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BW Businessworld

Clear Roadmap Needed

Health care is among the top reasons millions of Indians are below the poverty line. Access to affordable quality health care is a dream for the majority of the rural and urban population.

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By Muralidharan Nair

A few years ago, at a healthcare conference, the keynote speaker — then deputy chairman of Planning Commission — made a remark in response to other speakers’ observations about India’s extremely poor statistics in per capita health spending. He said India probably had a similar record on other parameters such as per capita shoe consumption, or shirt consumption.

The comment was made in a lighter vein, but it summed up decades of government indifference towards public health issues, despite the country’s abysmal performance on crucial health indicators. India’s government health expenditure has been well below that of China, Brazil, Sri Lanka and even Bangladesh.

Health care is among the top reasons millions of Indians are below the poverty line. Access to affordable quality health care is a dream for the majority of the rural and urban population. Yet, the issue has traditionally had little political currency. Without political will, transformation of health care in India will remain a dream.

After 2008, however, things seemed set to change as Rajiv Gandhi Arogyashree — a free health insurance scheme for the poor — introduced by the Andhra Pradesh government, covered almost 80 per cent of the state’s population. It was cited by the then chief minister Y.S. Rajasekhara Reddy as a key reason for his government’s success in overcoming the anti-incumbency factor.

The belief got strengthened when every state going for elections started to announce free health insurance schemes for the poor. The 12th Five-Year Plan increased the allocation for health from less than one per cent in 2012 to 2.5 per cent by 2017.

Subsequent periods saw the announcement of major health schemes by the Central government, including the Rashtriya Swasthya Bima Yojna and National Rural Health Mission. Government health allocations increased from one per cent to 1.2 per cent. There were gaps in implementation, but it was a step in the right direction.
During the 2014 national elections, after many years, overall development was a plank of one of the national parties. A particularly attractive element was health assurance, as opposed to just health insurance. When that party won with a clear majority, it was expected that ‘achche din’ for health care would finally arrive.

But the last 18-20 months have been an anti-climax, to say the least, with a negligible increase in fund allocation and no clear roadmap yet for much-needed transformation of the sector. The agenda for overall development will lose much of its shine without transformative change in social
infrastructure, including health and education.

The development agenda taking root now should be a change in narrative, from “roti, kapda, makaan” to “sadak, sehat, shiksha”. The top five priorities in the sehat agenda should be: (a) To increase government spend on health care to at least 2.5 or 3 per cent in the next five years, with a clear roadmap for universal health coverage by 2022; (b) A focus on preventive health care, including Swachh Bharat, immunisation and basic care; (c) Comprehensive policy on public-private partnerships, which will help create capacities and deliver care; (d) Overhaul of health education and shoring up of human resources; (e) Implementing a regulatory framework as recommended and developing a clear roadmap for integrating traditional medicine with primary care.

The author is senior partner, healthcare practices, at EY India. Views are personal.

(This story was published in BW | Businessworld Issue Dated 28-12-2015)