India faces multiple health challenges which, if not tackled urgently and effectively, will seriously slow down our economic growth and increase inequalities in many dimensions. Apart from confronting the continuing challenge of under nutrition and infections in childhood, unsafe pregnancy, TB, malaria and AIDS, health services have also to counter and contain the onslaught of cardiovascular diseases, diabetes, cancers, chronic respiratory diseases and mental disorders.
This requires a strengthening of health systems across the country, through rapid infusion of financial and human resources. Higher levels of public financing are required, to provide a wide range of needed health services and also to ensure that the health system has the required work force, infrastructure, drugs and equipment to fully and appropriately utilise the funds allocated. There has to a break from the previous vicious cycle of underfunding resulting in a weak health system. This has to be replaced by a virtuous cycle of allocating more money for health to generate more health for the money.
Priority setting in resource
allocation and efficiencies in
design and delivery of health programmes are vital if population health benefits are to be maximised at any level of health
financing. Consultative priority setting and consensus on the core content of national programmes is essential if successful Centre-State collaboration in health is to be achieved.
The National Development Council and the Council of Health Ministers must become active platforms for earnest Centre-State engagement for agreed agenda setting on national health policies.
Strengthening of primary health care is a high priority. So far comprehensive primary health care has been denied to most of India. The National Rural Health Mission mostly focused on some elements of maternal and child health, failing to integrate the fragmented and often poorly resourced programmes that address other health priorities.
The Urban Health Mission, an afterthought, is yet to take off. Health workforce shortage has been a barrier to both outreach and quality of health services, diminishing the actual impact of even well intended programmes.
These challenges can be overcome by extensively training and deploying a wide range of technology enabled frontline health workers. New, effective and honest regulatory systems must be created for training and accreditation of health professionals.
The health sub-centre must become the trusted health outpost for the community, providing basic health services to all. District hospitals must be upgraded and become capable of hosting new medical colleges which must be preferentially located in states which presently have very few. Medical colleges across the country must become technical support and monitoring partners of district health services. The
proposal to provide every citizen with accessible and affordable health care through a National Health Assurance Programme is most welcome.
In the mixed health system that we have operating in a federal polity, we have to draw upon all societal resourcesStates and Centre, public and private sectors, allopathic and Indian systems, health and non-health sectors to act in concert for producing good health in the population and providing good health care to individuals. Health, therefore,
requires a unifying framework of national action which is efficient, equitable and accountable. If delivered as promised, it will be truly transformational for Indias development.
K Srinath Reddy
President, Public Health Foundation of India (PHFI)