Has the National Health Mission been effective enough?

The spotlight is on the adequacy of public healthcare facilities during the pandemic. The National Health Mission (NHM) has helped improve the infrastructure over the last fifteen years, but much more needs to be done to improve health security.

The NHM has increased the number of 24x7 delivery points from 2,243 in 2005 to 15,494 (rise of 591 per cent) in 2020, while the number of First Referral Units (FRU) that provides comprehensive obstetric care services has also gone up from 940 units in 2005 to 3,122 units (rise of 232 per cent) during the same period.

While the Sub Health Centres have grown by 8 per cent, Primary Health Centres (PHCs) have increased by 7 per cent. Community Health Centres has gone up from 3,346 to 5,335 ( rise by 59 per cent), while 121 district hospitals have been added during the last 15 years.

Among the facilities conceptualised and implemented under NHM, the government has started 77, 278 Ayushaman Bharat Health and Wellness Centres and 5,895 urban PHCs.

Reduction in out of pocket expenditures

In the data provided to the Lok Sabha on July 20, the Ministry of Health and Family Welfare claimed that as a result of the health systems strengthening efforts of NHM, the proportion of those seeking care from public health facilities increased from 28.3 per cent to 32.5 per cent in rural areas and 21.2 per cent to 26.2 per cent in urban areas between 2014 to 2017.

Utilisation of public health facilities for institutional deliveries increased from 56 per cent to 69.2 per cent in rural areas and from 42 per cent to 48.3 per cent in urban areas.

The average medical expenditure per hospitalisation and childbirth also declined in this period, from ₹5,636 to ₹4,290 in rural areas, and ₹7,670 to ₹4,837 in urban areas for hospitalization and from ₹1,587 to ₹1,324 in rural areas and ₹2,117 to ₹1,919 in urban areas for institutional delivery. This indicates the impact of NHM reducing out of pocket expenditures (OOPE) for health.

Much more needs to be done

But there is a long way to go when it comes to healthcare services. An increase in public spending on healthcare can significantly reduce the OOPE from 65 per cent to 35 per cent of the overall healthcare spend.

India’s public health expenditure is between 1.2 per cent to 1.6 per cent of GDP between 2008-09 and 2019-20. The Economic Survey 2020-21 has recommended increasing public spending on healthcare services from 1 per cent to 2.5-3 per cent of GDP. The current expenditure is relatively low as compared to other countries such as China (3.2 per cent), the USA (8.5 per cent), and Germany (9.4 per cent), according to the PRS Legislative Research.

NITI Aayog study on the ‘Not –for-profit hospital’ model in India published in June this year states that India faces significant challenges of unavailability and unaffordability in healthcare services despite economic growth and modernisation. India’s lower bed density substantiate this more than the rest of the world. The bed density ( number of hospital beds per 1000 population) in India is 1.0 while in low-income countries it is 1.2, in middle-income countries it is 2.4 while in the world it is 2.7.

Overall, 72 per cent of hospital beds in India are available in urban areas, while 28 per cent are in rural areas.

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