Needed, a resilient health care system

The second surge of Covid-19 in India has indeed been ferocious, brought untold misery to numerous, overwhelmed the healthcare system and affected every aspect of our daily lives. It is clear that we cannot go on as before: we need to invest now, invest wisely in ensuring a resilient health system that will serve us well in normal times and during times of disaster.

A resilient health system is that which has ability to prepare for/learn from shocks, one that is enduring and has equity as a central principle, is comprehensive, and addresses the whole spectrum of health-care needs: preventive, promotive, primary, secondary and tertiary.

Central and state governments, civil society, the private sector, academics and researchers must come together immediately and develop a long-term vision as well as time-bound plans to ensure adequate investments in infrastructure, human resources, information systems, procurement and supply chains for medicines and diagnostics, health security, and mutually beneficial ways to share best practices and resources for capacity building.

The policy commitment to spend 2.5 per cent of GDP on health by 2025 should be met and we need to aspire for a five per cent spend by 2030, with two-thirds being committed to primary health care.

A key guiding principle in making investments is that no individual in this country should face financial hardship in accessing care, be it by way of access or use of services . The pandemic has shown investments are required in meeting the needs for critical care and emergencies, and in strengthening primary health care.

Investments vital

This is the time to invest in improving health literacy and emphasising the value of preventive and promotive health, including underscoring the value of multi-sectoral convergence, by enhancing allocations in health-related sectors such as nutrition, drinking water, sanitation, housing and transport.

Our greatest strength is our health workforce. Their selfless service during the pandemic has kept us afloat. However, there are shortages and their distribution is skewed. We must correct these shortcomings by appropriate investments.

This is the time to take advantage of recent legislation pertaining to reforms in medical education and allied health professions and leverage the numerous institutions created in the public and private sectors for pre-service and in-service training by developing and enforcing standards of education.

Our human resource investments must recognise the invaluable role of our frontline workers, and ensure adequate remuneration and dignified working conditions.

There’s a need to invest in high quality information systems to provide us with actionable data in real time that serves the needs of service providers, programme managers and policymakers. An integrated alert system with animal husbandry, agriculture and environment has to be developed. Digital health tools must have safeguards to address date security and privacy concerns.

India has a rich resource in non-governmental organisations: be it in service delivery, advocacy, community education, relief and rehabilitation, NGOs have played an important role. A few black sheep cannot be allowed to colour our perception of their significant contributions. The government needs to facilitate their functioning.

The private, for-profit sector must collectively reflect on its role in the pandemic and develop robust internal mechanisms to be seen as a reliable, credible partner. A well-regulated private sector with transparent and clear rules of operation would complement the health system, particularly in the delivery of secondary and tertiary care.

Primary health care and essential public health functions should be publicly funded. The government must play its stewardship role of setting standards and ensuring adherence in the public and private sectors.

The pandemic has shown that health is everybody’s concern. The role of communities in resilient health systems is paramount. They need to be central to decision-making and be involved in planning and monitoring. Community collectives and local government institutions need to be nurtured and strengthened. Mechanisms of social audit of health care institutions to ensure accountability must also be strengthened.

Government medical and public health research and training departments and institutions need clarification of their mandates and changes in their institutional functioning. The pandemic has shown that their role is critical. How well they are able to perform depends upon the government’s investments in, and expectations of, them.

Recent initiatives in the health sector have already set the stage. Ayushman Bharat and health insurance/assurance under PMJAY are a step towards universal health coverage; 22 new AIIMS and 157 new medical colleges sanctioned recently need to completed quickly.

The e-Sanjivini experience, the tele-learning and now the tele-conferencing platform need to be expanded. The reformative legislation of National Medical Education Act and the National Commission of Allied Health Professionals Act need careful implementation to reap long-term benefits. The learnings from the pandemic experience need now to be incorporated in both policy and practice.

The writer is former Secretary, Health & Family Welfare, GoI

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