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Why the next government has its work cut out in the healthcare sector

E Kumar Sharma     April 11, 2019

How has the healthcare sector fared under the Modi Government? And what can one expect from the next government, which comes into power? To get answers of these questions, Business Today got in touch with a healthcare expert, who has worked closely with the government for years. The expert, on the condition of anonymity, raised some important queries and answering them might be a good start for the next government.

Without a doubt, the biggest healthcare initiative by the Modi Government has been its flagship health insurance scheme, Ayushman Bharat. While the coverage offered by the scheme is meant to bridge an important gap in the Indian healthcare sector, the expert raised some questions about the form and nature of the programme.

Ayushman Bharat, as we see today, stands out for its emphasis on hospital-based or more precisely hospital-admission-based care since outpatient care is not covered in the scheme. While hospitals are important, there is more to primary health care. Therefore, the focus should also be on the other component of Ayushman Bharat. The government plans to turn the primary community health centres into wellness centres and this is an important component of Ayushman Bharat. The plan is to strengthen and develop wellness centres so that they have at least one doctor holding an MBBS degree, a modest number of nurses, supporting paramedical staff and essential medicines. But it is unclear what steps are being taken to achieve these promises. Though there has been some movement and around 17,000 wellness centres have been set up out of a total goal of 150,000, there are questions about the hiring of the required number of doctors and nurses. From where will the government source the large number of doctors and nurses needed to man these centres? Also, can we get the states to commit that there will be a doctor, holding an MBBS degree, in every centre?

Another issue, which has been raised by many experts, is the increasing public investment in health and the next government, which comes into power, will have to deal with it. The spending would be needed in areas such as improving the anganwadi set-up and ensuring that every worker is well-paid and motivated to make a difference in child care and development.

Though raising public investment into healthcare will be a tough nut to crack, there are ways in which the state governments could be persuaded and incentivised to raise allocations on healthcare. The state governments, for instance, could be asked to provide land and the centre could then extend funds for setting up a medical college; or they could be encouraged to invest more in health care infrastructure and manpower by promising a matching grant from the centre. The centre could ask the states to invest more for efficient inventory management of essential medicines. Also, they can be persuaded to replicate the models of other states, which have been more successful with their healthcare initiatives.

The new government should also ensure that the newly sanctioned All India Institutes of Medical Sciences get as much annual budgets as AIIMS in New Delhi gets.

Increasing healthcare spending from a little over 1 per cent of GDP to 2 per cent will be a major way forward for India. It would also be ideal to bring in a 'right to health' law as the government has done with mental health so that patients get care before it is too late.

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