States can play a vital role with their wide array of primary care services such as sub-centres, primary health centres and village health workers. However, the Union Government’s role in specific areas cannot be ignored
The Ministry of Health & Family Welfare is giving special emphasis to tertiary healthcare in the country. This was stated by Union Minister for Health JP Nadda, at a four-day global conference on head-neck cancer, organised recently in Delhi. In this context, he also mentioned that his Government was developing 20 cancer institutes and 50 tertiary cancer centres across the country.
That the Union Government has been emphasising hospital care is well known also from the fact that this Government has decided to build 12 new tertiary-level All India Institutes of Medical Sciences (AIIMS) hospitals (in addition to the six new AIIMS already built under the previous Government) and to upgrade several Government medical college institutions under its Pradhan Mantri Swasthya Suraksha Yojana.
Another area in the health sector that the Union Government has prioritised is preventive and promotive health. On preventive/promotive care, the Modi Government is educating the people on the role of physical exercise as well as the power of alternate system of medicines in human wellness.
The importance that the Government attaches to it, can be seen from the fact that it has created a separate Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), has launched the National AYUSH Mission, included Sowa-Rigpa medicine (traditional Tibetan medicine) under AYUSH, signed an agreement with the World Health Organisation on promoting the quality, safety and effectiveness of traditional medicine, signed several memorandum of understandings with other countries for cooperation in the field of traditional systems of medicine, and so forth.
So, the two broad areas in the health sector that the Modi Government has prioritised are (a) hospital care, and (b) preventive and promotive care. What could explain this prioritisationIJ The implicit assumption is that people in India need to take control of their health. Inexpensive tools like yoga — the ancient Indian science of exercise and healing — and natural/alternate remedies are available to stay healthy and even to counter minor day-to-day ailments. In case of hospitalisation, which is an unfortunate event, and deals with life and death of a person, the Government believes that the people should have access to quality care and the poor be protected financially against hospitalisation costs.
The Government fully recognises that building of new hospitals and strengthening of existing medical institutes will not be sufficient to make hospital care accessible to all, especially the poor. To protect the poor against hospital care costs, the Government is all set to revamp the existing health insurance scheme, the Rashtriya Swasthya Bima Yojana (RSBY), which in its new avatar will cover nearly one-third of India’s population.
Hospital care and preventive/promotive care are two ends of the health care spectrum. Primary health care — that falls somewhere in the middle of this care spectrum — has been the ‘missing middle’ in the Government’s prioritisation of health. The Government has refrained from designing any national programme for strengthening primary healthcare delivered by the public system.
Despite health experts asking the Government to also prioritise primary care and all the evidence pointing towards its overriding importance from the health system perspective, the Government has so far left the primary care to individual States that are expected to play a greater role in the post-14th Finance Commission period.
Guided by evidence as well as sound judgement, the Union Government believes that States are better placed to strengthen, manage and monitor a wide array of primary care services provided by its vast network of public health facilities — sub-centres, primary health centres, community health centres — and village health workers. The Health Ministry is, of course, playing an important role in selected areas such as in regulating the prices of essential drugs, increasing the production of health workers, and so forth.
The same is true in certain disease-specific interventions, such as control of leprosy, tuberculosis, and HIV/AIDS. The role of primary care cannot be over-emphasised especially when the burden of non-communicable diseases such as diabetes, strokes, cancer, cardio-vascular diseases, is on the rise. Primary care has an important role not only in prevention, early detection and management of risk factors of these diseases, but also in guiding patients to appropriate health facilities.
The States need to prioritise primary care, which is as much a question of providing higher public funding as of finding the right delivery model. Tele-consultation, tele-medicine, and tele-radiology that have a potential to economise scarce medical personnel, is fast becoming the reality. States need to conduct pilot surveys before scaling up public investments in strengthening primary care.
(The writer is a development economist)