Millennium Post

Decentralising healthcare

The first-ever state-level disease burden and risk factors estimate by the Indian Council for Medical Research, The Public Health Foundation of India, and the Institute of Health Metrics and Evaluations, titled 'India: health of the nation states' estimated that non-communicable diseases today pose a greater risk to the average citizen than it did a few decades ago. The 20th-century Indian had been plagued by communicable diseases such as tuberculosis, HIV and diarrhoea, but now in the 21st century, we have entered a time when the average citizen is more plagued by non-communicable disease such a cardiovascular deficiencies and cancer.

The stark aspect of this report, other than emphasising this shift has highlighted the varied conditions prevailing across different states in India. While Kerala, Goa and Tamil Nadu are the top states where non-communicable diseases dominate, Rajasthan, Uttar Pradesh and Bihar are still dominated by a prevalence of communicable diseases. This has brought to the forefront a wide gap between the progress of the different states across India. While health is essentially a matter which is centrally dealt with, its implementation has largely relied on the states, as has also been evident in this report. It calls out for a decentralisation of health policymaking. This does not indicate that the Centre must wash off its hands, instead, it emphasises the need to tailor-make policies for different states depending upon their current condition.

The report has called out for the need to address the lapses in each state and thereafter identify methods to progress accordingly. Health depends largely on state budgets and the Centre has already called out for an increase in the share towards health policymaking. Now, as the report has highlighted large disparities across states of the country, the issue of health has to be dealt with at the most local level, by engaging with individuals through the lowest rungs of governance.

All major decisions that have so forth been initiated by the Centre have to be dispersed, and the lower power holders have to now play a greater role in bridging the difference evident between different states in the country. A most alarming aspect of this report, aside from the wide disparity has also been the looming presence of child and maternal malnutrition which is contributing to 15 per cent of all of India's disease burdens in 2016. Malnutrition is a global problem that we must quickly tackle as it jeopardises the future of our economy.

The prevalence of malnutrition too varies across states and this heightens the role of state and local governments in bringing about a very methodical change. With growing populations and pollution, health of citizens posits one of the greatest challenges to the government today. Decentralisation is the only way forward where decision making is distributed among levels of governance as implementation can only be thoroughly meted out by the lowest rungs.

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