Electing India’s health transformation

As the heat and dust of campaigning ends with the election of a new Lok Sabha, followed by the hustle and bustle of government formation, India’s development agenda impatiently awaits for deliberative attention and decisive action.

Will the new government, whatever its composition, place health on its priority list? If so, what actions should it undertake to transform the health system to achieve higher levels of access, affordability, quality, effectiveness and equity?

If the intent is to win popular praise while undertaking transformational reforms, a mix of initiatives will emerge. Some actions will be chosen for early impact and high visibility. Others will be system-strengthening efforts that will be less visible to the public eye but will have an evolving impact of enduring benefit. The following is a suggested menu.

• Progressively increase public financing for health, starting with a 25 per cent increase in the first budget, compared to the previous budget. The budgetary allocation should double by 2024. 

• Allocate 70 per cent of the public financing to primary healthcare. 

• While strengthening the rural primary healthcare services, scale up and launch the long-delayed urban primary healthcare component of the National Health Mission with full vigour. 

• Develop the capacity for delivering Comprehensive Primary Health Care, covering a wide range of health services for common health conditions, through technology enabled frontline non-physician healthcare providers (community health workers, midwives, nurses and nurse practitioners, community health assistants or physician assistants). 

• Create supportive work and social environments, supplemented by attractive financial and non-financial career progression incentives, to improve recruitment and retention of medical doctors and dentists in primary care. 

• Properly position doctors trained in Indian systems of medicine (AYUSH) in primary care, with support for practicing the methods of care they were trained in. 

• Ensure free provision of all drugs in the national list of essential medicines, as well as essential diagnostic services, in all public healthcare facilities. 

• Merge all government-funded health insurance/assurance programmes in to a single payer system that can fund pre-paid, cash-free services through an evolving Universal Health Coverage programme. 

• Create seamless bidirectional referral and follow-up linkages between primary and advanced care facilities, alongside dependable emergency health services. 

• Strengthen district hospitals and link them to existing and new medical and nursing colleges. Make the upgraded district hospitals training centres for undergraduate and postgraduate training of doctors, nurses, midwives, community health assistants and other allied health professionals. 

• Establish 10 institutions of Allied Health Professional Training, to train a large number of young persons, especially women, in a wide range of paramedical/technical/counselling courses to meet health system needs and generate large scale employment in public and private healthcare sectors. 

• Allocate Central funding to support the creation of public health cadres, in each state and at Central level, for effective implementation of National Health Programmes. 

• Redesign the National Medical Commission Bill into a broader National Commission for Health Professional Education Bill, in consultation with the states, and advance it through both houses of Parliament to bring much needed reforms to the multiple streams of health professional education while creating platforms for inter-professional education. 

• Fund a National Mission for Affordable Health Technologies, with special stimulus for technologies that can transform primary care. 

• Improve technologically-upgraded health information systems for real time representative data collection to enable rapid health system response, monitoring and evaluation. 

• Create a multi-sectoral coordination platform for concerted action on the social, environmental and commercial determinants of health and nutrition, with augmented capacity for health impact evaluation of policies and programmes in other sectors which impact on health. 

• Strengthen regulatory systems for pharmaceutical products, medical devices, clinical establishments, food safety, tobacco control, alcohol sale and consumption as well as pollution control, through better enforcement and new laws as needed. 

• Promote population health literacy through mass media, health system and civil society partnerships. 

• Enhance community engagement in priority setting, programme design, delivery and evaluation by establishing Citizen Health Councils at block, district and state levels for monthly, quarterly and six-monthly consultations respectively, with the government agencies, and hold an Annual National Health Assembly to stream multi-stakeholder perspectives into collective societal action to advance the health agenda.

This is a wide canvas of action that integrates many of the essential components of health system transformation. It also calls for concerted action by the Central and state governments.

To ensure this, the new government must convene a meeting of Central and state health ministers soon this year and then annually, to build consensus across the political spectrum and accelerate action on an agreed agenda.

Not an easy task, but essential if we have to achieve the Sustainable Development Goals. Such collective commitment will be the true proof that our political leadership has matured, as they move beyond electoral battles to nation building.

*The author is the President, Public Health Foundation of India (PHFI). The views expressed are personal.