Ministry performance gets mixed review from public health experts

Some laudable programmes, some frustratingly poor implementation, a whole lot of wait and watch; heath as a sector under two years of the NDA government is a mixed bag for public health experts.

This government has done two years of stock-taking; major changes are waiting in the wings, Dr K Srinath Reddy, president Public Health Foundation of India, told dna. "Mission Indradhanush and the Kayakalp scheme are good programmes, but address only segments. There is no holistic solution for problems in the health sector yet."

Earlier this week, the Union health ministry released an ebook of its accomplishments. It echoed much of what health minister JP Nadda said, on May 28, the anniversary of the NDA government. Then, he mirrored the confidence displayed by the entire Centre, in talking about his ministry's performance in public health programmes and policies.

On both occasions, great care was taken to display the most visible feathers in his cap, such as Mission Indradhanush, the special vaccination programme to jump up the numbers of routine immunisation, to cover the 90 lakh children who, annually, get no or partial immunisation. Nadda pronounced India on track, "strategically" and "comfortably" for the Sustainable Development Goals, in terms of the country's Maternal and Infant Mortality Rates, and the Total Fertility Rates. He accepted criticisms about the poor patient doctor ratio, but lay stress on building up the primary and secondary health infrastructure along with the states. This, the book repeats in a section on the National Health Mission, stating 8205 "health human resources" had been added under NHM.

The most important question, Dr. Reddy said, was how this government would frame Universal Health Coverage, its resources, and portability for people who move across states at different point in their lives. "We hear of consultations, plans for changes happening in the PMO. The planning process to achieve the SDGs will be for 15 years with 3 yearly reviews. Before we know these changes, it's too early to say what this government has done for health," he said.

The ministry has made much of increasing the budget. However, even the recent parliamentary report criticised the government for not giving nearly enough money to health. "They've done good work, such as the AMRIT stores that distribute affordable cancer drugs. But the amount of funds allocated to health in the budget is disappointing," said Leena Menghaney, a lawyer who works in public health. Dr. Reddy explained it thus, "A classical economist's view will be to better the absorption and use of current allocated funds by the central and state health ministries. But public health suffers from poor resources." Calling the budget a "disappointment", he said the government needs to spend on and strengthen infrastructure, then see its performance, and reprioritise spending on primary health care. He pointed out the that very crucial National Health Mission (which Nadda spoke about in his interview as having paid special attention to maternal and child care) was not adequately supported.

The minister however, often espouses the former argument, saying that current funds need to be spent better before more are granted. He also spoke about how India has seen tuberculosis and HIV numbers arrested and in decline. Here, Menghaney throws a note of caution, "the numbers are in decline because of over a decade's work with affected communities. However, in the past two years, there have been unprecedented stock-outs of drugs, testing kits and condoms for these communities with no mechanism to report this. No government has checked this."

Menghaney added, "Public health results show after decades of work. No one government can claim results.