Solving India's health problems

Given India's need for good affordable healthcare, the Modi government has so far not been able to achieve the lofty reforms it has promised. Budgets came and went with little focus on the health sector, and it was only with the unveiling of the National Health Policy (NHP) 2017 by Union Health Minister JP Nadda earlier this year that one got a sense of what the government wanted to focus on.

Good intentions

Experts say the problem with the NHP is that while its intentions are good, there is some doubt as to how exactly they are to be implemented. The government has promised a string of reforms, some of which include: Meeting the UN target of tackling HIV/AIDS by 2020 which has stated that 90 per cent of all people living with the disease will receive antiretroviral therapy, eliminating tuberculosis by 2025, reducing premature mortality rates for cardiovascular diseases which include cancer, diabetes and chronic respiratory diseases by 25 per cent by 2025.

The other focus of the government is on improving primary healthcare centres and reducing the infant mortality rate. For this, it has promised to increase the current 1.6 per cent of public health spending on GDP to 2.5 per cent by 2025. But critics say there has been no indication of when this will be done by and whether it will be enough to tackle the health issues Indians face.

Patients not on rolls

On the issue of HIV, some experts in the health sector believe the government's target is an unrealistic one. According to a National AIDS Control Organisation (NACO) official, out of an estimated 21 lakh HIV patients in India, only 12 lakh of them are registered on government rolls. "There is a huge gap of 10 lakh patients that the government has no inkling about," the official said requesting anonymity.

Curing TB by 2025

The same issue comes up with the health ministry's goal of eliminating TB. The aim is to eliminate TB by 2025, which means that there should be not more than one case of TB for a population of one lakh.

But let's look at the facts. Currently, TB hits 217 persons per lakh population, and on average has declined at 0.91 per cent per year over the past 24 years. Going by this current average rate of decline, India will eliminate TB in another 183 years by 2197. If India is to really eliminate TB within the next eight years, the rate of decline of cases would have to be a drastic 21 per cent per year.

Dr Lucica Ditiu, Executive Director of Stop TB Partnership, said that the current rate of annual decline of TB cases in the world is 1.5 per cent. India's national decline rate is lagging behind the global rate.

"Even if the declining rates are accelerated by a few percentages, we do not peg elimination of TB from the face of the earth before 2100. While earlier we estimated that global elimination could be achieved by 2080, the date has been pushed further back," Dr Ditiu told DNA.

Problems with maternity schemes

Coming to maternal mortality, the government's prediction, too, seems far from the mark. According to the latest World Health Report 2017 released by the WHO, 174 mothers die in India for every one lakh live births. The NHP 2017 wants the maternal mortality rate (MMR) to come under 100 by 2020.

However, experts say that in order for that to be achieved, government schemes need to be extended to more mothers. Currently, the government extend benefit under the Maternity Benefits Programme (MBP) of Rs 6,000 to only those mothers who are pregnant for the first time, leaving out over an estimated one crore mothers annually who are pregnant for the second time.

It is not as if there are no scheme benefits for mothers who are pregnant for the second time. The Janani Suraksha Yojana, which comes under the NHRM National Health Rural Mission provides maternity cash benefits for mothers with two children, but only at Rs 1,400 per child. "They keep restricting benefits to mothers. One reason could be the lack of funds. But to dilute the extent of entitlement to this extent is shocking," said noted economist Jean Dreze.

Good news on tackling infant mortality

On the issue of infant mortality, there is good news. The Health Ministry launched Mission Indradhanush in 2014 to focus on interventions to rapidly increase full immunisation coverage of children by approximately 5 per cent annually and to expand full immunisation coverage from 65 per cent in 2014 to at least 90 per cent children in the next five years. By this calculation, the immunisation coverage should reach up to 80 per cent by the end of 2017.
"Between 2009 to 2013, the immunisation coverage increased by one per cent per year. However, there has been 6.7 per cent growth in one year, as compared to one year increase in the past," a statement from the Union

Health Ministry stated. The ministry is also targeting immunisation of all children by 2018 and has intensified the programme.

Curbing drug pricing

Coming to the issue of regulating drugs pricing and other medical necessities, the government has had a mixed record. The drug regulatory agency National Pharmaceutical Pricing Authority (NPPA) has been able, over the last three years, to bring down prices of certain items such as cardiac stents and knee implants, crucial for critical patients. Earlier, these items were sold at huge profit margins of over 300 per cent by private hospitals, distributors and importers. Today, it is less than 30 per cent, a commendable feat.

However, the same success cannot be seen in the prices of drugs which still continue to soar. The problem, health experts say, is that the majority of drugs — including those for critical illnesses — have been left out of the price control purview and revision of National List of Essential Medicines (NLEM).

"Even after having close to 750 drugs under the National List of Essential Medicines (NLEM) which means that their prices are capped by the regulator, it still forms only 20 per cent of the chunk of drugs available in the market," said NPPA Chairman Bhupendra Singh.

Strengthening primary healthcare centres

Apart from availability of cheap drugs, strengthening of health services at the bottom of the ladder remains a substantial challenge. The NHP talks about converting 1,50,000 sub-centres into health and wellness centres. Each of these centres will be equipped with a staff of at least four persons, including a bridge doctor who may be an ayurveda, unani, siddha or homeopathy practitioner.

"To train over one lakh doctors to run these sub-centres will be a huge challenge, though the policy looks great on paper," said a senior doctor from the All India Institute of Medical Sciences (AIIMS), requesting anonymity.

The government clearly has good intentions but it faces challenges for which much needs to be done if healthcare in India can be considered on par with other countries. A world study by Lancet has ranked India 154 out of 195 countries in terms of access to healthcare. So far, despite the NHP, healthcare experts say that this ranking doesn't look like it is changing anytime soon.