2019: The Year to Ensure Better Health Initiativesby Opinion Express January 2, 2019 0 comments
Last year was eventful for public health in India as the government followed up on some of its key decisions announced before. Ayushman Bharat was launched to implement select recommendations made in the National Health Policy (2017). The Mental Healthcare Act, 2017, was implemented while the Insurance Regulatory Development Authority (IRDA) mandated that mental health problems would henceforth be a part of insurance schemes. Several new health-related decisions were also taken — a series of approvals by the Union Cabinet, new bills for consideration by Parliament and setting up new medical colleges in various States. However, there is always a time lag between an idea translating into policy and programme. The initial discussion on health and wellness centres had started in 2013. The precursor of the Pradhan Mantri Jan Arogya Yojana (PMJAY) was the National Health Protection Mission, which was originally announced in 2016. Ayushman Bharat itself took off from the earlier discussion on National Health Assurance Mission of 2014 among others. The country has already suffered because of a laid-back attitude followed by a slow-paced implementation. Building upon what started in 2018, here is a wishlist for 2019.
Build on Ayushman Bharat programme: Ayushman Bharat, which was announced on February 1, 2018, was inarguably a major public health programme of the Union Government after the National Rural Health Mission (NRHM) in 2005. The Ayushman Bharat programme, with two components of health and wellness centres (for strengthening primary healthcare) and Pradhan Mantri Jan Arogya Yojana (for secondary and tertiary level hospitalisation) were credited for placing health higher on the political agenda. Yet, public health experts and journals alike continued to make the mistake of equating Ayushman Bharat with PMJAY, often forgetting that the health and wellness centre component is foundational for the success of PMJAY as well. It was not without reason that health and wellness centres as envisaged in Ayushman Bharat were launched on April 14 last year at Bijapur, Chhattisgarh, months before PMJAY was launched on September 23, 2018 at Ranchi, Jharkhand.
Much of 2018 was spent on planning for scaling up the healthcare scheme, so this year should be utilised for an accelerated implementation. More attention should be paid to getting more health and wellness centres going through state-specific innovations and increased utilisation of a range of service packages under PMJAY, especially in greenfield states, with efficient mechanisms for fraud detection. It will serve well if a detailed roadmap and execution plan for Ayushman Bharat is developed with proper funding, approved and placed in public domain, which will enhance its accountability at various levels.
States showing leadership in better health regimes: Towards the end of the year, the Uttarakhand government launched the breakthrough Atal Ayushman Uttarakhand Yojana, which covers 100 per cent of the State’s population compared to the proposed 40 per cent in Ayushman Bharat-PMJAY. Health is a State subject in our country and the success of any initiative by the Centre is largely dependent upon the additional inputs by the States. This year, we expect Karnataka, Meghalaya and Punjab to also take the lead and announce similar total population coverage under PMJAY. Besides this, it would be reasonable to expect that the newly-elected Government at the Centre in May extends the coverage with AB-PMJAY from the existing 40 per cent families to an additional 20 per cent of families. It should also announce a roadmap to cover 80 per cent or more population by 2022.
Basti dawakhanas in Hyderabad: The Greater Hyderabad Municipal Corporation (GHMC), in collaboration with the Telangana Government, launched 17 basti dawakhanas (or slum health clinics) in Hyderabad in April 2018. These facilities in the State are inspired by the mohalla clinics of Delhi and comprise the first urban local body-led community clinic initiatives in the country. Though they are not much in the limelight because of the distance from Delhi, initial reports suggest that basti dawakhanas are equally popular. The outcome of these two initiatives can change the way States and urban local bodies plan primary health services and prompt more States to take such initiatives to strengthen primary healthcare.
Reforms in medical education: The decision for revision in MBBS curriculum, with inclusion of courses on attitude, ethics and communication, was undertaken last year. The revised curriculum, the first after 21 years, will be implemented from the 2019-20 academic year. This comes at a time when issues of unethical practices in medicine and violence against doctors are gaining ground, a phenomenon documented in the book, Healers or Predators?: Healthcare Corruption in India, written by Samiran Nundy, Keshav Desiraju and Sanjay Nagral. The other pending reform concerns the Medical Council of India through the National Medical Commission Bill, which is still awaiting discussion in Parliament. In 2019, there is a need for consensus among political parties to reform healthcare education and delivery systems to root out corruption.
Tackling air pollution to make air breathable: In India, air pollution is a major risk factor for both acute and chronic respiratory diseases. It is documented as a key aggravator in a 2017 study on the state-level burden of diseases in the country. However, for the third year in a row, air quality has grabbed national and global headlines. The air quality index continues to be a cause of serious concern.
Air pollution is not limited to Delhi or north India but cities across the country have poor air quality with around 70 cities breathing bad as India undergoes a huge infrastructure overhaul. It has been estimated that if air quality standards meet global standards, people in India would live 1.7 to 3.0 years longer. The National Clean Air Programme (NCAP) was launched in India in April 2018, with a plan to reduce air pollution in 100 identified cities. It is now proven that efforts on improving air quality will be a high return investment in the form of better health, higher worker productivity and increased life expectancy. So this year, there is a need for developing multi-sectoral interventions, led by Prime Minister Narendra Modi and Chief Ministers of various States, for clean air. After October 2019, the phase II of ‘Swachh Bharat Mission’ can very well be focussed on ‘Clean air for all.’
Opportunities ahead: The year ahead is an opportunity for India to show global leadership in health. In September, the United Nations General Assembly (UNGA) will hold its 74th session on universal health coverage (UHC). Also, the World Health Organisation’s (WHO) annual World Health Day 2019 theme is around UHC with a focus on primary healthcare. These are additional opportunities for the country to assume a leadership role in advancing UHC, accelerate implementation of ongoing initiatives and work upon strengthening the healthcare system, by providing attention on all aspects.
The momentum generated in the last two years, the high political and public visibility of Ayushman Bharat and the competition among States to better their healthcare records are positive peaks in the graph. For long, healthcare and education have been on the lower spectrum of allocations of the GDP. Hope we look at these crucial asset sectors and push up our development indices.
(The writer is a leading public health expert based in New Delhi)
Writer: Chandrakant Lahariya
Courtesy: The Pioneer