Avanish Kumar
Research Scholar
Central University of Gujarat
In his speech on 12th May 2020, Prime Minister Narendra Modi announced a comprehensive special economic package of Rs 20 lakh crores - equivalent to 10 percent of India’s GDP. He gave a clarion call for the self-reliant India movement or Aatmanirbhar Bharat Abhiyaan. He also outlined five pillars of Atmanirbhar Bharat - Economy, Infrastructure, System, Vibrant Demography and Demand. COVID-19 crisis seems like a major driving force for refurbishing the Indian health sector in India and the world. This situation arose unexpectedly but it spawned many expectations in the hearts and minds of the common man. As on May 22, total number of infected people from Coronavirus reached 5.1 million. Death toll has reached 336,641 worldwide whereas in India the total case of infected people has reached 1, 24,073 with 3707 deaths. Further elaborating that in her speech, Finance Minister of India on 17th May 2020 had outlined health reforms and initiatives by putting them in separate categories. She stated that public expenditure on health will be increased by investing in grass root health institutions and ramping up health and wellness centres in rural and urban areas, setting up of Infectious Diseases Hospital Blocks in all districts and strengthening of lab network and surveillance by Integrated Public Health Labs in all districts and block level Labs & Public Health Unit to manage pandemics. Further, the National Institutional Platform for One health by ICMR will encourage research. And implementation of National Digital Health Blueprint under the National Digital Health Mission.
India has a legacy of weak health care since independence. The government spending on health is meagre 1.2% of GDP. The health insurance coverage is less than one-third of the total population coverage. Public spending on health continued to languish. Health insurance is fragmented and less than one-third of the population has coverage. Therefore, structural reform are imminent in following ways:
Change Triggers
It requires a large scale reform at macroeconomic or at political level. It includes economic shocks, emergence of charismatic leaders, and a transition between political regimes. For India, it is considered as once-in-a-century triggers which will be an important issue among voters.
Emergence of Technocratic Capability
In India, at the hour of pandemic, we have had strong and valid technocratic capabilities that include schemes in Kerala, Andhra Pradesh and Telangana. The way Kerala handled the COVID-19 and Nipah situation outbreak showed how technocratic capabilities can drive outcomes.
Strong stewardship
The roles of NITI Aayog, the National Health Authority and State Health Agencies are evolving. This will likely add positive pressure on the system for efficiency and better results.
Set of ‘lock-ins’
This is an early initiative that cannot be overturned without serious consequences. The visible reforms like Ayushman Bharat are effective “lock-ins” that are hard to roll back and provide a platform to build on.
Doctors-Population Ratio
According to the World Health Organisation (WHO), the Doctor-Population should be 1:1000 but in India it is 1:1,445. Considering the fact that health is a state subject, Union government time and again wash their hands off the issues calling it as a state issue.
In countries like India there is urgent need of attention in two particular areas especially- first, inadequacy of the health centres and second, the absence of safety nets which includes a large section of labour force and working class. India continues to languish on public spending. Yet over the period of time, a tendency to favour insurance-based models has been developed. The COVID-19 crisis has exposed the inadequacies and limits of the model. In the Union Budget of 2020-21, central government spending on health was fixed at Rs 67,484 crore, or 2.1% of its total budgetary outlay. There is a significant need for spending on health at all levels.
Our Finance Minister, Nirmala Sitharaman recently announced the increase of public expenditure on health by empowering the health agencies and institutions at the grass- root level and restoring the Health and Wellness Centres in various rural and urban areas in our country. Further, this has been initially announced on opening up 1, 50,000 new Health and Wellness Centres (HWCs) by converting the prevailing sub centres and primary health centres as the base for ‘Ayushman Bharat’. Now, during this novel Corona Pandemic, COVID 19, its need of an hour to work for the development of the Health sector primarily as India is facing a situation of crisis which will take a longer span of time to regain.
Health sector always demands exceptional support, funding and encouragement by the government and the onus lies truly on the government for providing good healthcare facilities in the country. A country can grow and develop more efficiently when its countrymen are healthy. The National Health Policy (NHP) 2017 envisions highest quality of health facilities to all people, at all age groups via mounting access, refining and improving quality and by reducing the cost of healthcare delivery. Its basic outline revolved around a few key concepts of ‘Universality, Citizen Centric, Quality and Accountability’ respectively. National Health Stack (NHS) is one of the major initiatives of NITI Aayog for the provision of crucial foundational components, which are required in the health IT programs in India. ‘National Digital Health Mission’ prepared ‘National Digital Health Blueprint (NDHB)’ under which various suggestions were taken into consideration. The main objective NDHB was to improvement in the field of health sector and to create national digital health forum, which will substantiate, support and encourage universal health coverage in an effective and efficient manner. It is based on the principle of five layered architectural building blocks. In order to achieve and to get success in some areas like- Life expectancy, IMR, MMR, TFR, immunization, malnutrition, disease control, the NHP 2017 laid stress on adoption of digital technologies respectively. National Digital Health Blueprint (NDHB) is based on the principle of ‘Think Big, Start Small, and Scale Fast’ and is a foundational base for the National Digital Health Ecosystem which can be planned further effectively in the long run.
COVID-19 pandemic has brought back the focus on India’s health care. It is an opportunity to bolster India’s health system, sustained investment in technology and reorienting budgeting priorities towards what is truly essential – our own health.