The healthcare system in India needs complementary solution of increased Government funding so as to bring efficiency in utilisation of available resources
India has nearly 938,861 allopathic doctors. However, only 12-14 per cent of them are available to work in public health systems. Training of specialist and super-specialist doctors is highly subsidised in the country. But a majority of the sanctioned positions for specialist doctors in Government health facilities are vacant. The Government's share in healthcare services has declined from 92 per cent at the time of independence to nearly 30 per cent in 2013-14.
Health services are unaffordable for many and people delay health-seeking because of the cost of services where they have to often sell assets or borrow from others when situation arises. The Government’s spending on health is just 1.15 per cent of the gross domestic product, which is one of the lowest in the world. Nearly two-third of the total health expenditure is borne directly by the people and about 6.3 crore Indians fall into poverty due to health-related expenditure every year.
The situation has not improved much in spite of repeated commitments by successive Governments. There is global evidence that when Governments spend, people don't have to pay from their pockets. However, increasing Government funding for health amongst many competing priorities cannot be the only solution. Other mechanisms must be explored in parallel.
It has been felt that needs must be fulfilled for identifying and adopting mechanisms so that available funds are utilised more efficiently. This can be done through something which the public health system is not known for, such as, developing good practices; through innovations among others. Possibly by recognising these challenges and needs, the Government of India had organised the first National Health Summit on innovations and good practices in the public health system in 2013. The fourth edition of the summit concluded recently in Indore, Madhya Pradesh.
These summits are attended by senior health policy-makers and programme managers from most States and Union Territories. A number of States and Union Territories were a part of this summit. Presentations focused on wide range of topics, including recruitment and retaining specialist doctors in tribal district of Bijapur, Chhattisgarh; bringing accountability in public health system in Madhya Pradesh; overcoming vaccine hesitancy in mass vaccination campaign in Karnataka; intensive non-communicable diseases screening programme in urban primary health centres in Tamil Nadu; experience from creation of public health cadre in Odisha, and family healthcare approach for universal health coverage in Kerala, amongst many others.
The common threads in the good and innovative practices presented this year were: (1) implementation of services with available financial resources and with existing system, (2) high-level of political engagement to the extent of Chief Ministers and Health Ministers (3) focus on strengthening health systems. The last two are increasingly becoming the sine qua non for healthcare reforms in Indian States.
The process can be further strengthened by giving considerations to a few aspects. First, scalability should be examined prior to developing innovative practices. Second, innovative practices should be selected to address core challenges in the health sector to be impactful. Innovations should be explored and expanded in challenging areas such as increasing public financing for health services, in areas of administrative and financial planning, governance reforms in health sector and private sector engagement in health services etc. There is also the need for innovation by health sector where other social determinants are covered and social sector is engaged.
As health is a State subject in India, the desire and drive for good and innovative practices and required finances has to come from State Governments. Rather, State Governments should consider setting up its own innovation fund for health sector which can have contributions from other non-governmental organisations and corporates as part of Corporate Social Responsibility.
The National Health Policy, 2017 aims to achieve universal health coverage in the country. As resources for health sector is always less than optimal, it is pragmatic that good and innovative practices as well as implementation/operational research are promoted to make best and efficient use of resources in the country. The solution of age-old health challenges would come from good, replicable innovations in addition to increasing Government-funding for health. This is the right path for advancing universal health coverage in the country.
(The writer is a leading public health expert based in New Delhi)