Tuesday, March 15, 2016

Health care in India: Gasping for breath

Sudhir Raikar, IIFL | Mumbai | March 14, 2016 09:19 IST

A new health protection scheme providing a cover of Rs. 1 lakh per family, with top-up for senior citizens, Prime Minister’s Jan Aushadhi Yojana for providing generic drugs at affordable prices, National Dialysis Services Programme to make dialysis affordable and accessible in the same breath, all these are indeed heartening budget pronouncements. But are they adequate and effective, especially for a country with the highest tuberculosis deaths, maximum still born cases and the lowest per capita health care spending among BRICS countries? Despite India’s adoption of Global Monitoring Framework on non-communicable diseases (NCD), about 60 per cent of deaths in India are NCD cases, with one among every four Indians at a risk.

The conventional symptomatic approach of the government – whether current or previous – of focusing on end-stage ailments, not their root causes - which include diabetes, high BP, hypertension, malnutrition and substance abuse and a host of other fatal triggers – has always proved self defeating beyond a point. We all know the state of primary and community health centers in India, which are invariably short of specialist doctors and devoid of even the most basic facilities at many places. On paper, these centers serve the poor but in practice; the poor are forced to rely on the private setup which is almost always exorbitantly priced.

Notwithstanding the 2016 budget provisions, health care is yet deprived of high-impact spends - whether in terms of infrastructure development, better access to health care services or significant insurance coverage. If pro-poor was the agenda, this sector’s priorities should have been right on top. The idea of sustainability that India pledges allegiance to on every forum is simply not possible without a healthy India – literally healthy we mean.

There’s no concrete plan either to improve the number of specialist medical experts in government hospitals, nor any scheme to improve their infrastructure. Privatizing Health care is fraught with risks in India even if one assumes the legitimacy of government intentions to promote it. As it is, many private hospitals are trying to emulate the hospitality model of BLD packages rather than focus on providing fundamental care. Umpteen hospitals and clinics in India have been reduced to insurance companies profiting from the fear of death and disease which, at best, allow mere scientific possibilities to dictate the patient’s curative and palliative ordeal.

We don’t negate the value of private participation – especially in the areas of telemedicine, digital document management and archival, R & D in biotechnology, integrated manufacturing and product quality control systems – but the government can’t shrug its responsibility, watching the action, or the lack of it, from the sidelines, more content to underline its role as a catalyst, rather than playing it.

‘Make in India’, Skill Development and ‘Start up Stand up India’ have the biggest role to play in improving health care facilities & infrastructure as also stimulate action in key areas including manufacture of active pharma ingredients. The government should provide as many fiscal and tax incentives to build traction in this low-key if not neglected space. Letting bidis remain cheaper is clearly not one of them.