It was with some expectation that patient groups watched Election 2019. The Ayushman Bharat (AB) insurance programme, its flaws aside, had been rolled out. And statements on promoting less expensive generic medicines and on controlling the price of cardiac stents had been made in the past by no less than the Prime Minister.

Expectations were high that the incoming government would build on this momentum, especially since India sits at the top of many global health problems, ranging from tuberculosis to lifestyle-related communicable diseases like diabetes. Studies show that both communicable and non-communicable diseases vie for attention from the Government, for attention from the Union Budget, for attention from policymakers.

And now, adding a new layer of complexity to this already over-burdened healthcare system, is the political disruption witnessed in different parts of the country.

Just months ago, a young resident of Kashmir recounted how her mother’s high blood pressure could have had fatal repercussions, as telephone lines and the internet were down following the revocation of Article 370. The resident had to run to a doctor 10 minutes away and get back in the nick of time to administer the necessary medicine. Access to medicine and healthcare runs into a new hurdle when there is political turmoil and uncertainty, a complexity the Indian healthcare could do without.

An editorial then in the British journal The Lancet said on the Kashmir situation, “the protracted exposure to violence has led to a formidable mental health crisis.” Citing a Médecins Sans Frontières (MSF- Doctors without Borders) study in two conflict-affected rural districts, the article said that with one in five people having witnessed death first hand, due to violence, the region was seeing an increase in anxiety, depression and post-traumatic stress disorder.

These mental and physical health concerns threaten to silently permeate as people deal with job losses, a struggling economy and, more recently, uncertainties over their citizenship. The Government’s need to get healthcare to citizens across the country only becomes more critical with each passing day.

Abysmal spending

But former Health Secretary at the Centre, JVR Prasada Rao, says health has never been a top priority across governments. Certain specific programmes may get attention, but overall healthcare spending remains too abysmally low to make an impact, he says.

The country’s total spending on healthcare hovers around 1 per cent of GDP and the long-standing promise of governments is to push it to 2.5 per cent by 2025. There were expectations over Ayushman Bharat’s attempt to provide health cover for 40 per cent of the population, he agrees. But questions are being raised on priorities. Referrals to secondary and tertiary level care seem to get more attention than basic primary care.

Strengthening primary healthcare, including the health and wellness centres that the Government has earmarked, should be priority, as it takes care of medicines and diagnostics, which compound healthcare bills for a patient. It also helps catch and treat a problem before it flares up to require treatment in a larger secondary or tertiary hospital. “Making basic primary healthcare available is the duty of the Government,” he stresses. The money is available, he says, adding it requires political will. Given the different pressures on healthcare, the Centre must spend more, he says, pointing out that about 90 per cent of state health budgets are spent on salaries and routine spends. Health being a state subject, certain individual States were undertaking good schemes, but that does not aggregate to the national level, as others lag behind.

Indranil Mukhopadhyay, a health economist and Assistant Professor, OP Jindal University, calls for transparency in the AB programme so independent researchers can review anonymised microdata on claims reimbursed by the scheme and help fix the flaws.

Disturbing trends

Government health data (2017-18) shows disturbing trends in the tendency towards more expensive caesarean operations, for example, he points out. A recessionary economy is showing less rural consumption of healthcare as well. Health workers fear for the fate of the National Rural Health Mission and urge the Government to strengthen and expand it to urban settings too, rather than whittle it down, as is the buzz.

Pointing to the increasing commercialisation of healthcare in both the private and the public sector, experts caution that health is a segment unlike any other. It is the Government’s responsibility to administer it to its citizens, be it in peace or when faced with disruptions as witnessed this year.