There should be a 20 per cent increase in funding for health by States, the Centre and Urban Local Bodies. Inter-departmental coordination is also needed for stronger implementation linkage between health, water and sanitation and nutrition-related initiatives

Legislations or related deliberations were arguably the highlight for India’s health sector in 2019. The Prohibition of Electronic Cigarettes Act, 2019; the National Medical Commission (NMC) Act and the Motor Vehicle (Amendment) Act were passed by the Parliament. The Surrogacy (Regulation) Bill is being considered by the select committee of the Rajya Sabha and a draft Bill to protect doctors and health care providers from assault is also under consideration.

The health sub-committee of the Fifteenth Finance Commission made recommendations to enact the right to health in India by 2022 and to shift “health” into the concurrent list.

A few States, namely Rajasthan, Madhya Pradesh and Chhattisgarh, deliberated about enacting the right to health legislation. During the year, public health experts argued that the Ayushman Bharat Yojana, announced in 2018, had put health higher on the political agenda and nearly six States started a variant of Mohalla Clinics (neighbourhood clinics) to increase the provision of free primary health care services.

There were a few negative developments as well. Violent attacks on doctors, health care providers and facilities were reported from different parts of the country, followed by protests and strikes by the medical fraternity.

In the summer of 2019, encephalitis deaths were reported from Muzaffarpur in Bihar. The experts were once again divided on the cause of this and consequently, the children of the nation are still waiting for scientific and long-term solutions to prevent such tragedies from recurring.

In the last quarter, poor air quality returned to affect the health of the people in many districts of north India and all policymakers did was to question the proven evidence on the impact of air pollution on people. Hence, it is clear that there are many issues that need to be addressed in this crucial sector.

Legislative approach in health works: The Motor Vehicle (Amendment) Act, which has hiked the penalties for traffic violations, has the potential to improve health, as nearly one in every 10 preventable deaths occurred due to road accidents. After the Mental Healthcare Act of 2017, mental health services in India received a boost at the implementation level as the Insurance Regulatory and Development Authority directed companies to include mental health care services in their insurance package as one in every seven people have one or other mental health care needs.

Though the Bill to protect doctors and health care workers could not develop a consensus, it is also true that preventing such attacks requires more than just a legislative approach. Improving the quality of health services, preventing commercialisation of health services and changing health-seeking behaviour to get early care is the need of the hour. A realistic expectation from health services needs to be developed and the “market-based belief” that every health condition is treatable, needs to be addressed. In health services, the outcomes are completely unpredictable and even the best of the treatment and advanced care may not save a person, while another person with a similar health condition may quickly recover with basic health interventions.

Kerala averted Nipah virus outbreaks: Learning from the experience of 2018, the Kerala Government acted swiftly when a new case of Nipah was reported in 2019. With effective surveillance, early identification, effective containment/isolation and case management, an epidemic was averted. This highlights the need for a stronger and effective surveillance system across all Indian States to tackle emerging disease threats.

What to expect in 2020: In the last two years, India has seen a lot of focus on policy formulation, legislation and other broader health issues. However, in 2020, policymakers would do well to rapidly scale-up and allocate more resources for the health and wellness centres, a vital component of the Ayushman Bharat programme.

States must also give additional priority to adopting community clinics for urban settings. The country also needs to follow a focussed approach to integrate preventive and promotive health interventions with overall wellness initiatives and linkage with AYUSH.

The Government must shift focus from making isolated health facilities functional to a group of amenities in entire planning units, i.e. blocks in rural areas and entire corporation planning units, functional.

There should be at least a 20 per cent annual increase in Government funding for health by States, the Centre as well as by Urban Local Bodies. Inter-departmental coordination is also needed for stronger implementation linkage between health, water and sanitation and nutrition-related initiatives.

Taxation on “demerit goods” such as tobacco products should be further increased to global recommendation of tax being 70 per cent of the product price.

Beverages sweetened with sugar, including fruit juices, must be taxed as demerit goods at higher rates. And last but not the least, healthy behaviour should be encouraged at all levels, especially in schools and colleges, with ban on sale of “junk food” near schools and colleges.

In short, for the health sector, 2020 should be a year of implementing policies, improving provision of a broad range of health services as per the needs of the people, State Governments taking the lead in health provision to make a healthy India.

(The writer is a Delhi-based senior public health specialist.)