Crucial times for India’s health policy

By the end of this month, Finance Minister Arun Jaitley will present his first Union Budget

201502ehm03By the end of this month, Finance Minister Arun Jaitley will present his first Union Budget. For the healthcare sector, the big question is: how will he raise the funds to implement the new National Health Policy (NHP) and and the National Health Assurance Mission (NHAM)?

Open for comments till end February, the draft NHP tries to address the need to improve the performance of health systems so that the country achieves universal health coverage. While the goal is very laudable, is the path right?

The NHP proposes that public health expenditure should be raised to 2.5 per cent of GDP, with 40 per cent coming from the Centre. It proposes that the major source of financing would remain general taxation and suggests the creation of a health cess. This is ironical since the same government has already announced a 20 per cent cut in the health budget last year, even though our country’s health spending is a measly 1.04 per cent of GDP, among the lowest among developing countries. Will the union budget announce such a cess this year?

Secondly, there are signs that the NHP envisages a greater engagement with the private sector and public health advocates see this as further proof that the government is abdicating its responsibility. The draft policy says that free primary care provided by the public sector would be supplemented by strategic purchase of secondary care hospitalisation and tertiary care services from both the public and private sector. The care would be purchased on a reimbursement basis against cashless services, from empaneled private hospitals.

The whole system would need the creation of trusts or registered societies which would lay down standards, empanel providers and process and make payments. The policy sees this as a way to ‘orient the private sector to public health goals’ and enhance investments, rather than merely substitute public by private services.

The draft does not mention any time frame for implementation of these measures but acknowledges the enormity of the task and the inherent challenges. And lastly, it deliberates the legal framework for a health rights bill making health, like education, a fundamental right. The architects of this draft policy hope (naively?) that such a policy push might give the right signal to increase public health expenditure.

While these seem well intentioned goals, the document itself admits that ‘a policy is only as good as its implementation.’ This is but the first step in the right direction and we hope that comments from industry will add a more realistic edge to these intentions.

One of the draft policy’s intentions is to encourage private providers in the rural and remote areas or in under-served communities and we are happy to be profiling one such exemplary figure in the February issue of Express Healthcare: Dr NC Borah, Founder & Chairman, GNRC Hospitals, Guwahati.

His has been a pioneering endeavour of surmounting obstacles in his early life to become a doctor, then morphing into healthcare entrepreneur and finally, into a social entrepreneur. Today, his medical facilities provide healthcare services to remote areas of Assam and adjourning areas of the North East as well as across our borders to needy patients South Asian countries. His ultra low cost model has been recognised by no less than the World Bank Group and received a grant of $150,000 through its India Development Marketplace initiative, to scale up its operating model. It is indeed heartening that two of his children are already involved in this venture and the third one would be joining him soon. (Read more in the story, ‘Torchbearers of GNRC’; pages 22-27)

Viveka Roychowdhury

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