A much-needed upgrade

Health infrastructure, especially in rural areas, is going to be one of the most challenging tasks ahead for the new government. In its last tenure, it brought the Ayushman Bharat scheme, the government-run health insurance programme which was seen as a major health policy intervention. However, according to experts, the scheme was unable to solve the larger crisis in the health sector.

There is an urgent need to invest in building healthcare infrastructure, especially in the periphery, says Joyti Ghosh, a professor in Jawaharlal Nehru University's (JNU) Centre for Economic Studies and Planning. "The much-celebrated insurance scheme has only filled the pockets of the insurance companies but has neither improved health infrastructure nor helped the people," she added.

Ghosh stressed that the new government must increase its public health spending up to at least three per cent of the gross domestic product (GDP). Currently, India's GDP for health is less than 1.5 per cent. With almost all neighbouring countries investing 2-3 per cent of GDP, the country has one of the lowest in the world.

Another area to be looked into is the escalating prices of essential medicines. A Parliamentary standing committee report on drug pricing, submitted in February 2019 noted that the government has actually failed to check the rising cost.

"The government has allowed the firms to set the prices as per the market-based system rather than what they accrue as costs of production. However, while pharma firms are making a lot of profits, the common man is suffering. The government must without delay ask the firms to go back to cost-of-production pricing system," Jan Swasthya Abhiyan's Amitava Guha said.

Ghosh pointed out that the practice of granting secondary patents has added to the cost. The new health minister should completely stop it and make the patents' office more transparent, she noted.

Further, the government needs to tackle the acute shortage of manpower in the health sector and triple it, Ghosh suggested. According to a study published by Indian Journal of Public Health in 2017, India would need more than 20 lakh doctors by 2030. But, the sub-centres and Primary Health Centre (PHCs) are short by more than 10,000 Auxiliary nurse midwife (ANMs) and 99,000 male health workers, reveals the Rural Health Statistics 2017.

"Any new government must see to it that ASHA workers get a fixed remuneration rather than incentives based on paltry services. They are the backbone of our rural healthcare and we depend on them heavily for improving our health indicators, however, we don't treat them the way they should be treated," Ghosh said.

Experts also stated that the ultimate goal of the new government should be to achieve Universal Healthcare Coverage (UHC). For this, they need to cut down the out of pocket expenditure of hospitals as well as of outpatient departments (OPD).

According to the recent study by Harvard TH Chan School of Public Health, more than 100 constituencies of the country spend more than Rs 763 on ODP in catering to OPD services and another more than 100 spend Rs 559-Rs 763 for the same. OPD services are not part of Ayushman Bharat Scheme.

More capital should be invested in providing cheap drugs and diagnostics services to people, they suggested.

(The views expressed are strictly personal)