Will the Lancet study be the wake-up call India needs on public health?

One of the high points of the last Union budget speech was the statement by the Finance Minister Arun Jaitley which said that the "government has prepared an action plan" to eliminate Kala-Azar and Filariasis by 2017, Leprosy by 2018, Measles by 2020, tuberculosis by 2025.

During the speech, he did not just dish out specifics on diseases and dates, but also added that action plan has been prepared  to reduce IMR (infant mortality rate) from 39 per 1000 live births  in 2014 to 28 by 2019 and MMR (Maternal Mortality Rate) from 167 per 100,000 live births  in 2011-13 to 100 by 2018-2020."  Surely, it was a paragraph full of good intentions and we hope he succeeds.

However, findings of a recent study published in medical journal Lancet on the healthcare access and quality index across different countries, reveal that there is a reason to worry. This study, which created an index involving 32 causes of death and rated 195 countries for each of these for a period of 25 years, gave India a poor 154 rank.

What do we make of this and where are we headed?

Experts say that there are serious reasons for us to stay concerned and to introspect.

"The Lancet  study only shows that India needs to do some self-reflection," says Dr Dileep Mavlankar, director of the Indian Institute of Public Health, Gandhinagar, Gujarat, a public health university that is a joint initiative of the Public Health Foundation of India and the Gujarat government.  The self-reflection is needed all the more because of the far from impressive track record India has had so far on disease elimination and control.

"Since 1947, we have just been able to eliminate, that too with delays, only Small Pox, Guinea worm, Yaws and Polio and also much of this with international help," says the doctor. To him,  disease control and elimination is more than an action plan or setting a date for elimination.

"We need to back it with resources and move on  a path to spend more on healthcare from 1 per cent of GDP to 3 per cent. Get the states involved, since much of it is from states. It is important that states commit themselves," says Dr Mavlankar. And, to top it all, he feels, even resources alone will not help till it is matched with better reporting, tracking, treatment  and follow up and on all these fronts. We have a long distance to cover given that we still need to get to 100 per cent reporting of all deaths and causes.

"An action plan would work best only if it is backed by a review mechanism and a coordination with the states," says Vishal Bali,  co-founder and chairman of Medwell Ventures and the former Group CEO of Fortis Healthcare.

He feels given India's population, it is time, the government brings out an annual report or a white paper on the status of healthcare in India, with details on key action areas coupled with similar reports from states, so that there is inter-state competitive index on various health initiatives that are a part of the action plan.  May be after this is put in place, we may not need a wake-up call from the global experts.