in accredited private and not-for-profit hospitals.
Many states have launched health insurance schemes that mainly cover tertiary care services. However, the bulk of out-ofpocket expenditure occurs on outpatient visits and on diagnostic tests and drugs.
India’s dilemma is to expand the coverage of essential or high-priority health services to the entire population on the one hand, and also to meet the demands of various patient groups who legitimately want the best treatment available for their medical conditions.
When setting national priorities, reasonable decisions and their enforcement can be facilitated by robust public accountability and participation mechanisms. While the available evidence may not be perfect, one cannot always wait for this to be generated; decisions need to be based on the impartial scrutiny of available data. These mechanisms should be institutionalised. A strong system for evaluation is needed to promote accountability and participation and is indispensable for effectively pursuing UHC.
India’s vast network of pharmaceutical manufacturers and biotech companies provide opportunities to manufacture biosimilars and novel treatments at reasonable cost. Similar to the Hepatitis C story, in which big pharma giants voluntarily licensed their patents and transferred technology to several Indian generic companies and brought down the cost of treatment to less than 0.5% of what it had been, it should be possible to do this for many more therapies. Not only would Indian patients benefit, but this could be a game changer for patients living (and currently dying) with these diseases in many low- and middle-income countries. Access to good quality, affordable medicines is an important aspect of UHC.
Finally, an upgrade of the skills of healthcare workers will be necessary. Health staff at sub-centres (now to be called health and wellness centres) should be able to treat simple diseases, refer those with serious symptoms as well as provide preventive and promotive healthcare.
These are a few steps which are needed to achieve the goals, which are enunciated in the National Health Policy 2017. One hopes that in 2018, health truly finds its way into all policies — whether they are made by the ministry of food processing, agriculture, environment, road transport, housing or commerce. A good healthcare system can only provide solutions to problems. Their prevention, however, depends on determinants (air, water, nutrition, sanitation) that are outside the health ministry.
AN UPGRADE OF THE SKILLS OF HEALTHCARE WORKERS WILL BE NECESSARY. THEY MUST BE ABLE TO TREAT SIMPLE DISEASES AND PROVIDE PREVENTIVE HEALTHCARE
parameters and mindset to achieve the goals they’ve set for themselves. We need to be confident that god will give us the strength and courage to overcome any doubts we might have about our ability to achieve our goal. Success in life depends upon how much you believe without doubting anything.