Challenges to health sector and Draft National Health Policy
India topped almost every worsening health indicator in the Asian region even beyond countries like Bangladesh and Nepal. The gross ignorance to this sector is evident to several health indicators be it Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), death of children under-5, due to diarrhea, pneumonia and several such indicators surfaced time and again speaking the negligence of government to handle it.
Challenges to health sector
Some of the indicators: IMR is 50 per 1000, which is poorer than Bangladesh. MMR is 209 per 1 lakh women lives. India spends merely 1% of its GDP, which is further cut by 20% recently. Out of pocket expenditure amounts to 10% of total household expenditure and 22% of total non subsistence expenditure as per WHO. Household in India spends 24% equal to or more than their capacity to pay. Illness to a person in poor family makes every member suffers because of the high cost of treatment which often makes them take loans and sell their property the little they own.
TB, HIV/AIDS, diarrhea, pneumonia, and non-communicable disease are still prevalent in the country. In 2010 country topped the under-5 deaths due to diarrhea, pneumonia in absolute numbers. Poor training to health-care providers in the rural areas is a reason to this number. Poor doctor and nurses to population ratio is another factor contributing to it as it is below critical WHO standard of 2.8 per thousand.
The new DNHP
Draft National Health Policy (DNHP) attempted to address the challenges to this much ignored sector. It includes making health as justiciable right, private participation in delivering the health services through a well networked public health delivery system. To mobilize the funds the public spending is enhanced from present 1% to 2.5% of GDP. Also increasing taxes on alcohol and tobacco, gains from medical tourism, special health cess. Instead of exhaustive coverage, the draft is silent on many aspects.
Need for enhanced spending
There is a need to understand the inter linkage of health, development and economic growth. Industrial labor on account of ill health unable to work and spends more than his capacity in the treatment. The demographic dividend could only be reaped if the youth remains healthy and thus productive.
Indicator of poverty not only includes employments and incomes but also good quality of education and health, availability of safe drinking water and pollution free air. It is not only about providing the adequate number of hospitals, doctors, nurses, free drugs, along with it includes unadulterated food, water, air, open space, park and a clean environment.
What should be done?
Because of constrained finances government should initiate indicative financing meaning thereby conditional grants to the states for achieving the laid down goals leaving states to implement the policy their way. The goal should be to provide the comprehensive primary care to the citizen in the first instance. One size-fit-all approach needs to be done away with as it leads to a disproportionate distribution of funds and places it requires the most remain neglected. India’s burden of disease is not uniform and it requires recognizing the distribution of that burden and accordingly allocating the resources to curb the problem. There are place in the country where the primary health centre is more than hour distant because of poor connectivity. It is quintessential to address the problems of these places to attain measure of equalization.
In order to meet the human resource challenge bodies like the Medical Council of India constituted in 1933, need to be revamped. Laws need to be put in place to make the private sector more accountable. At present there is neither concrete grievance redressal mechanism nor any regulation to the malpractices and fraudulent.
There is a need of institutional reforms and a political will to rectify the distortions with clearly demarcated roadmap.
