Last year, the Indian government made some momentous announcements impacting the health sector. Ayushman Bharat was held up as the largest health insurance scheme in the world, covering about 50 crore Indians, providing secondary and tertiary healthcare to the under privileged.

But the establishment of a string of Wellness Centres under the scheme to provide primary healthcare services hasn’t acquired the same visibility.

Despite the policy formulations in the last 20 years, public health expenditure has stagnated at 1 per cent of the Gross Domestic Product, making India one of the low performing countries in the health sector. The Central and State governments are equally responsible for this glaring failure to scale up public health expenditure to 2-3 per cent of GDP. This is also reflected in low allocations for health in state government budgets.

Any appreciable increase in budget allocations for health is unlikely in an election year, unless social sector issues like health and education figure prominently in the election manifestos of major political parties. Health has rarely been an important election issue for any political party. It is therefore a historic opportunity for parties in the next general election to turn the tide and display political commitment to improve the health status of the people.

The National Health Policy 2015 proclaims the government’s intention to spend 70 per cent of public expenditure on primary healthcare. But primary healthcare is constantly denied priority allocations in the health sector. The establishment of Wellness Centres is a great opportunity to reverse this trend. By 2020, the Wellness Centres should be functioning to full capacity to minimise costly referrals to hospitals. The success of Ayushman Bharat depends on how effectively the healthcare needs of people are taken care of at the primary level.

Focussed coordination missing

The contributory factors or social determinants to health get varying degrees of priority in governments but lack a focused coordinating mechanism to ensure optimal allocation of resources across these sectors. Safe drinking water, sanitation, hygiene and nutrition are treated as ends in themselves. Their contribution to good health is not adequately recognised as an indicator that should be measured and evaluated.

There is an urgent need to establish a coordinating body in the Prime Minister’s Office or the Cabinet Secretariat to coordinate the work of agencies that contribute to improvement of the health status of people.

Disease control to reduce morbidity and mortality is an ongoing mandate of governments at the Central and State levels. India has some of the world’s largest disease control programmes for TB, AIDS, and malaria. They achieved partial success but got into stagnation precisely at a time when they need massive scale-up to achieve the targets set for 2020.

It is no longer practicable to treat each of them in isolation. Convergence of fully-funded programmes with a common budget and delivery system is the urgent need of the hour. Initiatives for control of non-communicable diseases like cancer, diabetes, stroke and heart diseases should not be limited to treatment but should include prevention strategies steered by largescale awareness programmes.

All these are linked to the larger issue of governance of health sector. Public health, including preventive health, should get primacy at all levels of governance.

Governments have been dithering on structural reforms like formation of separate cadres of public health professionals to manage health programmes, putting primary healthcare under the charge of trained nursing cadres instead of allopathic doctors and rolling out three-year courses for medical graduates.

It requires political will and commitment to overcome resistance from powerful lobbies to carry out these reforms. It is high time elections are fought on issues like health and educational reforms rather than on palliatives like loan waivers and subsidies.

The writer is a former Health Secretary with the Government of India. Views expressed are personal

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