By invitation. This year, let’s turn the clock on political ‘inattention’ to health

As India goes through a period of financial reforms, hopefully, the resultant economic gains will translate into improved health for its citizens.

Despite impressive growth, public investment in health has been a disappointing 1 per cent of GDP. Low resources and overall political “inattention” to health explain why India continues to be a major contributor to the global disease burden — under both communicable and non-communicable categories — quite disproportionate to its population.

The growth of the health system, with a weakly regulated private sector and an overstressed public sector, has been disorderly. This has been exacerbated by successive governments’ patchy attempts to reduce impoverishment due to hospitalisation through heavily subsidised insurance schemes. Neglecting primary care and focusing on hospital treatment — which in most cases is unnecessary and of poor quality — is a costly strategy.

Such insurance programmes have, undeniably, benefited several. However, a majority of the poor have been denied access to care due to the concentration of hospitals and doctors in urban and semi-urban areas, where 36 per cent of the population resides.

Besides, for the poor, what is catastrophic is not just a single hospital episode, but the daily confrontation with simple and inexpensive-to-treat conditions such as TB, malaria and diarrhoea.

What they require is not access to high-end hospitals that insurance programmes promise but to safe tap water, sanitation, nutrition and basic healthcare that is free and affordable.

India has wide disparities epidemiologically and in terms of access to affordable care.

Three quarters of maternal, infant and child mortality takes place in about 250 districts, largely in North Indian States. These States are poor, and account for the largest below-poverty-line population.

Reducing interstate disparities needs attention so that no citizen is disadvantaged on account of residence.

In my forthcoming book, Do We Care? India’s Health System , I have attempted to indicate the nation’s priorities for the future.

For an effective “cooperative federalism”, the Centre needs to forge a national vision that all States are bound to.

It will also then need to provide substantial fiscal support to the weaker States to build their woefully poor health infrastructure that alone requires almost 0.75 per cent of the GDP.

The universal provisioning of comprehensive primary care — that must include access to essential social determinants as an entitlement of the citizen — needs to be recognised.

Combating communicable diseases must be through strategies that make citizens active participants.

Focus also needs to shift to improving health governance by bringing in institutional reform and systems that reduce, if not eliminate, corrupt practices; instituting public health laws; using technology for enhancing access; bringing in effective oversight; and ensuring accountability to outcomes.

In 2017, I wish to see the government increase public investment from the current level of about 1.1 per cent to 1.75 per cent of GDP.

A sizeable portion of this must be earmarked for building health infrastructure and the strengthening of primary care to facilitate prevention and early diagnosis of diseases, both communicable and non-communicable.

Finally, I would also like to see decisive action towards reforming the Medical Council of India that has earned such infamy for corruption, alongside treating medical education as a public good where merit rather than the capacity to pay determines who becomes tomorrow’s doctor.

(The writer is a former Union Health Secretary. The views expressed here are personal)

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