National Health Policy: New doctor, old prescription

The National Health Policy, released by the NDA Government recently, advocates an incremental, assurance-based approach to achieve primary healthcare for all. And for that, it has allocated a major proportion (two-third) of resources to primary care. It talks about the Government's objective to repose public faith by improving the ever-increasing disease burden of the country; growing incidence of communicable and non-communicable diseases and poor financial structure etc. It has set a go-getting target of eliminating kala-azar and filariasis by 2017, leprosy by 2018 and measles by 2020.It also proposes to eliminate tuberculosis by 2025, and to reduce infant mortality rate to 28 by 2019 and maternal mortality rate to 100 by 2020. To achieve this, it has called for a public-private partnership model and a close Centre-State coordination to deliver on the set vision.  While the intent of the Government looks fine – to provide affordable, universal healthcare for all – but while setting targets, it has failed to provide a clear path about the way it hopes to achieve these promising targets. Moreover, it was expected that the policies of the Government ought to be balanced, unambiguous and also time-bound. The NHP on this count has been a big disappointment. The policy, which has come after a gap of 15 years, makes an attempt to undo failures of the UPA Government but in a half hearted manner. One of the most glaring lacunae for successive Governments for the health sector has been poor public spending, which has been the largest contributor towards poverty.  First, though the Government has raised the expenditure on healthcare from the UPA’s abysmally low allocation of 1.04 per cent to 2.5 per cent of its gross domestic product (GDP) but this isn't enough compared to the World Health Organisation’s recommended standards of spending five per cent of the GDP on healthcare. India's healthcare spending has remained abysmally low compared to that of China's spending of 3.4 per cent or of Malaysia's spendingof about four per cent.  Though we opted for a public sector model for healthcare since independence, but post-liberalisation of the economy in the 1990s, the private sector took the onus onto themselves to govern this sector. The resultant is that we now have a highly unregulated, haphazard healthcare market structure of which 70 per cent is owned by the private sector.   To top it all, India’s monthly per capita out-of-pocket expenditure was as high as 6.9 per cent in rural areas in 2011-12 and 5.5 per cent in urban areas. Due to the non-availability of public health services, poor people from rural India have been forced to opt for private services. The number of people opting for private institutes in rural areas has seen a constant rise - from 56 per cent in 1995-96 it shot up to 58 per cent in 2014. This is why, according to estimates, about 63 million people have been pushed into the poverty.  Second, funding of public health systems still remains a challenge. Resources accessible for health programmesreveal that India allocates just 0.1 per cent of its GDP on publicly-funded drugs and medicines. Meaning, people incur about two-thirds of the total out-of-pocket expenditure for drugs. This business of non-funding of drugs has had disastrous consequences.  Instead of addressing key issues like the under utilisation of resources, poor quality of services, non-availability of doctors and nurses, regulation in medical education, the Government has reposed high faith on the private sector. The policy advocates for "a positive and proactive engagement with the private sector to fill the critical gap". It has called for private sector collaborations for strategic purchase, capacity building, skill development programmes, awareness generation, developing sustainable networks for community to strengthen mental health services and disaster management. Third, it remains to be seen how prudently the Government decides to spend whatever little it has allocated for health - will it expand the delivery system, or will it spend most of it in the private sector by investing in insurance schemes, or will it spend the money by spending a little for both? At best, as various experts have argued, the Government must chalk out a plan to synergise the relationship between public and private players.  Fourth, matters do not end with the allocation of money. Yet another problem remains is the state’s capacity to utilise these funds efficiently. It is often seen that most States return back their funds because they could not be utilised. Expectations run low on the ability of the state to effectively spend the allocated amount also because the Health Minister ruled out a cess to fund this. This will further complicate situations for the Government to reach a target to effectively spend the 2.5 per cent target amount. Moreover, the policy is either a repeat version of the previous policy or has taken a backward step from the promises it made in its 2015 draft policy. For example, certain old ideas of the UPA Government have found a place in the new policy with a few improvements. In fact, certain provisions duplicates sections from the Budget. It has failed to fulfill the promise it made in its draft policy of a right to health. A  health cess, as promised in the draft, could have been path breaking, but the Health Ministry has dropped the idea all together. Diagnostics, drugs and essential health care services are already free in many States. Implementation of the existing promises though remain the foremost challenge now. Disclaimer: The opinions, beliefs and views expressed by the various authors and forum participants on this website are personal and do not reflect the opinions, beliefs and views of ABP News Network Pvt Ltd.