According to the recently established UN High Level Taskforce on Innovative Internal Health Financing, ?a health system encompasses both personal and population services and influences policies and actions of other sectors to address the environmental and economic determinants of health?. In 2009, India needs to strengthen its health system by addressing all of these components simultaneously.
There must be a shared societal vision which provides Universal Health Assurance as every citizen?s entitlement. To attain this, the government must become the guarantor, even if it is not be the sole provider of services. It must expand the outreach of public sector services while enhancing quality, and enable the private and voluntary sectors to contribute independently and through well defined public-private partnership models, within a well regulated health system.
The long neglected provision of rural primary health care (well designed but not yet well delivered) and urban primary health care (only recently proposed) must receive the highest priority through expansion and effective implementation of the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM), which provide for convergence of health programmes, decentralisation of management, flexible funding and expansion of the health workforce.
Severe shortages in the health workforce must be addressed through training of more personnel and by redefining their roles. Non-physician health care providers, especially nurses and community health workers (CHWs), have to be better utilised by transferring some of the tasks from doctors to nurses and nurses to CHWs (Task Shifting) and multi-skilling of health workers across different programmes to enhance collective outreach (Task Sharing).
Education and training in public health must be strengthened to infuse much needed public health expertise into health policies and programmes.
The avowed goal of increasing governmental health expenditure to 2-3% of GDP has not materialised and lags at 1.1% despite new central programmes like NRHM. States too must allocate greater resources to health. The Thirteenth Finance Commission should provide for higher non-plan grants to States whose health indicators are poor, with clear direction for spending on primary health care which has so far been mainly dependant on central financing.
Higher taxes on all tobacco products (especially the sheltered bidi sector) can generate more revenues for earmarked health spending, even as raised prices drive down tobacco consumption. New social insurance schemes like Rashtriya Swasthya Bima Yojna, intended to protect unorganised workers, must be extended to ensure free health care for the poor, children and elderly. Employer provided and private health insurance may supplement governmental coverage, but all insurance schemes must be integrated and regulated by an apex body.
Increased financial allocation will not yield optimal results, unless corruption and inefficiency are eliminated through defined technical and managerial standards, quality control, monitoring and evaluation, with transparency and accountability at all levels.
Irrespective of who holds the reins of national office after May 2009, there must be an across-the-board political commitment to health as a developmental priority requiring increased financial allocation, multi-sectoral action and good governance.
