The incumbent government led by Narendra Modi got a huge mandate for his second consecutive term in the recent Lok Sabha elections 2019. The government does not have any coalition compulsions and can take any complex decisions. The compositions of the Council of Ministers (COM) and the allocations of the portfolio also reflect the focus of the government on talent and good governance. The huge mandate given to the incumbents also creates tremendous expectations. “Health will be a topmost priority of the government”, said Dr. Harsh Vardhan, Union Health Minister in his first official statement. Even Prime Minister Narendra Modi mentioned in his speech that this victory is for those poor people who wait for years to save money and also to seek treatment. Now the poor people are covered under Ayushman Bharat. In fact, now health is going to dominate the discourse of public policy in the country as it is one of the most important components in Human Capital approach. If India has to take advantage of its huge ‘demographic dividend’, it has to bring about structural transformation in the health sector to achieve the goal of “Health for All”.
During the elections, two narratives were going on with respect to achieving the goal of universal healthcare. One narrative was to make the ‘right to healthcare’ as a legal and justiciable right proposed by Indian National Congress (INC) in its manifesto and supported by various civil society organisations. Another narrative was created by the incumbent government to achieve the goal of universal health coverage via the route of insurance schemes like Ayushman Bharat. The winning of the incumbent government led by the Narendra Modi shows that the goal of achieving universal healthcare will be led through the insurance-based model. However, many health experts have criticized the insurance-based model. The argument here is that when the proper infrastructure related to healthcare facilities and personnel will not be available, how can the Auyushman Bharat scheme be able to provide quality services? The role of the private sector in the scheme is also criticized. Providing basic services like health which is indispensable for the survival of poor people should not be left to the private sector.
In the last five years, the Narendra Modi government has launched two important schemes namely Swachh Bharat Mission and National Health Protection Scheme (NHPS) also known as Ayushman Bharat to bring about substantive changes in the health sector. Swachh Bharat Mission (SBM) aims to make India ‘open defecation free’ by 2nd October 2019 which in turn will help in preventive healthcare of the country. The government also launched Ayushman Bharat on Sept 23, 2018, as the world’s largest publicly-funded health insurance scheme as a tool to achieve universal health coverage in the country. It aims to provide a Rs 5-lakh medical insurance cover to 50-crore low-income citizens. Annually, Rs 10,000 crore is the budget estimate of the scheme being touted as the biggest universal medical care program in the world. The scheme also aims to establish 1.5 lakh Health and Wellness centers to upgrade the primary healthcare infrastructure of the country. This scheme is going to solve the problem of out-of-pocket expenditure of the people. In fact, as per one report, 65 % of health expenditure is out of pocket and some 57 million people are sent to poverty every year due to this expenditure This government launched National Health Policy 2017 (NHP 2017) in its tenure. This health policy was launched after 15 years since the last policy launched. NHP 2017 aims at increasing the public health expenditure as 2.5% of the GDP gradually.
Challenges for the New government in achieving Universal Health Coverage:
As health is one of the most important priorities, the government of India has to face many challenges in the coming five years to achieve the goals set in the National Health Policy 2017. Some of the challenges are mentioned below:
- The most important challenge is to change the perception of the health sector. The investment in health sector needs to be seen in a positive manner as it will play an important role in building a healthy population. This healthy population will be contributing to the overall development of the country as a working population in the future. The health expenditure as a percentage of GDP is less than 2%.
- As per the National Family Health Survey-4 2015-16, less than 10% of children receive adequate nutrition in the country. The lack of proper micro and macro nutrients to children is reflected in the high incidences of malnutrition and under nutrition in the country. As per the Global Nutrition Report (GNR) of 2018, India accounts for 23.8% of the global burden of malnourished and 30% of stunted children under 5.
- India has a severe shortage of medical professionals, especially in rural areas. India has only 0.62 doctors per 1000 population as opposed to the World Health Organization (WHO) standard of 1 doctor per 1000 population. 74% of all sanctioned specialist doctor positions are lying vacant in community health centers across the country, including surgeons, gynecologists, physicians and pediatricians as per the Rural Health Statistics 2018.
- There is also a need for institutional and regulatory reforms in the pharmaceutical and medical devices sectors as there is no exclusive ministry governing both the sectors. The pharma sector is partly governed by the Ministry of Chemicals and Fertilisers as well as Ministry of Health and Family Welfare. The Medical Devices are still governed under the Drugs and Cosmetics Act. Though the government has implemented Medical Device Rules 2017, there is still a need to enact a separate law for effective governance of medical devices industries.
- There is also a lot of policy anomalies in terms of promotion of generic drugs, price control policies on drugs and medical devices, issues related to fixed drugs combinations (FDC), shortage of medical professionals and treatment of Ayush doctors with respect to the medical fraternity, etc.
- The second component of Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana) in terms of opening 1.5 lakh Health and Wellness Centres needs to be implemented in letter and spirit. It will give the real boost to primary healthcare infrastructure which needs to be strengthened to make the goal of “Health for All” a reality.
- The government has also kept its momentum in making the country open defecation free to emphasize the role of preventive healthcare in the overall improvement of health indicators.
The challenges mentioned above should guide the policy actions of the government in the health sector. The government got a huge mandate to bring about change in the lives of the people. This term of the government will be very significant as India is at the cusp of change due to the high youth population, technological advancements, and most importantly, the country will be celebrating its 75 year of its existence in the year 2022. Not only this, the Government of India is obligated to achieve Goal 3(Good Health and wellbeing for all at all ages) of the Sustainable Development Goals(SDGs). On the face of it, the government of India has a great window of opportunity to bring about policy changes with respect to the health sector to achieve the goal of “Health for All”.