The SC's Verdict on 'Right to Health' Calls for Revamping Health Ecosystem in India

Despite having a prolific policy in place, the lacunae in its implementation at state levels creates a disparity in ‘Primary Healthcare Delivery’

By Dr Swadeep Srivastava

The unprecedented and unexpected outbreak of COVID-19 has almost wiped off the year 2020 from our lives, pushing many into depression, delivering knockout punches to economies across the world. It has locked our children, happiness and joy behind the frightening shadows of gloom. However, there is a flip side too – the COVID-19 pandemic has interconnected lives, made remote working possible, spurred healthcare to new realms – all thanks to the brilliance of cloud technology and the ubiquitous internet. It has redefined the digital technology, multiplying its utility and significance in our lives.

The COVID-19 has also given policymakers a big reminder on the need to focus more on healthcare, especially for a country like India. It’s worth mentioning that India’s bedrock of healthcare was the Primary Healthcare Centres (PHC). Countries like South Korea, Taiwan and states like Kerala did well in tackling the COVID-19 crisis due to a robust public healthcare system. However, such a robust system is not equitably available across the Indian subcontinent.

As far as PHCs in India are concerned, over the years, these haven’t been neglected in terms of the allocation of manpower, funds or infrastructure. However, with the neglect of PHCs, the private sector saw a boom, and COVID-19 has shown that there could be not just limits, but also yawning gaps.

The pandemic has shown that India can afford to continue neglecting public health care only at its own peril; not only to the well-being of its citizens but also to the nation’s economy. Just a few months of economic disruption was enough to set India’s $5 trillion economy dream back by a few years, if not decades. The blow that India’s economy got directly relates to healthcare. A nation needs hands to keep its economic engines chugging.

As COVID-19 seems to be on the wane, there is another important lesson ahead. It is time for India’s policymakers to create a transparent and doable roadmap for a universal vaccination programme against the Coronavirus. Here again, a robust chain of PHCs could have eased the process of vaccination, especially in rural India.

Moreover, had there been well-oiled PHCs, lives would have been saved and the blow to the economy cushioned. The impact of COVID-19 on India’s dismal GDP growth and the number of infections and deaths makes it one of the worst affected countries in the world. But what should be the way out to come out from the ongoing crisis?

The answer to this is – India’s public spending on healthcare is an abysmal 1.3% of GDP, barely up from 0.9% two decades ago. How can such insufficient allocation of funds keep either COVID-19 or other such impending infectious diseases or non-communicable ailments at bay?

This is the clarion call for India to learn the bitter lesson from the devastations brought in by the COVID-19 and enliven the reality that there is a need to shore up her healthcare infrastructure. The argument that COVID-19 will soon vanish and money can be diverted to other sectors is specious and flimsy. What needs flagging here is that COVID or no COVID, India still has a huge burden of infectious disease to tackle in rural areas and an alarming rise of non-communicable disease in burgeoning urban pockets. All this needs attention as only a robust population can crank up the wheels of the economy. It’s quite loud – COVID’s underlying message has been the need for a robust public health system to tackle a rainbow of disease burden.

Experts say that one extra year of life expectancy adds 4 per cent to GDP; and with every dollar/rupee spent on health, return on investment will be 9 to 10 times.

It is with this idea of having a healthy skilled workforce that Prime Minister Narendra Modi launched Ayushman Bharat, or, healthy India. The PM’s words of 2014 ring clear: “The need of the hour is to think big”.

India’s vision for the health sector post-COVID should be more ambitious and inclusive. And the starting point is to revisit the earlier schemes and tweak it, if needed, in the light of COVID aftermath. A relook at PHCs is a good starting point.    

As part of thinking big, start a genuine and professional audit of the National Health Protection Scheme (NHPS) for over 10 crore poor and vulnerable families announced in the 2018 Union Budget. This was one of the biggest `thinking’ and plans chiselled by Modi for a skilled India. In real numbers, an estimated 50 crore individual beneficiaries would get coverage of up to Rs 5 lakh per family per year.

Where are we now? What is the road ahead? 

The NHPS was to be part of an umbrella Ayushman Bharat scheme, along with a preventive healthcare component worth Rs 1,200 crore. “These two far-reaching initiatives (the other being the Pradhan Mantri Jeevan Jyoti Bima Yojana or PMJJBY) under the Ayushman Bharat will build a New India in 2022 and ensure enhanced productivity, well-being and avert wage loss and impoverishment,” the then Finance Minister Arun Jaitley had said.

Probably, post-COVID, India must move from selective coverage to universal coverage. A universal cover will ease the implementation of schemes and eliminate selection bias, which has always been a key pitfall of social security measures across the world. It should be remembered that universal coverage and selective coverage operate on dissimilar designs. Hence, it would be a good move to announce health cover for all residents eligible to get Aadhaar.

Another factor that will need sharp focus is that the healthcare policy must give more emphasis to preventive healthcare. This will ease the burden of tertiary care and government hospitals. The move of the government to reactivate the rural health centres to push towards preventive healthcare is in the right direction. These 1.5 lakh centres were to be recalibrated as wellness centres to bring the healthcare system closer to the homes of people. Under the new plan, these centres were to provide comprehensive health care, including for non-communicable diseases and maternal and child health services. These centres were also to provide free essential drugs and diagnostic services.

Where are we now on this? Or is the laudable scheme still on paper or a cob-webbed planning table?

Added to this, India faces a major shortage of beds. COVID has bared the burden borne by the already full and overflowing government hospitals. India needs over 6 lakh beds to cater to the country’s growing population. It seems impartible to bridge this gap unless there are innovative partnerships.

India also needs more doctors, paramedical staff and other trained professionals. It is time to open more medical colleges in a controlled manner.

The government should set up medical college hospitals in backward districts to address the twin goals of treatment facilities and producing more doctors and nurses for underserved areas. The need for more field workers, trained contact tracers, lab technicians etc., was exposed by COVID. The paucity of critical care infrastructure and adequate ICU beds was felt even in big cities like Delhi, Mumbai, Bengaluru, Chennai and Ahmedabad.

To ease the burden on hospitals, innovative and `big thinking’ is a must. This is where public-private participation is crucial. Public-Private Partnership (PPP) can be achieved by making health cover possible at accredited facilities across private and public sectors.

Home healthcare is another viable option. The government has to seriously consider facilitating partnerships with the home healthcare segment especially to solve the perpetual problem of shortage of beds. Home healthcare can directly address the issue of shortage of beds, doctors and paramedical staff. COVID brought this out to the forefront, but the facilities remain in the metro cities only. This is the time to spread home healthcare to other places and the crucial aspect is the need for trained manpower.

The government should also leverage the strengths in information technology to reach out to the masses in rural areas. Telemedicine is a success, but there are other emerging fields like remote monitoring, health care at home and Artificial Intelligence (AI) waiting in the wings to be tapped for their potential.

Healthcare is a state subject. India’s federal apparatus, encompassing the Union government and state governments must sync on respective budgetary policies that channel more funds to public health.

Understandably, COVID-19 has shown how a creaky or inadequate public healthcare policy can only spell disaster to all sectors. Let’s take a lesson from the disaster and resolve to be part of the change to begin now.

We are all set to bid a farewell to the high voltage and historic 2020, which has added a new chapter in the charter of healthcare – ‘Preventive Public Health’. However, it would be prudent to draw a lesson from the pandemic – the significance and adherence of preventive health for the holistic health of the nation. With an optimistic note, let’s welcome 2021 and help equip preventive health reach to the cultural proportion.

Wishing to witness a Healthy, Safe and Happy ‘Vaccinated’ New Year 2021!