\u201cHealth\ncare is the cornerstone of the socialist state. It is the crown jewel of the\nwelfare state\u201d\u2014quoted by Monica Crowley holds true in all aspects. A country\u2019s\nactual wealth lies in its people. United Nations Development Programme annual\nreport of 2018 states that the basic and fundamental aspect of governance\nis \u201cstate of health care in any\ncountry\u201d.<\/p>\n\n\n\n
Health\ncare is a fundamental right, but it is not fundamentally right in India. The\nSupreme Court has held health care to be a fundamental right under Article 21\nof the Constitution. However, historical public spending of just over a percent\nof GDP on health care has ensured that the country\u2019s health care need has\nremained underserved and left for the private sector to service. The\nfundamental aspect of health care\u2014primary health care\u2014is in a shambles. There\nis only one primary health care centre (often manned by one doctor) for more\nthan 51,000 people in the country. The World Bank report states that 90% of all\nhealth needs can be met at the primary health-care level.<\/p>\n\n\n\n
Primary\nhealth centres are the backbone of the rural health-care system. By 1991, India\nhad about 22,400 primary health centres, 11,200 hospitals, and 27,400\ndispensaries. These facilities are part of a tiered health care system that\nfunnels more difficult cases into urban hospitals while attempting to provide\nroutine medical care to the vast majority in the countryside. Primary health\ncentres and sub-centres rely on trained paramedics to meet most of their needs.<\/p>\n\n\n\n
The\nmain problems affecting the success of the primary health centres are the\npredominance of clinical and curative concerns over the intended emphasis on\npreventive work and the reluctance of staff to work in rural areas and on the\noutskirts of the town. In addition, disintegration of health services with\nfamily planning programmes often causes the local population to perceive the\nprimary health centres as hostile to their traditional preference for large\nfamilies, or beliefs carried from the time immemorial. Therefore, primary\nhealth centres often play an adversarial role in local efforts to implement\nnational health policies. \u201cSuccess starts from base\u201d a very practical quote\nwhich we all know and even implements. The same happens in health care also. If\nthe basic tier is not strong how can we expect the apex to be strong. <\/p>\n\n\n\n
India\nis presently in a state of health transition. Infectious diseases such as\ntuberculosis, as well as malaria, dengue, H1N1 pandemic influenza and\nantimicrobial resistance remain a continued threat to health and economic\nsecurity over the past six decades. At the same time, the country is having to\nconfront the emerging problem of chronic non-communicable diseases such as\ncardiovascular diseases, diabetes, cancer which are now the leading cause of\nmortality rate in our country.<\/p>\n\n\n\n
This\nepidemiological transition is being fuelled by social and economic determinants\nof health sector,
\nas well as by demographic changes such as an ageing population, by\nenvironmental factors such as climate change and environmental change, and by\nfactors such as globalisation, urbanisation and changing lifestyles.<\/p>\n\n\n\n
To\ncater to the primary health-care system, our honourable Prime Minister has\nlaunched a flagship scheme \u201cAyushman Bharat\u201d. <\/p>\n\n\n\n
To\naddress these challenges, Finance Minister Mr. Arun Jaitley on\nFebruary 1, 2018 unveiled the world\u2019s largest government-funded health\nprogramme termed as \u201cNational Health Protection Scheme\u201d(NHPS), covering 10\ncrore families or approximately 50 crore people, with Rs. 5 lakh insurance\ncover per family per year. This scheme is for secondary and tertiary health\ncare, mainly for hospital care.<\/p>\n\n\n\n
This\nflagship scheme is most likely to benefit more than 37% of the population,\nmeaning that nearly all the poor and vulnerable families will be covered. The\ngovernment will require Rs. 12,000 crore for its implementation, with cost\nshared on a 60:40 basis between Central and State governments.<\/p>\n\n\n\n
Mr.\nJaitley further announced setting up or converting some 1,50,000 subcentres in\nthe country into so-called \u201chealth & wellness\u201d centres which will offer a\nset of services including maternal and child health services at the primary\nlevel, mental health services, vaccinations against selected communicable\ndiseases, and screening for hypertension, diabetes and some cancers. The\nsub-centres which at present cater to a population of about 5,000 people each\nand are manned by two paramedical staff.<\/p>\n\n\n\n
The\nAyushman Bharat programme is apparently driven by two main aims: 1) to\nstrengthen primary health care which has been lacking in the country for the\npast six decades and 2) to offer financial protection from catastrophic\nexpenditure, often encountered once a family member is sick and needs long-term\nhealth care.<\/p>\n\n\n\n
The\nscheme, if implemented properly, could be a game changer by enhancing access to\nhealth care including early detection and treatment services by a large section\nof society which otherwise cannot afford them and in lieu falls victim. The\nidentification of beneficiaries can be done by linking with Aadhaar and\nsimilarly following up for services received and health outcomes achieved,\nthereby helping to monitor and evaluate the impact of the programme.<\/p>\n\n\n\n
Ultimately,\nNHPS can help country move towards universal health coverage and equitable\naccess to health care which is one of the UN Sustainable Development Goals or\nSDGs. This new scheme builds on the already existing Rashtriya Swasthya Bima\nYojana or RSBY\u2014a health insurance scheme for the below poverty line families,\nwith entitlement of up to Rs. 30,000 per annum for diseases requiring\nhospitalisation. However, given that States are expected to agree for 40% share\nunder the NHPS and that health being a State subject, State ownership and\ncommitment will be critical for the success of the programme.<\/p>\n\n\n\n
The\nFinance Minister has made a budget allocation of Rs. 52,800 crore for the\nHealth Ministry, up from Rs. 47,352 crore during the previous year\nsignifying an increase of 11%, yet as percentage of the GDP, it is still among\nthe lowest in the world. In addition, the government plans increase the levy of\nhealth cess from 3 to 4%. According to Health Minister Mr. J.P. Nadda,\nRs. 2000 crore have been allocated as of now.<\/p>\n\n\n\n
It\nis clear that the NHPS scheme, which primarily offers support for clinical\nservices such as hospitalisation, is unlikely to help fix the broken public\nhealth system in the country. The most critical issue remains the limited and\nuneven distribution of human resources at various levels of health services,\nwith up to 40 percent of health worker posts lying vacant in some States. Most\nprimary health care centres suffer from perennial shortage of doctors and even\ndistrict hospitals are without specialists.<\/p>\n\n\n\n
Without\naddressing the human resource situation, public sector health care will remain\nof poor quality and largely unacceptable, forcing patients to go to the private\nsector. Therefore, it seems as if NHPS is likely to benefit private parties\nmore than government health services. This will ultimately be unsustainable and\nfor even detrimental to the poor for whom the scheme is intended. To maximise\nbenefits, it may be wise to establish a link among various health initiatives\nannounced in the budget and also with related programmes such as the National\nHealth Mission. Clarity is also needed on what services will be provided by\ngovernment health facilities and for which conditions patients will have to use\nprivate parties and what mechanisms are being thought of. There is a need for\nuniform pricing systems for various health interventions, including diagnostics\nand medicines, and making them transparent by displaying them in hospital\npremises.<\/p>\n\n\n\n
Moreover,\na continuum of care system also needs to be established by linking institutions\nor hospitals, with health centres and the community. Community engagement is\nthus crucial in planning and implementation of the programme and in ensuring\nthat the health and wellness centres and the primary health centres are\nresponsive to the needs of the community.<\/p>\n\n\n\n
Finally,\nthe scheme is innovative and path-breaking in the history of public health in\nIndia, which may have a transformative impact if implemented in an effective\nand coordinated manner. The enduring interest and level of discussion in the\nmedia do reflect the wider realisation in the country that only healthy people\ncan build a strong and prosperous nation.<\/p>\n","protected":false},"excerpt":{"rendered":"
\u201cHealth care is the cornerstone of the socialist state. It is the crown jewel of the welfare state\u201d\u2014quoted by Monica Crowley holds true in all aspects. A country\u2019s actual wealth lies in its people. United Nations Development Programme annual report of 2018 states that the basic and fundamental aspect of governance is \u201cstate of health […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/posts\/569"}],"collection":[{"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/comments?post=569"}],"version-history":[{"count":1,"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/posts\/569\/revisions"}],"predecessor-version":[{"id":570,"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/posts\/569\/revisions\/570"}],"wp:attachment":[{"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/media?parent=569"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/categories?post=569"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.competitionreview.in\/blogs\/wp-json\/wp\/v2\/tags?post=569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}