We have a sound draft health policy

In India, public investment in health has failed to cover the entire spectrum of healthcare needs. In this context, the draft national health policy (dNHP) is progressive in outlook. It recognises the public health system as distinct from health services, human resources, and investment; and acknowledges upfront that trained human capital is abysmally inadequate, that financial resources are unrealistic, and that achievements have fallen short.

The remedy has much more to do with governance than has been highlighted. The dNHP 2015 has not emphasised sufficiently the primary role and responsibility for stewardship vested with the Centre and the ministry of health and family welfare. India is short of 3 million doctors, and 6 million nurses (according to a PwC study), with a virtually non-existent para-medical training programme.

Continuing to build more AIIMS-like institutions is not helping to bridge this gap. The government needs to reform medical, nursing and para-medical education. It can begin by equalising the number of UG and PG seats in medical colleges, extending PG education beyond medical colleges, and providing career progression prospects for GPs and nurses. The Centre the State governments should remove restraints on State-owned medical universities, and enable them to train medical specialists, nursing and para-medical professionals.

We need immediate revival of district-level ANM training schools and state of the art nursing colleges in every State. We cannot continue to endorse a regimen of MBBS-centric healthcare and desist from empowering nurses.

The government needs to ensure that the Medical Council of India or other professional bodies focus on their core responsibility of regulating the registered medical practitioners’ compliance with prescribed professional standards. Although the Clinical Establishments Act 2010 has been notified, there is need to build consensus and ensure that standard treatment and practice guidelines across all specialities are implemented, and regularly updated.

Cooperative federalism forces State governments to improve their fiscal management in order to assign at least 8 per cent of expenditure for population health and wellbeing, to integrate public health programmes with public interventions, and to energise health systems so that they become responsive, efficient and effective.

The Centre and the State governments need to ensure approval of new drugs, prioritise the conduct of clinical trials, mandate appropriate regulation, facilitate and support local manufacturing, update health legislation, mainstream the access to affordable drugs and incentivise medical ethics.

The dNHP 2015 promises “assured comprehensive primary healthcare” as an entitlement. Some suggestions for moving towards this objective include the following.

(i) Adopt ICT technologies, and democratise all tasks concerning prevention of ill health, and promotion of healthy living, at ‘pre-primary level’. Use health coupons and/or vouchers to incentivise wellness and compliance. For example, issue “no smoking” and “no gutka” health vouchers; issue health vouchers for compliance in respect of household toilets, and so on.

(ii) Train and certify non-medical persons so that they may be assigned specified tasks. (iii) Make an almost asymmetrical investment in human resources to significantly expand the availability of doctors, qualified nurses, and generalist and specialist para-medical personnel. Cuba adopted this approach and has an excellent healthcare record.

(iv) Reorganise primary healthcare as a speciality. Bring in the GP, the nurse practitioner, and the family-based medicine model, successfully demonstrated by the NHS in the UK.

(v) Put in place accountable care organisations in every district, in public-private partnership mode. (vi) Regulate all providers at the primary and secondary care levels to ensure strict compliance with the national accreditation board initiative in the interest of patient safety, rational use of drugs, and observance of medical ethics. (vii) Integrate initiatives for publicly funded health assurance, with publicly funded health insurance at pre-primary, primary and secondary care levels.

Further, the role of the private sector in healthcare provision needs to be recognised where 78 per cent of outpatients and 60 per cent of inpatients are being serviced by private providers; they, however, have control over only 20 per cent of the existing health infrastructure.

It is, therefore, imperative to evolve public-private partnership to achieve the desired targets..

The dNHP 2015 is seeking a raise in public health expenditure over five years, from 1.2 per cent to 2.5 per cent of GDP. This translates into a four-fold per capita increase from ₹957 to ₹3,800. This hike has been promised in the Twelfth Plan.

Making this commitment by the end of the Plan (March 31, 2017) will significantly help strengthen a base for introducing universal health cover.

This is required to stabilise provisioning of patient-centric assured comprehensive primary healthcare in partnership with the non-government sector and enable the patient to access and navigate healthcare seamlessly between public and private health facilities.

The financial and institutional ecosystem must support widespread adoption of ICT technologies, updated medical devices, electronic health records, consultation between academia and industry for R&D, and a national data repository on key diseases.

To address all infirmities and shortfalls in achievement so far, the NHP 2015 must seek assignment of not less than 70 per cent budgetary resources towards primary care, 20 per cent towards secondary care, and 10 per cent towards tertiary care.

Jairam is chairman of the Ficci health services committee. Datta Ghosh is chairperson of the Ficci group on NHP 2015

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