When the results of the Lok Sabha polls are announced on May 23rd, the ramifications will be immense and felt across every stratum of Indian society. No matter the victor, the aftermath will determine the future direction of the world’s largest democracy. With this in mind, Health Issues India calls on the incoming government to listen to the experts on health.
When we convened an expert panel in New Delhi amidst the elections, it was with the objective of making healthcare part of the political discourse. With both the BJP and the Indian National Congress incorporating pledges on healthcare into their manifestos, we wanted to draw attention to these proposals; to the track record of the incumbent government on healthcare issues; and to lay a roadmap for making a “Healthy India” a reality.
A chorus for a holistic health ministry
The experts called for a holistic health ministry for healthcare continuum. Expressing the need for a single platform for all health departments in the Union Ministry of Health and Family Welfare, panellists stated that such an approach would pave the way for fewer bureaucratic hurdles in the path of health policy reforms.
Speaking at the ‘Health For Polls’ conference, health experts brainstormed solutions to make healthcare in India more affordable, accessible and of higher quality. Titled ‘How to make Health for All a reality in India’, a diverse panel deliberated upon the significance of health in terms of the role it should play in the national rhetoric surrounding this year’s Lok Sabha polls and what is holding back India from realising its full potential as a healthy nation.
The panel included Aman Gupta, Managing Partner at Strategic Partners Asia Group (SPAG); Dr CM Bhagat, Vice President of the Association of Healthcare Providers, Delhi Chapter; Kannan Krishnaswamy, Advocacy Manager at the George Institute of Public Health; Mark Chataway, founder of Health Issues India; ; Meenakshi Datta Ghosh, Former Special Secretary in the Ministry of Health; Dr Sai Subhasree Raghavan, President of Solidarity and Action Against the HIV Infection in India (SAATHII); Dr Shagun Sabarwal, Associate Director (Policy & Training) at J-Pal South Asia; and Vibhav Garg, Vice President of Health Policy and Government Affairs at GE Healthcare.
Chataway opened the conference by elaborating on the significance of health communication and its pertinence in the Indian context. He shared his experience of working in India in the 1990s and stated, “health is not a minor issue in Indian politics and there are points for which sufficient political motivation develops and it becomes a national concern. Something that happened in the case of polio and AIDS.”
Restructuring the health ministry may be a solution for easing accessibility and better governance
In her keynote address, Ghosh highlighted the state of affairs in the public health sector and emphasized on how for the first time health has prominently featured in the political manifestos of the two main national parties: the governing BJP and the Indian National Congress. The launch of the Ayushman Bharat and Swachh Bharat Abhiyaan initiatives under the current BJP government had a big role to play in bringing the conversation on health to the centre stage in the current political discourse.
Ghosh feels restructuring the health ministry may be a solution for easing accessibility and better governance. “Recast the Ministry of Health to include nutrition and pharmaceuticals and all related projects under its remit,” she said. “This has never been comprehensively attempted. For example, even today, some maternity benefit schemes are run by the Department of Women and Child Development, and any attempt at rationalisation leads to a huge battle for turf.”
Dr Subhashree elaborated, “there is no option between either or, we have to create a uniform pathway for healthcare delivery.” Answering a question on public-private partnership in healthcare, she added, “A big hurdle that is deterring the government, either Congress or BJP, from engaging with the private sector for strategic purchase is the lack of stewardship.”
The basic rules need to be changed
Garg also shared a similar view of putting all the healthcare departments in one basket: “one ministry that brings together all the components of healthcare together can be a real puzzle solver.”
Dr Bhagat deliberated upon the reasoning behind the lack of health staff in the country and underpinned bureaucratic deficiencies in medical college as the main cause. “It is time to de-license the medical faculty members and bring in guest lecturers. The basic rules need to be changed and the paramedical staff needs to be empowered to deliver results.”
Krishnaswamy emphasized that “[an] evidence-based system should be promoted and made a prominent part of the dialogue on healthcare for informed policymaking. People need to be made aware of their healthcare requirements so that they can seek their rights from the policymakers.”
Ayushman Bharat: Dilution and largesse
Ayushman Bharat came under severe criticism by the panellists, who felt that the “launch of the government’s health insurance scheme has diluted the primary healthcare sector and is seen to provide insurance without adequate support structure on the supply side. Since the scheme is not accompanied by any significant public expenditure for modernising public health infrastructure the requirement to meet the additional demand will be restricted to the private sector and would end up escalating cost.” Meenakshi Ghosh asked, “should the largesse being allocated to Ayushman Bharat be invested into infrastructure, modernising every single district hospital?”
Shagun Sabarwal focussed on the importance of preventive healthcare, stating “it is important to incentivise on behavioural economics so that people can offset present bias. The present bias refers to things that will give us results immediately rather than invest in long-term benefits.” She adds, “to increase accessibility door-to-door immunisation, school programmes as a vehicle to reach more people.”
Sustainable solutions to make health for all a reality
Aman Gupta concluded the discussion with remarks on how to change the discourse in common man’s favour, “politicians like to be seen doing things and that is what adds to their political mileage, so an announcement of a hospital is good politics compared to announcement of a preventive health scheme. So it is important to flip the healthcare messaging. Instead of government identifying the needs, we need to make start people demand their healthcare needs. Instead of a short-term plugging, focus on long-term goals.”
The panel concluded that a holistic ministry can streamline the health delivery system and find sustainable solutions to make health for all a reality in India. Preventive healthcare is the underpinning of primary healthcare so has Ayushman Bharat failed to be the healthcare solution India was awaiting? Has the time come for reverse innovation for sustainable answers for impending reforms in the sector? These questions must be asked and answered. Health matters to voters and the Government at every level – central, state, district, and municipal – should not let them down but work towards achieving important healthcare objectives to better guarantee the development, wellness, and security of the nation.