While hailing Narendra Modi’s Universal Health Coverage Scheme, well-known as the Ayushman Bharat Scheme, experts from diverse fields were of the opinion that “there is yet no cohesive policy to build healthcare system in India”. They also indicated the need to move beyond being “interventional” as in the case of Polio or Swine flu.
The burden of non-communicable diseases is still very much a reality and high quality, comprehensive care remains to be the norm. For instance, there are 74 million diabetics in India today. That is the result of not getting checked at the right time. In order to decrease the burden of disease, there is a need to move towards a non-interventional way where cure is just not disease-specific but an overhaul of the system that focuses on prevention as well,” said National Institute of Public Finance and Policy (NIPFP) Professor Ajay Shah.
“Fix-me up healthcare architecture needs improvement,” he further added.
Discussing ‘The Last Mile: Healthcare in India’ at the Zee Jaipur Literature Festival were panellists Professor Shah, World Bank’s Global Lead for Social Inclusion Maitreyi Bordia Das and Cardiothoracic surgeon Naresh Trehan, with moderator Govindraj Ethiraj, who is a prominent journalist.
India continues to be one of the lowest performing countries when it comes to healthcare. While levels of infant and maternal mortality are on the decline, the high prevalence of poor nutrition and rampant infections are continued challenges.
The cost of delivery “leaves a lot” as healthcare providers also don’t have enough deeper incentives,” said Shah.
Cardiologist and Cardiothoracic surgeon Naresh Trehan said, “Safety net is missing. There are fundamental flaws considering that every year, 2.3 per cent people above the poverty line are moving below the poverty line because of healthcare expenditures. This is a disaster.”
There are also “perception problems” pointed out the panel when Journalist Ethiraj engaged the trio in a conversation about the issues that plague the healthcare system.
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“There is a clear understanding that private health care spending is more. The dichotomy between what private delivers and what it charges is also huge,” said the panel.
The experts also hailed Bangladesh and Nepal for their efforts in improving health indicators especially when it comes to sanitation, life expectancy, immunisation programmes and child and maternal mortality.
Notably, data from the World Bank health indicators show that Nepal and Bangladesh with per capita Gross Domestic Product (GDP) around half of India’s have done better.
“State in Bangladesh created a system so that state and NGOs could together work on health,” said Maitreyi Bordia Das, who is also Manager in the Global Practice for Social, Urban, Rural, and Resilience.
Can bottom-up approach to healthcare be a plausible solution?
“In order to cater to the last-mile, India has an advantage because broadband has almost connected (the rural and urban areas). What is needed is local health centres to become wellness centres,” said Trehan.
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“People are not aware. Absolutely last mile needs to be a reality and implemented for which State needs to act responsibly. But one can’t put the entire burden on the State. There are countries that have created transport incentives where vouchers are given and whoever has jeep in the area will pay that person a little bit and take the patient to the hospital. Though much more extensive last-mile connectivity needs to take place, it is being implemented in India in the form of Janani Suraksha Yojana,” Das told Delhi Post referring to the safe motherhood intervention scheme under National Rural Health Mission that aims for promoting institutional delivery among pregnant women.
Listing the current issues affecting health like air pollution, cholesterol and diabetes, the panel highlighted that “excessive capacity in the private sector needs to be leveraged”.
“Focus on prevention, focus on ensuring that one doesn’t run to hospitals every time and food, road safety and air pollution need to be tackled at the earliest,” said moderator Govindraj.
