ADVERTISEMENT

New Health Policy Promises ‘Tectonic Shift’ For Public Health Care

Government spend on health needs to spread wide but not too thin, writes Sangita Reddy of Apollo Hospitals.

An ambulance stands outside the Primary Health Care Center in Raghopur, Bihar, India.(Prashanth Vishwanathan/Bloomberg)
An ambulance stands outside the Primary Health Care Center in Raghopur, Bihar, India.(Prashanth Vishwanathan/Bloomberg)

On March 16 this year, something wonderful happened in the public health domain that many Indians may not have realised. The Union Cabinet, under the pragmatic leadership of Prime Minister Narendra Modi, took a giant step by adopting a path breaking National Health Policy 2017 (NHP 17). After a hiatus of nearly 15 years, this new policy promises to be a tectonic shift in the way public health care is addressed in India. It is a recognition of the fact that keeping a nation’s citizens healthy helps the nation to be healthy. This new policy holds the promise of far-reaching health benefits for every citizen of this diverse country. It spreads the health net wide enough and, more importantly, early enough with a plan. This should, in my opinion, reduce the burden of disease significantly via the virtuous cycle of prevention, early detection, and medicine compliance through a strong primary care network.

Consultative Approach

So what makes this policy different from its predecessors? First, this policy was not simply thrust upon the population by its architects in Delhi but was formed by a process of consultation which spanned more than two years during which 5,000 suggestions from the public and medical community were considered before it was vetted and endorsed by the Central Council for Health & Family Welfare. In a country where the common man has had little say in policy making, this was an extraordinary exercise that merits special recognition.

A Healthier Budget

What strikes us most is the increase in the public health budget from a stingy 1.2 percent to a more practical 2.5 percent of GDP. The government plans to make the funds available in a calibrated time-bound manner. China spends 3 percent of its massive GDP on health and the global mean is 5.4 percent. India, therefore, has some distance to cover but has taken the first bold step. Having said that, the conservative 2.5 percent of GDP allocated to health is still marginally higher than the 2.4 percent being forked out for India’s defense expenditure.

Despite a period of calm on the inflation front, healthcare costs are still rising every year due to increase in wages, cost of investment and health delivery costs across India.

Notwithstanding the doubling of the budget, the available funds will have to be spread wide and also not too thin. This means that the Ministry of Health and Family Welfare must be both innovative and sagacious while identifying its priorities.

Wide-Ranging Initiatives

There is plenty to be said about this new policy but what stands out is the following:

  • The government plans convert its 150,000 healthcare centres into Health and Wellness Centres, and will offer a broader and more comprehensive package of services through this network.
  • There is a move to focus more sharply on non-communicable diseases (NCD) such as diabetes, cardiac diseases, respiratory disorders and cancer. According to the World Health Organization (WHO), NCDs are responsible for 60 percent of the deaths in India. In fact, 26 percent of the population between 30 and 70 years dies of NCDs.
  • Importance has been given to mental health, palliative, rehabilitative care and considering that citizens are living longer than ever before, geriatric care has been moved up in priority.
  • In this policy, the government has articulated its intent to organise and finance healthcare services, access the latest technologies, accelerate the development of human resources, provide financial protection and assured healthcare delivery to all – especially to the underprivileged.
  • The policy also envisages the use of medical pluralism – which is the use of traditional medicines and alternate treatments. Yoga is being promoted as an economical tool to improve the general health of citizens. India will show the world a new way!
  • By strengthening the primary healthcare facilities, the government hopes to provide comprehensive services at the first point of contact for patients, freeing up resources at hospitals for more serious interventions. In acknowledgement of this strategy, the ministry has channeled two-thirds of the health budget towards primary healthcare.
  • What is notable is that in a bid to provide financial protection to the citizens, the policy proposes to provide free diagnostics, free drugs and free emergency services in all public hospitals.

In all honesty, I believe the approach of ‘free’ needs to be well calibrated to be effective and sustainable. That said, it is heartening to see the policy go in the direction of affordability and access.

A lone patient sleeps in the post operation recovery ward of the district hospital in Jind, Haryana. (Photo: Prashanth Vishwanathan/Bloomberg)
A lone patient sleeps in the post operation recovery ward of the district hospital in Jind, Haryana. (Photo: Prashanth Vishwanathan/Bloomberg)

Let The Numbers Do The Talking

The new health policy enunciates ambitious growth in health facilities and has assigned quantitative targets (see table) to measure the progress of healthcare in the country. From boosting hospital bed availability to increasing life expectancy and reducing the fertility rate, the objectives are clear. Demographic dividends notwithstanding, India’s burgeoning population has held back improvement in the citizens’ quality of life. In view of this, the ministry’s objective to reduce the Total Fertility Rate from 2.5 to 2.1 by 2025 makes sense.

As we close in on that target, we will have to ensure that we do not slip into negative population growth.

This happened in the case of China’s hugely successful family planning programme, when the Total Fertility Rate level reached 1.6 prompting the country to review its one-child policy.

New Health Policy Promises ‘Tectonic Shift’ For Public Health Care

Public Private Partnership And Its Collateral Benefits

The NHP 17 takes a fresh approach to working with the private health sector for delivering quality medical care. This means that the citizen will have access to more secondary and tertiary care services through a combination of public hospitals and accredited non-government healthcare providers. In case of an emergency, these facilities will be accessed within the “golden hour”.

Corporate hospitals such as Apollo have been at the forefront when cooperating with government institutions in delivery of health services.

This partnership policy has the potential to multiply the reach of health services to all corners of urban and rural India.

For the sector to grow, it needs the building up of human resources like never before. We will need more doctors, nurses, public health cadres and mid-level service providers. Along with infrastructure growth, more medical and diagnostic equipment will have to be deployed, and technicians will be required to operate and maintain them. All this will result in increased jobs, more manufacturing and an impetus to the economy just when we need it the most.

Lifestyle Modification: Catch Them Young

Healthy citizens do not need frequent medical care and that saves the country money on medical treatment. To prevent our citizens from getting sick in the first place, several areas need attention. With growing incomes Indians are taking to junk food and unhealthy lifestyles. Keeping our population properly nourished while preventing childhood and adult obesity is a challenge. It stands to reason that we must be a more active, and sport- and exercise-loving nation. Our schools and colleges have their jobs cut out for them.

Make sure every child gets adequate time to play active games. National campaigns to get youngsters off their couches and onto sports grounds will be required to build a healthy nation.

Keeping adults and children from smoking is a priority all over the world and India has done a fair job of spreading the anti-tobacco message.

Students play volleyball in the sports field of the Indian Railways Eastern Railway Intermediate College in Mughalsarai, Uttar Pradesh. (Photographer: Dhiraj Singh/Bloomberg)
Students play volleyball in the sports field of the Indian Railways Eastern Railway Intermediate College in Mughalsarai, Uttar Pradesh. (Photographer: Dhiraj Singh/Bloomberg)

Cleaning Up Our Act

Whatever we do to treat disease is inadequate if the environment we live in is unsanitary, unhygienic or polluted – we are asking for trouble. With increased industrialisation and growth in vehicular traffic, the air quality in many of our cities has declined, causing respiratory diseases in urban areas.

More than 6 lakh people die in India every year due to fine particulate matter in ambient air.

Industrialisation has also affected water bodies and ground water. This is a major health hazard and a challenge that needs to be addressed on a war footing. The Modi government is making significant efforts to clean up and modernise our cities and sensitise citizens about cleanliness. The Swachh Bharat mission, building of toilets and stopping open defecation will all play a part in cleaning up our cities and villages and improve the health of our population.

In April 2015, the Union Cabinet cleared a project to develop 100 smart cities and rejuvenate another 500 in the country, allocating close to Rs 1 lakh crore for a period of five years. These initiatives are also addressing issues of air quality, better water, improved sanitation, efficient waste management and clean public transport. As our cities clean up and improve, so will the health of our citizens.

Make In India: Make More Affordable

In recent years, we have seen how costs can come down with import substitution and when the government exerts a beneficial influence to bring costs down. Prices of coronary stents have dropped 85 percent after they were included in the National List of Essential Medicines and added to Schedule I of the Drug Prices Control Order, 2013. It is time to push the Prime Minister’s Make in India policy with great vigour in the public health space. With improved support for research, industry-friendly regulations, economies of scale and healthy competition, healthcare will not only be available more widely, but can be delivered at affordable costs. The role of digitisation, indigenous manufacturing, innovative access mechanisms, and large-scale skilling and policy rationalisation remain to be addressed, but I believe that will soon follow.

Patient Centric Policy

Finally, the new policy puts the patient at the centre of things. The patient must be kept informed and empowered, and should be able to seek out solutions to problems.

Tribunals where the aggrieved can seek redressal of grievances over the treatment received would empower the patient further.

Make our citizens healthy and our country will reap the benefits of being one of the world’s most productive and hard working people. I am now hopeful that this powerful futuristic plan will be followed by pragmatic, time-bound implementation to achieve health for all, with the help of all.

Sangita Reddy is joint managing director of Apollo Hospitals.

The views expressed here are those of the author’s and do not necessarily represent the views of BloombergQuint or its editorial team.