Health Sector: An Analysis

With the launch of Ayushman Bharat in India, a critical analysis of India’s health sector becomes imperative.

About:
• On 25th September, the birth anniversary of Pandit Deendayal Upadhyay, Ayushman Bharat – Pradhan Mantri Jan Arogya Abhiyan (PMJAY) became operational.
• AYUSHMAN BHARAT: It comprises of two schemes:
• National Health Protection Scheme: This aims to provide assurance cover to 10 crore families upto Rs 5 Lakh crore cover per year.
• Health and Wellness Centre: It aims to overhaul 1.5 lakh primary health centres in India.
• The scheme will be completely paperless, cashless and portable.

What is Health?

• Health is a state of complete physical, mental and social well-being and not merely an absence of disease.

• The determinant factors of good health are accessibility to health services and healthy lifestyle choices along with good family and social relationship.

Challenges Faced by Indian Health Sector:
• Low Public Health Expenditure as % of GDP:
• According to National Health Profile, 2018 government spends only 1.3% of its GDP for public healthcare, it remains way below global average of 6 per cent.
• It results not only into poor healthcare infrastructure in rural India but also into severe scarcity of doctors, and low health insurance penetration.

Status of Health Sector in India
• Total industry size: Around $160 billion in 2018 and expected to cross $372 billion by 2022.
• Employment Generation: Expected to generate 40 million jobs in India by 2030. 1 lac jobs are expected to be created from Ayushman Bharat,
• Primary Health Centres (PHCs): As of September 14, 2018, number of PHCs increased to 32,899 and number of sub-centres reached to 167,809.

• Private sector accounts for 74 per cent of the country’s total healthcare expenditure, whereas Public sector: 28% in rural areas; 21% in urban.

Continuously Improving Health Indicators:
Life Expectancy: Average lifespan went up from 48 in 1980 to 67.9 in 2014.
• MMR: From a MMR of 556 in 1990, the nation has achieved a MMR of 130 by 2014-16.
• IMR: The infant mortality rate at the national level stands at its lowest i.e. 34 per 1,000 live births in 2018.
• Institutional Delivery: As per NFHS-4, nearly 79% of women are now giving birth in hospitals, both public and private.
• Immunisation: Around 75% of children below 12 months of age were fully immunized by 2016 end.
• Intensified Mission Indradhanush (IMI) Program aims to achieve 90% immunisation coverage by Dec, 2018.
• DALY rate: The per person disease burden, measured as disability-adjusted life year (DALY) rate, dropped by 36% from 1990 to 2016.

Various Stats that Still Pose Significant Challenge:
• Out-of-pocket (OOP) Medical Expenses: 62% of all healthcare costs in India, whereas it is 11% in U.S., 32% in China and world average remains around 18.2%.
• Insurance Coverage: 27% Indians as per National Health Profile 2018.
• Total expenditure: India’s total expenditure, public and private, is around 4.7% of GDP, much below world average of around 10%.
• Rural–Urban Divide: 75% of all doctors are in urban areas which accounts for only 31% of India’s population.
• Poor Doctor-Patient Ratio: One allopathic government doctor in India, on an average, attends to a population of 11,082, whereas WHO recommends ratio of 1:1,000.

Lack of Health Infrastructure:
• Rural-Urban Divide: Concentration of doctors, secondary and tertiary facilities in Urban areas weakens the cause of Universal Health Coverage

• Doctor-Patient Ratio: It remains abysmally low, about one-tenth of what recommended by WHO.

• Primary Health Centres (PHCs): PHCs remain very scarce in number in catering the needs to 1.3 billion strong Indian populations.
• Secondary and Tertiary Sector facilities are mainly located in Urban areas.

• Inadequate Implementation of NHP:
• Poor Monitoring and Implementation: Accountability failures along with absence of mechanisms to ensure fool proof implementation of schemes free from quacks, intermediaries etc.
• It also happened due to lack of empathy and sense of responsibility among healthcare professionals.

• Weak Regulatory Mechanism:
• Recently, Medical Council of India (MCI) was dissolved as the institution was marred by corrupt practices such as non-transparent and biased inspection for medical college approval leading to poor quality standards in Indian Medical colleges.
• Earlier the Supreme Court appointed an oversight committee to supervise the functioning of MCI. This committee abruptly resigned stating the MCI was non-compliant and non-cooperative with the committee.

• The National Medical Commission Bill, which would have replaced the Indian Medical Council Act, 1956, is also pending in the parliament.

• Healthcare in Tribal Areas:
• Tribal and backward regions remain at the bottom ladder of India’s Human Development Index (HDI) health indicator.
• Interregional disparity, unspent budgetary allocation, negligence of duty by official and low level of people literacy place them at lowest rung of the ladder.

• Poor Health Insurance Penetration:
• Only 27% of Indians have been given insurance cover even after flagship RSBY.
• Earlier, Rashtriya Swasthya Bima Yojana (2007) failed to achieve its desired objective of meeting health insurance needs of poor due to following reasons:
• High transaction costs due to insurance intermediaries,

• Low coverage for primary health resulting into high out-of-pocket expenditure.

• Non-targeted approach: Not designed as per state specific disease profile resulting into lack of outcome-oriented approach.

Initiatives Taken:
• National Health Policy (NHP), 2017:
•It aims at providing healthcare in an “assured manner” to all.
•Its proper implementation in consonance with Ayushman Bharat – National Health Protection Scheme, and National Nutrition Mission in letter and spirit will completely overhaul the Indian Healthcare scenario.
• National Nutrition Mission (NNM):
• Targets: NNM targets to reduce stunting, under-nutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
• Mission 25 by 2022: NNM would strive to achieve reduction in Stunting from 38.4% (NFHS-4) to 25% by 2022 which is referred to as Mission 25.
• Greater convergence: Under NNM, many central ministries will work together in an outcome-oriented manner.
• Other features: ICT based real-time monitoring system, incentives to states and UTs on meeting their targets, social audits, setting nutrition resource centres, use of IT based tools by Anganwadi Workers (AWWs).
• National Nutrition Strategy: It is launched to address the issue of malnutrition in India.

• Pradhan Mantri Swathya Suraksha Yojana (PMSSY):
• This scheme has been extended by two years till 2020.
• Under PMSSY, 20 AIIMS in the country, six have already been established, and would upgrade 73 medical colleges. This is a historic decision,” said the Union Law and Information Technology Minister.

• Pradhan Mantri Bhartiya Jan Aushadhi PariYojana Kendra (PMBJAK).
• It is a campaign launched by the Department of Pharmaceuticals, Govt. of India.
• It aims to provide generic medicines, of equivalent efficacy as the original drugs, at affordable prices to the masses through special centers known as PMBJAK.

Way Ahead:
• World Economic Forum estimated that India stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions. Hence, timely actions are needed.
• Behavioral Change: On the lines of “Hum Fit toh India Fit” by promoting healthy dietary practices, physical activity, prevention of smoking, alcohol and pollution.
• Improved Health Infrastructure: Increase public health expenditure, Better monitoring of schemes and targeting of patients etc.

• From Sports Loving Nation to a Sports Playing Nation: As Sachin Tendulkar pointed out in his Rajya Sabha Speech, India must transform itself from a sports loving nation to a sports playing nation to keep everyone healthy.

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