If we continue to fool around with basic issues, we will be jeopardising the long-term interests of the nation and perpetuating mass poverty, illness and deprivation. People will surely back the right policies
The UPA Government’s ambitious National Rural Health Mission was conceived with the laudable intent of improving delivery and accessibility of healthcare across rural India. This would mean improved access, equity, quality, accountability and effectiveness of public health services to rural population, especially women and children. But anybody with a nodding acquaintance of India’s health sector knows that it suffers from both organisational and resource constraints. Manpower and resources must go hand in hand if the public health system in the country is to be revived and strengthened.
Today, the only time the NRHM is mentioned in the media is when there is news of multiple-crore scams in States such as Uttar Pradesh and Jharkhand. The only worthwhile contribution of the NRHM thus far has been the appointment of Accredited Social Health Activists in villages, who as per reports are doing a commendable job. The three-tier National Health Care structure comprising village-level sub-centre, block-level Primary Health Centre and the Community Health Centre, set up on the recommendations of the Bhore Committee (1946) lies in ruins due to population explosion and failure of the State to provide matching financial and manpower resources.
Instead of addressing the problems of health, manpower and financial resources upfront, the NRHM has created an elaborate web of instructions on how the increased funding to the States is to be utilised, without creating a requisite planning, implementation and monitoring machinery at the State and District level, leading to various multi-crore scams.
There has to be a proper matching of what is sought to be achieved with the resources available in hand. Otherwise, there will be a disaster like the NRHM. Thanks to the Sixth Central Pay Commission, Government functionaries have become too expensive and unaffordable. While the Pay Commissions may have made common people comfortable, but they have also bankrupted the States who have to bear the brunt of paying CPC pay scales to lakhs of their education and healthcare functionaries at the village, panchayat and block level who are anyway not accountable for either being present at the place of their duty or for any quality outcomes.
The least the Union Government can do is to scrap the CPCs and replace them with National Wage Commissions with the mandate to lay down broad wage norms for various skilled and unskilled jobs in the public and private sector, to be followed as broad indicators, so that public services like health and education which are labour intensive, can evolve their own wage norms keeping in view their resources position.
The basic malaise of the health sector in India has been the capture of the decision making process by the elite cadre. Medical Council of India and the Indian Medical Association have been exercising undue influence over policy making in Nirman Bhawan and have sabotaged every move to create a cadre of ‘rural doctors’ for manning health sub-centres, primary health centres where medical graduates often do not wish to be posted. A large number of doctors privately admit that this is the only practical way of manning these health centres.
However, primary healthcare does not run only by having doctors in place. You need nurses, laboratory technicians, medical equipment and essential drugs supply 24x7, 365 days a year which requires logistics management of a high order. This requires an organisational structure at the State and every district or divisional headquarter.
A well-structured national health service at State, district and primary levels, staffed by a multi-disciplinary team with requisite mandate and resources should be put in place without further delay, with requisite budgetary resources earmarked by the Central Finance Commission from time to time.
The Centre-sponsored and State sector schemes should be rationalised to provide the needed resources. It will require a quantum jump in both Central and State expenditure on health which should be made available by scrapping various non-performing and low priority schemes and raising of additional resources. Increasing tax to GDP ratio and saving every penny of worthless public expenditure are the only ways out if the nation has to provide resources for health, education and vocational training, and ensure that ‘demographic dividend’ does not become a ‘demographic liability’.
Is there any political party today which is willing to include the creation of a National Health Service and bringing ‘health’ in the Concurrent list in its election manifesto in 2014IJ
You cannot please all, but if you do the right thing and make all sacrifice equitably for a good cause, people ultimately swallow even the bitterest pill. If we fool around with basic issues any longer, we will be jeopardising the long-term interests of the nation and perpetuating mass poverty and deprivation.
(The writer is Chairman of Jharkhand Public Service Commission)