The year, 2015, is likely to be a significant one from the perspective of health. At the national level, the Government of India will release the new National Health Policy and is all set to launch the National Health Assurance Mission (NHAM) to progress towards universal health coverage (UHC) in the country. Internationally, this is the last year for Millennium Development Goals (MDGs) and as part of the post 2015 development agenda, the global community will begin to work towards achieving sustainable development goals.
In this New Year, 2015, let’s break the rituals and move away from the done and dusted path. The health and health systems challenges in India are well known and documented. Let’s spend more time on the implementation of the known and proven health interventions; build upon the lessons learnt and design new and innovative health solutions as well. This is the first thing I would like to highlight.
Second, as India releases the next national health policy for the country, I hope there would be a few path-breaking proposals for improving health in India and the new policy will guide progress towards UHC in India.
Third, I am hopeful that NHAM will pave the pathway for progress in universal health coverage in India and focus on increasing access with additional number of health services - of sufficient quality to be effective - in challenging geographical areas and for additional populations. I am also hopeful that NHAM will focus on continuity of care, effective referral linkages, strengthening primary healthcare and systematic attention to improving quality of health services.
Fourth, in India, most people have to pay at the point of service delivery and out of their pockets. This leads to people often spending beyond their paying capacity and, as a result falling below the poverty line. The health insurance schemes, such as Rashtriya Swasthya Bima Yojana (RSBY), provide an opportunity to address these challenges. It is hoped that NHAM will have the mechanisms to reduce out of pocket expenditures (OOPE) on health and protect people from falling into poverty due to health related expenditure at the time when they are sick.
Fifth, medicines and diagnostics are a major part of health expenditure for the people in India. A number of states have started free medicine schemes, which have contributed to the reduced OOPE and increased attendance at public health facilities. These schemes seem to be the right policy initiatives and I hope that these would be adopted by more states in India, building upon experience from these states.
Sixth, the eradication of polio from India is one of the biggest public health success stories globally in recent times. India is also getting very close to elimination of maternal and neonatal tetanus in 2015. This momentum must be utilized for control and elimination of a number of other communicable diseases such as measles, kala- azar, yaws and lymphatic filariasis, amongst other.
Seventh, noncommunicable diseases (NCDs), including injuries and mental health issues, are emerging as a major disease burden of in India. This has led to the dual burden of diseases in the form of combined morbidity in India. It is expected that tacking NCDs and comorbidities will become more central at all levels in both, public and private sector and there will be more intersectoral coordination and response across all ministries to effectively tackle this challenge.
Eighth, the integration of health services and making them people-centred to ensure that it is not the disease, which is treated, but the whole individual is provided continuum of care. This is the need of the hour in India. Integrated service delivery with people at the centre of these services should be the focus in this year and years ahead. This will require a paradigm shift and reorganization of service delivery paths. It is only logical that essential services for both, NCDs and CDs and for the entire family should be available through a single entry and a common platform for all the people. Both NHAM and national health policy provide this opportunity.
Ninth, the Prime Minister launched the ‘Swachh Bharat Mission’ in 2014, which is clearly linked to ‘Swasth Bharat’. This is an opportunity for intersectoral coordination at multiple levels such as universal access to safe drinking water, sanitation, school health and other social determinants of health. Swachh Bharat Mission also provides an opportunity for bringing ‘health in all’ policies for better health outcomes.
Tenth, the challenges in India are enormous and they require a holistic system approach. Universal health coverage is a journey for progressive attainment over a period of time. The significance of strong health systems has been further reinforced as recently as in the fight against Ebola in the African countries. It is critical that India works towards strengthening health systems responsiveness to people’s needs, efficiency, effectiveness, transparency, accountability and governance in both, public and private sectors. It is only through effective collaboration and partnerships across all sectors of the government and engagement of private sector in contributing to public goals that India will improve health outcomes and achieve progress in UHC.
To conclude, India is clearly repositioning health in its national development agenda for better outcomes are linked to the economic development and productivity of the nation. The whole country is looking towards the top leadership to position health at the centre of the developmental discourse and act boldly for a healthier nation. This is perhaps the New Year wish that every Indian has.
The writer is WHO Representative to India