With Prime Minister Narendra Modi’s tenure entering its ninth year, the impact of his government’s health policies has come under scrutiny, particularly analyzing its response to the pandemic that has swept the globe. Covid has exposed many weaknesses in healthcare systems around the world, from the production of critical vaccines to shortages of medical personnel, facilities and equipment. India discovered several areas that needed attention, but also a lot to celebrate. Although India has only been independent for 75 years, it has managed to build an important infrastructure meant to take care of its citizens, which has quickly adapted to meet the demand for manufacturing and production in the face of the global health crisis. During the nine years of the Modi government, several changes were made in the health sector that made this possible. Here are some of the highlights:
Ayushman Bharat: One of the significant health initiatives of the Modi government is the Ayushman Bharat programme, which aims to provide health coverage to over 500 million people belonging to the economically weakest sections of society. The scheme provides cashless health insurance coverage up to Rs 5 lakh per household per year for secondary and tertiary care hospitalization and prescriptions after a hospital stay of up to one year. As a result, India has made significant progress in providing coverage for what could otherwise be catastrophic healthcare costs. But now the focus needs to shift to coverage of annual physical exams and prescription drugs for the management of chronic conditions like diabetes and heart disease to prevent those hospitalizations while maximizing the health of Indians, regardless of income status.
Digital Health Mission: The Government launched the National Digital Health Mission (NDHM) in August 2020, which aims to create a digital health ecosystem that will provide universal health coverage, including access to medical records and other health services for all the citizens. Millions of people have switched to telehealth consultations during Covid-19, allowing them to receive treatment without high travel costs while minimizing the spread of the disease.
Infrastructure Development: The government has invested significantly in improving the health infrastructure, including building new medical faculties, upgrading existing health facilities, and expanding the number of hospital beds. Many of these programs have been successful, largely because India has established 302 new medical colleges in the past nine years, surpassing countries around the world. Today, India can boast a growth of more than 78% in the number of medical schools, opening the door to training more doctors and medical staff, thus meeting an ever growing need for these professionals globally. While more medical professionals are needed, India is increasing the educational opportunities available. The next stage in its development is to maintain the highest standards within each new medical school as it comes online. Also, one recommendation will be to mandate NABH accreditation for all medical colleges and hospitals, including government hospitals.
Response to Covid-19: The government has taken several measures to fight the pandemic, including the creation of Covid-19 hospitals and increasing the number of testing facilities. They have also ramped up vaccine production and have been able to vaccinate almost the entire population, a feat achieved by few other countries.
Despite these initiatives, several challenges still need to be addressed in the healthcare sector. Here are just a few suggestions to continue building on the progress you’ve already made:
ONE INDIA, ONE HEALTHCARE
Healthcare delivery in India is decentralized and varies from state to state as it is currently a state entity. Various factors such as low education levels, lack of environmental sanitation and safe drinking water, malnutrition, poor housing conditions, tobacco use, poverty, unemployment, unhealthy lifestyle, etc., affect health.
The allocation of funds to the health sector depends, among other things, on the overall availability of government resources, competing sectoral priorities and the absorptive capacity of systems. With the advancement of technology, telehealth and labor migration leading to interstate commerce, it could be argued that it is time for a constitutional amendment to ensure access to basic health care for every citizen as a fundamental right and transform the health care in a central subject. The Covid-19 pandemic has also shown us that state borders are irrelevant when it comes to disease prevention and health care delivery. It’s time for One India, One Healthcare.
PUBLIC HEALTH EMPLOYEES
Government hospitals are run by doctors who are promoted based on their seniority rather than their training in hospital management, while professional hospital managers run private hospitals. Running a public health system for the world’s largest population takes work, even for the best physician with decades of patient care experience.
The Indian civil services select and train senior bureaucrats who lead the Indian government. India currently has several MBBS trained IAS and IFS officers. I propose that the Government of India create a branch of the Indian Health Service (IHS). India will need 742 IHS officers, one per district, who are ranked on a par with IAS officers to coordinate the district’s public health system. By creating a civil service branch to manage the health centers and increasing the medical and nursing institutions to one per district, a large manpower could be made available to staff these facilities adequately.
Work could also be mandated in rural areas, enabling communities and villages to receive quality care. For example, part of a medical education might include a year or more of service in a rural village working in a primary care centre. Other options include incentives to reduce educational costs in exchange for time spent in a primary health center.
FOCUS ON PRIMARY AND PREVENTIVE HEALTHCARE
While the Ayushman Bharat program focuses on secondary and tertiary healthcare, more emphasis should be given in the future on fraud prevention using the DRG payment system and covering primary healthcare including chronic disease management and life health. community. With all its advances, India continues to struggle with the rapidly growing burden of chronic diseases and the demands on its healthcare system. Chronic conditions like diabetes only get worse, resulting in complications and hospitalizations without proper and consistent treatment.
How can these problems be addressed? First, by mandating annual wellness exams and prioritizing primary and preventive care for all citizens. Identifying and managing chronic diseases early is more effective and less costly than managing and treating their complications. Like countries around the world, India faces geographic variations in the quality of healthcare services and providers, reflecting the need for consistent processes and standards across the country.
Second, in determining the best path forward, the process of health care delivery must be enhanced by differences in the funding and availability of health care options within each state. To move towards a universal healthcare system, India must be willing to move away from the current state model which does not uniformly cater to the needs of all Indian citizens. Instead, we must embrace One India, One Healthcare for all citizens. Public-private partnerships in primary health care delivery should be encouraged.
With a long history of meeting challenges, India can continue to lead the world in addressing health problems for all, especially by increasing the value of primary care, annual physical exams and continued investment in environmental policies which can have a positive impact on all Indians. With the largest population in the world, India could lead the world in providing quality healthcare to all its citizens.
The world’s largest democracy needs urgent investment in the health of all its citizens and reform of the public health system while maintaining the current growth rate of infrastructure.
Prof. (Dr.) Joseph M. Chalil is Adjunct Professor and Chair of the Complex Health Systems Advisory Board in the School of Business at Nova Southeastern University, Chief Medical Officer at Novo Integrated Sciences, Inc, and Chief Strategy Officer of the American Association of Physicians of Indian Origin (AAPI). He recently published a best-selling book, Beyond the Covid-19 Pandemic: Envisioning a Better World by Transforming the Future of Healthcare.
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