It’s been a decade of health like no other. At least not in the last 100 years – as the Covid-19 pandemic continues to dominate many lives and conversations, till date.

For Governments, it was not the best of times — trying to understand the virus, its impact and to draw-up a plan to contain the virus and treat the infection. Back home too, the story was not too different, from navigating lockdowns to stocking up on medicines, vaccines, diagnostics and so on. The terrain was difficult.

Having done well in childhood immunisation, the health administration managed to run a largely smooth adult vaccination campaign — about 220 crore Covid-19 vaccine doses were given. But there have been huge learnings from the experience, as well, involving communication, consent, transparency and disclosure — as families claiming vaccine-linked injuries today, deal with their loss. In fact, Covid-19 remains a moment of truth, with much to learn on preparing and planning for a health crisis.

The unprecedented crisis aside, the last decade has seen efforts in multiple segments contributing to delivering healthcare — pharmaceuticals, medical devices, hospitals and the ever-increasing fledgeling digital companies.

In the public health arena, initiatives like Ayushman Bharat and the Jan Aushadhi stores (selling less expensive medicines), for example, have been turbo-charged from their earlier avatars. While the initiatives are in the right direction, there is need of more work in expanding to more hospitals and weeding out corruption, as pointed out by the CAG report, to mention a few drawbacks. The Jan Aushadhi stores, too, need to stock-up more and become more visible, besides gaining the confidence of consumers through supplying quality products.

Health coverage

Public health experts prefer a universal health coverage model, to an insurance-backed one. Till we get there, the existing schemes should be seamless between Central and State programmes, they say, also calling for a greater thrust on preventive primary healthcare, to reduce the tilt towards more expensive secondary and tertiary care treatments.

Former Union Health Secretary JVR Prasada Rao calls for greater coordination between the Ayushman Bharat’s wellness centres (over a lakh were planned), the Jan Aushadhi stores and the insurance scheme. Every health and wellness centre should have a store where people can be given free or subsidised, quality medicines, he says, so a person goes to the hospital only when really unwell (where she is covered by the insurance.)

While the health and wellness centres are positive initiatives, more needs to be done to deliver comprehensive care, says Indranil, health economist, with the OP Jindal Global University. Several States have well-oiled health coverages, he said, reserving a verdict on the national health insurance scheme and its long-term outcome, that is not known, he adds.

The Centre needs to increase its spending on health to over 2.5 per cent of GDP (from about 1 per cent), he said, pointing to several national schemes that require support. The progress on infant and maternal mortality, childhood immunisation campaigns etc, have been achieved with strong public health efforts, he points out. But medicine bills have increased, says Indranil, calling for measures to prevent companies from side-stepping price control by changing their formulation.

Health spends

Rao also points to the spending on public health and calls for the promised 2.5 per cent of GDP to be spent entirely on health (not including other social determinants like sanitation, that are important but need their own separate spending.)

While the pharmaceutical sector has built on its existing legacy of being pharmacy to the world, it needs to keep a stringent watch on quality for both domestic and overseas consumers. Recent cough syrup-linked tragedies have highlighted the need for stringent norms and a stronger drug regulatory system, equipped with more people, training and technology to ensure quality products and devices enter the system.

Efforts are underway to set up bulk drug parks and medical device parks, to ensure sustainable domestic supplies. Digital companies have sprung up, with digital lockers, for example, to help people access their medical records in one place.

But health has several mountains to scale — from improved procurement of medicines to prevent stockouts, payments for frontline workers, affordable hospital care, protecting healthcare data — the list is long. The last 10 years have reflected this uphill task, but it requires constant and increased attention and funding to get quality healthcare to people.

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